Quality differentials and reproductive health service utilisation determinants in India.
OBJECTIVE
This paper seeks to establish relationships between women's reproductive health service use, assessed longitudinally and by facility type, with service quality perceptions related to public or private health facilities.


METHODS
The study was mainly secondary and quantitative in nature. It included analysing data collected by the International Institute for Population Sciences (IIPS) and The Johns Hopkins University (JHU) as a follow-up study to the 1998-1999 National Family Health Survey (NFHS-2). The follow-up survey was carried out in Tamil Nadu, Maharashtra, Bihar and Jharkhand. In 2002-2003, these four states were selected to capture socio-economic and demographic variations. Analysis includes composite indices and logistic regression analysis. A scale was constructed to measure utilisation levels. Dimensions include: service proximity, doctor availability, waiting time, medicines, facility cleanliness, dignified treatment, privacy, service affordability and treatment effectiveness.


RESULTS
Findings indicate that doctor availability, waiting time, cleanliness, privacy and affordability at private health facilities enhance the probability that a health facility will be used for any reproductive health purpose. At the combined states level, medicine availability and treatment effectiveness at public health facilities enhances service use.


CONCLUSIONS
The major limitation is that the study includes only selected Indian states.


CONCLUSIONS
The findings may enhance Indian service-quality policy.


CONCLUSIONS
The paper's main contribution is that seemingly for the first time in India, healthcare service use has been measured longitudinally and then explained through service quality variables by comparing public and private health facilities.
Xavier Institute of Management, Bhubaneswar, India. sandipanand@gmail.com
Sandip
S
Anand
R K
RK
Sinha
D000293:Adolescent; D000328:Adult; D005260:Female; D006297:Health Services Accessibility / Q000458:organization & administration*; D006801:Humans; D007194:India; D017060:Patient Satisfaction; D017149:Private Sector / Q000458:organization & administration* / Q000706:statistics & numerical data; D017150:Public Sector / Q000458:organization & administration* / Q000706:statistics & numerical data; D011787:Quality of Health Care / Q000458:organization & administration*; D034121:Reproductive Health Services / Q000458:organization & administration* / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D013997:Time Factors; D016387:Women's Health; D055815:Young Adult