title: By 'default or design'? The expansion of the private health care sector in Madhya Pradesh, India.
abstract: OBJECTIVE
  Despite an extensive tiered public healthcare system, India has one of the most privatized healthcare systems in world. There is no evidence suggesting that this privatization at anytime has been deliberate. So what has contributed to the private healthcare sector becoming so dominant in the setting?
  
  
  METHODS
  We explore possible reasons for the rapid expansion of the private sector through in depth interviews with policy makers in the public and private sectors in Madhya Pradesh province, Central India. Interviews were analyzed using qualitative content analysis.
  
  
  CONCLUSIONS
  Public and private sector respondents concurred that the expansion of private sector had occurred by default; a passive privatization resulting from an underfunded and underperforming public health sector. Regulation by the public sector has lagged behind the development of a popular private healthcare market. Professional self-regulation functioned poorly, with professional bodies reported as being opportunistic. The private sector is fractured and heterogeneous making it more difficult to regulate. Further, the state has focused on regulating its own public sector, little attention has been paid to the expanding private sector. Income and career opportunities for qualified healthcare professionals are attractive in the private sector. India needs to invest more in the public health system, develop ways of reducing out of pocket expenses through integration of, regulation of and partnerships with segments of the private health sector.
authors.affiliation: Division of Global Health, Karolinska Institutet, Stockholm, Sweden. Ayesha.de.costa@ki.se
authors.forename: Ayesha
authors.initials: A
authors.lastname: De Costa
authors.forename: Eva
authors.initials: E
authors.lastname: Johannson
mesh_terms: D019981:Health Care Sector / Q000458:organization & administration*; D006270:Health Facility Administrators; D006280:Health Workforce; D006801:Humans; D007407:Interviews as Topic; D009436:Neural Tube Defects; D011050:Policy Making; D017149:Private Sector / Q000458:organization & administration*; D012959:Socioeconomic Factors