title: Private sector participation in delivering tertiary health care: a dichotomy of access and affordability across two Indian states.
abstract: Poor quality care in public sector hospitals coupled with the costs of care in the private sector have trapped India's poor in a vicious cycle of poverty, ill health and debt for many decades. To address this, the governments of Andhra Pradesh (AP) and Maharashtra (MH), India, have attempted to improve people's access to hospital care by partnering with the private sector. A number of government-sponsored schemes with differing specifications have been launched to facilitate this strategy.
  
  
  OBJECTIVE
  This article aims to compare changes in access to, and affordability and efficiency of private and public hospital inpatient (IP) treatments between MH and AP from 2004 to 2012 and to assess whether the health financing innovations in one state resulted in larger or smaller benefits compared with the other.
  
  
  METHODS
  We used data from household surveys conducted in 2004 and 2012 in the two states and undertook a difference-in-difference (DID) analysis. The results focus on hospitalization, out-of-pocket expenditure and length of stay.
  
  
  RESULTS
  The average IP expenditure for private hospital care has increased in both states, but more so in MH. There was also an observable increase in both utilization of and expenditure on nephrology treatment in private hospitals in AP. The duration of stay recorded in days for private hospitals has increased slightly in MH and declined in AP with a significant DID. The utilization of public hospitals has reduced in AP and increased in MH.
  
  
  CONCLUSIONS
  The state of AP appears to have benefited more than MH in terms of improved access to care by involving the private sector. The Aarogyasri scheme is likely to have contributed to these impacts in AP at least in part. Our study needs to be followed up with repeated evaluations to ascertain the long-term impacts of involving the private sector in providing hospital care.
authors.affiliation: ACCESS Health International, Center for Emerging Market Solutions, Indian School of Business, Gachibowli, Hyderabad 500032, India, Oxford Policy Management, Central Delhi, Delhi, India, SughaVazhvu Healthcare, A2 L.P Amsavalli Illam, Arulananda Nagar, Thanjavur 613007, India and University of East London, Institute for Health and Human Development (IHHD), UH250, Stratford Campus, University of East London, Water Lane, London E15 4LZ, UK anuradha.katyal@accessh.org.
authors.forename: Anuradha
authors.initials: A
authors.lastname: Katyal
authors.affiliation: ACCESS Health International, Center for Emerging Market Solutions, Indian School of Business, Gachibowli, Hyderabad 500032, India, Oxford Policy Management, Central Delhi, Delhi, India, SughaVazhvu Healthcare, A2 L.P Amsavalli Illam, Arulananda Nagar, Thanjavur 613007, India and University of East London, Institute for Health and Human Development (IHHD), UH250, Stratford Campus, University of East London, Water Lane, London E15 4LZ, UK.
authors.forename: Prabal Vikram
authors.initials: PV
authors.lastname: Singh
authors.affiliation: ACCESS Health International, Center for Emerging Market Solutions, Indian School of Business, Gachibowli, Hyderabad 500032, India, Oxford Policy Management, Central Delhi, Delhi, India, SughaVazhvu Healthcare, A2 L.P Amsavalli Illam, Arulananda Nagar, Thanjavur 613007, India and University of East London, Institute for Health and Human Development (IHHD), UH250, Stratford Campus, University of East London, Water Lane, London E15 4LZ, UK.
authors.forename: Sofi
authors.initials: S
authors.lastname: Bergkvist
authors.affiliation: ACCESS Health International, Center for Emerging Market Solutions, Indian School of Business, Gachibowli, Hyderabad 500032, India, Oxford Policy Management, Central Delhi, Delhi, India, SughaVazhvu Healthcare, A2 L.P Amsavalli Illam, Arulananda Nagar, Thanjavur 613007, India and University of East London, Institute for Health and Human Development (IHHD), UH250, Stratford Campus, University of East London, Water Lane, London E15 4LZ, UK.
authors.forename: Amit
authors.initials: A
authors.lastname: Samarth
authors.affiliation: ACCESS Health International, Center for Emerging Market Solutions, Indian School of Business, Gachibowli, Hyderabad 500032, India, Oxford Policy Management, Central Delhi, Delhi, India, SughaVazhvu Healthcare, A2 L.P Amsavalli Illam, Arulananda Nagar, Thanjavur 613007, India and University of East London, Institute for Health and Human Development (IHHD), UH250, Stratford Campus, University of East London, Water Lane, London E15 4LZ, UK.
authors.forename: Mala
authors.initials: M
authors.lastname: Rao
mesh_terms: D003695:Delivery of Health Care / Q000191:economics*; D019538:Health Care Surveys; D005102:Health Expenditures / Q000706:statistics & numerical data; D006291:Health Policy; D006297:Health Services Accessibility / Q000191:economics*; D061889:Healthcare Financing; D016304:Hospitals, Private / Q000191:economics / Q000706:statistics & numerical data; D006779:Hospitals, Public / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007194:India; D008137:Longitudinal Studies; D017149:Private Sector / Q000191:economics; D017150:Public Sector / Q000191:economics; D012189:Retrospective Studies
keywords: Health financing; health insurance; health policy; public and private sector