Availability & Efficacy of Healthcare in Smaller Indian Cities.

AuthorChattopadhyay, Subho


Over the last few decades the quality and availability of healthcare in India have improved owing to the introduction of modern medical facilities, advanced medical technologies, increase in the number of hospitals and doctors in the country. However, a conspicuous gap remains between the healthcare processes, delivery and quality offered by the government medical sector viz-a-viz the private sector. 70 percent of the urban households and 63 percent of the rural households avail medical facilities from the private medical sector (Sharma, 2018). About 58 percent of hospitals and 81 percent of doctors in the country are from the private sector (Thayyil et al., 2013). Similarly, there is a significant gap between the medical facilities available in the big cities as compared to those in the smaller cities. Most of the super speciality hospitals and those hospitals and healthcare institutions/ facilities that are considered to be superior and more trustworthy as compared to the others are located in the bigger cities. To offer quality healthcare to the Indian population a major chunk of which resides in the smaller cities, towns and villages it is important to understand the perception of the residents of these places about the availability and efficacy of the treatment and healthcare facilities available in their cities and towns.


Merely around 12% of the Indian population (which comprises 43% of urban population) resides in the 53 urban agglomerates in the country with the remaining 88% living in small cities, towns and villages (Census India, 2011), it is important to understand the perception of the people about the medical and treatment facilities available at their disposal. The choice of hospitals and treatment preferred by the people of these small cities also depend on the services delivered to them and their perception about these services. To improve the medical infrastructure and quality of treatment facilities in India, the country needs to think and work beyond the metro cities. For building a truly robust medical infrastructure and facility, it is very important to understand the perception of the people from small towns and cities regarding the availability and efficacy of treatment in their cities. The present study was conducted with this broad idea.

The objective of the study is to understand the perceived quality of medical services and treatment facilities available in the smaller cities viz-a-viz those available in the metro cities. The specific objectives are:

* To get an insight into the preferred destination of treatment of the residents of smaller cities.

* To understand the safety perception of the respondents regarding their treatment by the medical practitioners in their cities viz-a-viz the practitioners in the metro cities.

* To study the perception of the people regarding the quality of diagnosis in their cities compared to that in the metro cities.

* To study the perception of the people regarding the quality of medical testing and imaging facilities in their cities compared to those in the metro cities.

* To gauge the willingness of the people to opt for being treated in the established hospital chains, under different situations, if they get an access to these chains in their own cities.

Review of Literature

Most of the studies in India about the ability and efficacy of the healthcare establishments can be found to be focused on the large cities and related components of the research. For the purposes of the present study, a few of such researches which have been considered significant by the researchers have been mentioned. A very significant study has been conducted by Bajpai (2014) on the challenges and deficiencies of healthcare facilities in India and the same has identified the deficiencies like lack of infrastructure; smaller number of facilities, doctors, paramedical staffs in large cities and the smaller towns of India. However, this study has mainly concentrated on the public sector hospitals in the process of research. Researchers like Raina and Bhatt (2018), Sengupta and Trivedi (2014), Shah (2010), De Costa and Diwan (2007), Mudur (2003), Singh and Narayan (2003) and others have significantly contributed through their researches. None of these works have addressed the fundamental research issue the present research has attempted to address. Raina and Bhatt (2018) in their research have mainly focused on the policy challenges and priorities for the healthcare expansion through private sector's involvement in India, but the focus on the people perception to these has been found to be absent in the study. Sengupta and Trivedi (2014) have also focused on the growing private sector participation in the healthcare facilities expansion in semi-urban and rural India. However, their focus has remained on critical comparison of quality deliveries between the available private and public sector healthcare facilities in six large populated provinces of India. Shah (2010), in his study has attempted to focus on the customer perception about the critical patient care facilities available in the private sector hospitals and healthcare facilities in Madhya Pradesh and Uttarkhand only. The study by Mudur (2003) and by Singh and Narayan (2003) have also focused on the specific regions of India in understanding overall perspectives of patient perception about the facilities available either in public or private sectors. None of the above researches has attempted to understand the patients' preferences to choose the health clinics or facilities from the private sector which are either located in their smaller t owns or nearby large citi es. Therefore, the present research can be justified from the perspectives of being a significant attempt towards assessing the whole issue of patients' migration from smaller to larger urban locations in the context of available facilities. The present study has also been conducted from a larger geographical perspective and therefore can be claimed to be distinctively significant research effort.


To gauge the trust and perception of people about the availability and efficacy of treatment in smaller cities, responses were collected from residents living in smaller cities in India. The data was collected from hundred respondents from across five different Indian cities. The sampling technique used was non- probability sampling. The sampling unit was the household from the selected cities. Data was collected from the respondents using a structured questionnaire having non-disguised, close ended questions. Responses were sought from the respondents, using a set of close ended questions, about their generally chosen destination for the treatment of simple ailments and that for the treatment of serious health issues. Questions were asked to gauge the perception of the residents of smaller cities about the quality of diagnosis (of simple and complex ailments), medical testing services and imaging facilities in the small cities as opposed to those in the bigger cities. A five-point Likert scale was used to measure the trust of the people on the doctors and medical practitioners in the small cities and those from the metro cities for the treatment of simple and complex ailments. A set of questions were designed using a four point scale to understand the willingness of the respondents to avail the treatment facilities from reputed chains of hospitals, at different price points, if such hospitals came up in their cities.

For the analysis and comparison of the respondents' perceptions about the efficacy of treatment and the quality of diagnosis of diseases in their own cities and in the metro cities, paired sample t-test was used. One sample t-test was used to evaluate the perceived comparative quality of testing services and imaging facilities in the smaller cities. The degree of willingness of the respondents to avail the treatment facilities from hospitals belonging to reputed/organized chains (if such chains set shop in their cities) was gauged using the measures of central tendencies. Paired sample t-test was employed to understand if the willingness of the respondents to avail the services of the reputed/organized hospital...

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