The private health sector in India from the lens of Dalits and Adivasis

Health outcomes have remained grossly unequal with India’s Dalits and Adivasis living shorter lives of poorer quality. Private infrastructure now accounts for nearly 62% of all of India’s health infrastructure making it critical to examine the extent to which it is responsive to these communities. Only 4% of Adivasi and 15% of Dalits utilize private facilities. According to the 75th round of NSSO for inpatient care out of pocket expenditure in private facilities is 524% higher than in public facilities. This is unaffordable given that 45.9% of the Adivasi and 26.6% of the Dalit populations are in the lowest wealth quintile. Treatment is often rendered unsustainable and there is a clear impact on the quality and cost of healthcare with patients subjected to unnecessary and dangerous treatments. The high costs of healthcare were expected to be addressed through the introduction of health insurance. However, only 1.6% and 4% of private hospital admissions under PMJAY were from Dalits and Adivasis compared to their projected eligible population share of 19.7% and 15.4% respectively. Furthermore, private hospitals tend to have an urban bias with nearly 67% of private hospitals registered under PMJAY located in big cities while rural areas with Adivasi and Dalit populations continue to suffer from severe infrastructure gaps. Dalits and Adivasis face discrimination in the private healthcare system including disparity in care, denial of entry into private clinics and longer waiting times. There is a relatively low representation of Dalits and Adivasis in the leadership of the medical profession. There is also limited space for social accountability in the private sector, especially for marginalized communities. Existing regulatory mechanisms for the private healthcare sector are weak and key provisions are not implemented. The policy brief makes recommendations for ensuring equity and accountability in the private health sector and addressing the specific concerns of SC and ST communities.

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