School of Management and

Commerce
Project Draft
To study the perception and attitude
of customer towards public and
private healthcare facilities in Khanna
Submitted in partial fulfillment of the requirements for the
award of the degree
Of
Masters of Business Administration
Submitted by Under Guidance of
Gagandeep kaur Dr. Vishal Vinayak
To Study the perception and attitude of
customer towards public and private
healthcare facilities in Khanna
Chapter 1- Introduction
About the Public healthcare

During the past 150 years, two factors have shaped the modern public health system:
first, the growth of scientific knowledge about sources and means of controlling disease;
second, the growth of public acceptance of disease control as both a possibility and a
public responsibility. In earlier centuries, when little was known about the causes of
disease, society tended to regard illness with a degree of resignation, and few public
actions were taken. As understanding of sources of contagion and means of controlling
disease became more refined, more effective interventions against health threats were
developed. Public organizations and agencies were formed to employ newly discovered
interventions against health threats. As scientific knowledge grew, public authorities
expanded to take on new tasks, including sanitation, immunization, regulation, health
education, and personal health care.
Throughout recorded history, epidemics such as the plague, cholera, and smallpox
evoked sporadic public efforts to protect citizens in the face of a dread disease.
Although epidemic disease was often considered a sign of poor moral and spiritual
condition, to be mediated through prayer and piety, some public effort was made to
contain the epidemic spread of specific disease through isolation of the ill and
quarantine of travelers. So the public hospitals are medical facilities that are funded and
operated by the government or a government agency. These hospitals are generally
established to provide healthcare services to the general public, regardless of their
ability to pay . Historically, public healthcare initiatives were often driven by concerns
related to disease outbreaks, sanitation, and public welfare. As societies developed,
governments took on a larger role in public health, leading to the establishment of
government-funded and operated healthcare facilities. Over time, public healthcare
facilities expanded in scale and scope, offering a broader range of medical services.
Many public healthcare facilities became associated with medical colleges and research
institutions, contributing to medical education and advancements in healthcare. Public
healthcare facilities may vary in terms of quality, infrastructure, and availability of
medical staff. While some government hospitals provide excellent care, others may face
challenges such as overcrowding and inadequate resources. Considering the goal of
obtaining universal health care, scholars request policy makers to acknowledge the
form of healthcare the many are using. Scholars state that the government has a
responsibility to provide health services that are affordable, adequate, new and
acceptable for its citizens. Public healthcare is very necessary, especially when
considering the costs incurred with private services. Many citizens rely on subsidized
healthcare. The national budget, scholars argue, must allocate money to the public health sector
to ensure the poor are not left with the stress of meeting private sector payments.

Key features of public hospitals include

Public hospitals are an integral part of healthcare systems in many countries, providing
essential medical care to citizens. They play a crucial role in ensuring that healthcare
services are accessible to all, regardless of their financial status. Key features of public
hospitals include :
1 Government Funding : Public hospitals are funded and supported by government
resources, usually through taxes. This funding allows them to provide medical services
to patients who may not be able to afford private healthcare.
2 Universal Access :Public hospitals typically offer services to everyone, regardless of
their income level or insurance status. They are often required to provide a certain level
of care to all patients, including emergency services.
3 Affordable Care : Public hospitals often charge lower fees than private hospitals,
making healthcare more affordable for many people.
4 Community –Oriented :Public hospitals are often deeply involved in the communities
they serve. They may offer services tailored to the specific needs of their community,
such as specialized clinics or outreach programs.
5 Training and Research :Public hospitals often serve as teaching hospitals, providing
training to medical students, interns, and residents. They may also conduct medical
research to advance medical knowledge and improve patient care.
6 Public Accountability :As government-funded institutions, public hospitals are
subject to public oversight and accountability measures. This can include regular audits,
reporting requirements, and government regulation.
7 Safety Net :Public hospitals often act as a safety net for the most vulnerable members
of society, providing care to those who are uninsured, underinsured, or unable to
access care elsewhere.
8 Non-Profit : Many public hospitals operate as non-profit institutions, with any profits
reinvested into patient care and hospital improvements.
9 Comprehensive Services :Public hospitals typically offer a wide range of medical
services, from primary care to specialized treatments and surgeries. They may also
provide ancillary services like laboratory testing, imaging, and pharmacy services.
10 Public health initiatives:Public hospitals may be involved in public health initiatives,
such as disease prevention, health education, and community outreach programs.
11 Emergency Care: Public hospitals often serve as the primary destination for
emergency medical care. They are equipped to handle a wide range of emergencies and
may have specialized trauma centers.
12 Subsidized Care :In many cases, public hospitals provide subsidized care to low-
income patients or those who cannot afford to pay for medical services
Key features of public hospitals include:
 Public hospitals receive funding from government sources, either at the federal,
state, or local level. This funding is used to cover operating costs, infrastructure
development, and the provision of medical services.
 Public hospitals are designed to be accessible to all members of the community,
offering medical services to individuals regardless of their socioeconomic status.
This inclusivity is crucial for addressing public health needs and promoting equal
access to healthcare.
 Public hospitals often serve as a safety net for individuals who do not have private
health insurance. They are a crucial component of the healthcare system, providing
emergency care, routine medical services, and specialized treatments.
 Many public hospitals are affiliated with medical schools and serve as training
grounds for healthcare professionals, including doctors, nurses, and other medical
staff. They may also engage in medical research to advance healthcare knowledge
and practices

Performance of public hospitals:

 The performance of public hospitals can vary widely depending on a range of
factors, including the country's healthcare system, government policies, funding,
management, and the specific hospital's location and patient population. In general,
some indicators used to measure the performance of public hospitals include:
 Quality of care : This includes factors such as patient outcomes, patient safety,
infection rates, readmission rates, and adherence to clinical guidelines.
 Efficiency :This refers to how well a hospital uses its resources to deliver care,
including metrics such as length of stay, wait times, and cost per case.
 Equity :This refers to the fair distribution of resources and access to care among
different population groups, regardless of socioeconomic status, ethnicity, or other
factors.

 Community benefit : This includes measures of a hospital's contributions to the

community, such as providing charity care, community health programs, and
community partnerships.

Advantages of public healthcare

 Cost: Government hospitals typically offer services at a lower cost, or even for
free, making healthcare more accessible for low-income and uninsured
individuals.
 Wide range of services: Government hospitals often provide a wide range of
services, from primary care to specialized treatments, which can be beneficial
for patients with complex medical conditions.
 Availability: Government hospitals are usually located in areas with a high
demand for healthcare services, making them more accessible to patients in
remote or underserved communities.
 Emergency services: Government hospitals often have dedicated emergency
departments that can provide prompt care for patients experiencing a medical
emergency.
 Provider availability: Government hospitals often employ a large number of
medical professionals, which can increase the likelihood of a patient finding a
provider with the necessary expertise to treat their condition.
 Public Health: Government hospitals are often involved in public health
initiatives, such as providing vaccinations, screening programs, and other.

Disadvantages of public healthcare

While public hospitals play a vital role in providing healthcare services to communities,
they also face certain challenges and disadvantages. Some of the disadvantages of
public hospitals include.

 Underfunding and Budget Constraints :Public hospitals often face financial

constraints due to limited government funding and competing priorities for public
resources. This can lead to challenges in maintaining and upgrading
infrastructure, purchasing medical equipment, and recruiting and retaining skilled
staff.
 Long waiting times : Public hospitals may experience long waiting times for
appointments, diagnostic tests, and surgeries due to high patient volumes and
limited resources. This can lead to delays in receiving necessary medical care.
 Overcrowding and Staff burnout : High patient volumes can lead to
overcrowding in public hospitals, which can strain resources and contribute to
staff burnout . Overworked and stressed healthcare workers may be less
effective in providing quality care
 Limited Choice and Access to specialists : Public hospitals may have limited
availability of specialists and services, especially in rural and underserved areas.
Patients may need to travel long distances or wait for extended periods to access
specialized care.
 Bureaucracy and administrative delays :Public hospitals may be subject to
bureaucratic processes and administrative delays, which can impact the
efficiency and timeliness of care delivery.
 Political interface :Public hospitals may be vulnerable to political interference,
which can affect decision-making, resource allocation, and the overall quality of
care.
Performance of public hospitals:
The performance of public hospitals can vary widely depending on a range of
factors, including the country's healthcare system, government policies, funding,
management, and the specific hospital's location and patient population. In general,
some indicators used to measure the performance of public hospitals include:
1. Quality of care : This includes factors such as patient outcomes, patient
safety, infection rates, readmission rates, and adherence to clinical
guidelines.
 2. Efficiency :This refers to how well a hospital uses its resources to deliver
care, including metrics such as length of stay, wait times, and cost per case.
3. Equity :This refers to the fair distribution of resources and access to care
among different population groups, regardless of socioeconomic status,
ethnicity, or other factors.
4. Community benefit : This includes measures of a hospital's contributions to
the community, such as providing charity care, community health programs,
and community partnerships.

About the private healthcare

Early private healthcare facilities often originated as charitable or philanthropic

endeavors, driven by religious or community organizations. Over time, private
healthcare facilities evolved into for-profit models, with the goal of generating
revenue and returns for investors. Investment in modern medical equipment and
technology became a hallmark of private healthcare. Private hospitals often
collaborate with insurance companies to expand their reach. Marketing and branding
became important aspects of private healthcare.Private healthcare refers to medical
services and facilities that are owned and operated by private entities rather than the
government. In contrast to public healthcare, which is funded and managed by
government agencies, private healthcare relies on funding from individuals,
insurance companies, or other private sources. Private healthcare treatment centres
can provide with quick access to medical treatment ,Choice of when you would like
to be treated,Opportunity to choose your consultant or specialist,Option to have a
treatment which may not be available on the NHS ,Comfortable and ‘home like’
surroundings, usually with an ensuite bathroom, meal options and no restrictions on
visits so you’ll have more personal space,Quick access to medical treatment. ,Choice
of when you would like to be treated . ,Opportunity to choose your consultant or
specialist, Option to have a treatment which may not be available on the NHS. And
Comfortable and ‘home like’ surroundings, usually with an ensuite bathroom, meal
options and no restrictions on visits so you’ll have more personal space.

Here are key aspects of private healthcare.

1 Private healthcare facilities, including hospitals, clinics, and medical practices, are
owned and operated by private individuals, corporations, or nonprofit organizations.
2 Private healthcare is financially supported by patients who pay out-of-pocket for
services, health insurance companies, or employers who provide health insurance
coverage as part of employee benefits.

3 Private healthcare providers often emphasize quality of care, personalized attention,

and a focus on patient satisfaction to attract and retain patients.

4 Private healthcare facilities are funded through a variety of sources, including patient
payments, private health insurance, and investments. They may also receive funding
from government contracts or grants.

5 Patients have the ability to choose their healthcare provider, specialist, and treatment
plan in private healthcare. This can lead to a more personalized and convenient
healthcare experience.

6 Private healthcare facilities often strive to provide high-quality care and have a strong
focus on patient satisfaction. They may offer amenities such as private rooms,
personalized care plans, and a high nurse-to-patient ratio.

7 Private healthcare facilities often have access to the latest medical technologies,
equipment, and treatments. This can lead to more advanced and cutting-edge medical
care.

8 Private healthcare facilities often specialize in certain medical fields or procedures,

such as cardiology, orthopedics, or oncology. This allows patients to access specialized
care and expertise .

9 Private hospitals may have shorter wait times for appointments, diagnostic tests, and
surgeries compared to public hospitals. This can result in faster diagnosis and
treatment, leading to improved health outcomes.

10 Private healthcare facilities may charge higher fees than public facilities, but they
may also offer more amenities and services. Costs can vary widely depending on the
facility, services provided, and location.

Advantages of public healthcare

Private hospitals play a crucial role in the healthcare sector, offering a range of benefits
and contributing significantly to the overall health and well-being of communities. Some
key benefits and importance of private hospitals include;

Accessibility and choice :Private hospitals provide patients with options and the ability
to choose their healthcare provider, specialist, and treatment plan. This can lead to a
more personalized and convenient healthcare experience.

Efficiency and Timeliness :Private hospitals often have shorter wait times for
appointments, diagnostic tests, and surgeries compared to public hospitals. This can
result in faster diagnosis and treatment, leading to improved health outcomes.
Technology and innovation: Private hospitals tend to have access to the latest
medical technologies, equipment, and treatments. This allows them to offer advanced
and cutting-edge medical care, which can lead to better patient outcomes.

Quality care : Private hospitals often strive to provide high-quality care and have a
strong focus on patient satisfaction. They may offer amenities such as private rooms,
personalized care plans, and a high nurse-to-patient ratio.

Specialized Services: Private hospitals often specialize in certain medical fields or

procedures, such as cardiology, orthopedics, or oncology. This allows patients to
access specialized care and expertise.

Customer service :Private hospitals may offer a higher level of customer service and
patient support, including access to patient advocates and support staff
Innovation and research : Private hospitals may invest in medical research and
innovation, contributing to advancements in medical knowledge and patient care
Economic Contribution :Private hospitals contribute to the economy by creating jobs,
purchasing goods and services, and paying taxes
Competition and quality Improvement :Private hospitals can create competition
within the healthcare sector, leading to improved quality of care and innovation

Community Benefit : Private hospitals have the ability to adapt quickly to changing
patient needs, market demands, and technological advancements

Disadvantages of private healthcare

Even though private hospitals offer much more than public healthcare facilities, there
are problems you may have to deal with. Some disadvantages of private
hospitals include the cost of treatment, unavailability of expert staff, and many other
factors. Most times, it's the patient who has to face a handful of problems, some of
which are listed below.

Cost :Higher cost for treatment is one of the considerable disadvantages of private
hospitals in the US. Private hospital care is more expensive than public hospital care.
Healthcare cost was also the major concern among people during the mid-term
elections.

Affordability :Affordability comes to the debate as private hospitals are the place
where only economically stable people head to. People living on wages or minimum
salary cannot seem to afford the healthcare facilities provided by the private
hospitals.The private healthcare services are apparently only available to people who
can afford them. For people living with low-income jobs or no job at all, it's difficult to
afford medical expenses even if they wanted to seek treatment at a private hospital.

Long Wait :The other disadvantages are the long wait times at private hospitals. Even
though you have paid money to be seen first and get priority care, there still aren't
enough staff members working to ensure all patients are being taken care of as fast as
possible. Sometimes people who should've been rushed into an emergency room right
away ended up wasting hours upon hours so that they could receive basic healthcare
services such as constant observation from nurses and doctors.

Safety Concerns: Another disadvantage of private hospitals is that people may not
take their health as seriously because they know that they have a private hospital to fall
back on. This may lead to people being less careful with their hygiene, leading to
infections being spread more easily out in the community.

Less availability :As per the annual survey report from the American Hospital
Association 2014, there were 5,686 hospitals, out of which 2,904 are public, while 1,060
are privately owned. This means, even if the care is affordable to many, the number of
private institutions is still not enough.One common issue is the limited availability of
physicians in private hospitals. In some cases, these people will wait for an extended
period before they receive care. In other cases, it can be difficult to obtain a referral
from a physician to get treatment from specialists without going through a consultation
fee.

Pros and cons of private Hospitals

In an emergency, generally don't have the time to consider the pros and cons of
private hospitals. However, if you have time to consider the alternatives, make sure to
compare costs with outcomes. In certain situations, private health care centers provide
high-quality, individualized treatment; nevertheless, outcomes may not always be better
in each case. Depending on how serious your well-being condition is, you can
determine whether the expenditures are within your budget or not.

Aspects of both public and private healthcare

Dealing with both public and private healthcare facilities can offer several advantages
and benefits to patients, healthcare providers, and the healthcare system as a whole.
Some reasons to consider utilizing both public and private healthcare facilities include

Access to a wider range of services :Public and private healthcare facilities often
offer different services and specialties. By utilizing both, patients can access a broader
range of medical services and treatment options.

Quality care : Both public and private healthcare facilities can provide high-quality care,
but they may have different strengths and areas of expertise. Patients can benefit from
accessing the best care available in both sectors.

Economic Contribution :By utilizing both public and private healthcare facilities,
patients contribute to the economy by supporting both sectors and creating jobs.

Training and education: Both public and private healthcare facilities may provide
training and education for healthcare professionals, contributing to the development of
the healthcare workforce.

Patient advocacy :Patients may benefit from patient advocacy and support services
offered by both public and private healthcare facilities.

Introduction about the public and private

healthcare facilities in khanna
Khanna is an important Tehsil town of District Ludhiana and is famous for its grain
market, which is biggest in Asia. It is located on the National Highway-1, historically
known as Sher Shah Suri Marg about 42 km southeast of Ludhiana. To cater to the
health-care needs of the local population. Here are some prominent hospitals in
Khanna.

Civil hospital khanna

Civil Hospital Khanna is functioning on a very congested but prime one-hectare land
abutting the main G.T. Road. Prior to the construction of new hospital this site was
dotted with number of very old dilapidated structures, which were being used shabbily to
house various components of the hospital. When the Government of Punjab decided to
upgrade this hospital under the Implementation of World Bank Aided State Health
Systems Development Project, a conscious decision was made to demolish some
unsafe buildings, which have outlived their lives to make room for new additions. To
keep the project cost within specified limits some existing built-up area has been
retained for the time being, and renovated moderately to accommodate outpatient
department .To design a full-fledged 100-bed hospital was an arduous task due to
number of hardships like scarcity of land, paucity of funds and tough ground conditions
vis-à-vis functioning of hospital during construction. The hospital has been designed as
a compact multistoried complex in three blocks to be constructed in three phases. The

middle block, which has now been constructed in phase-I is a four-storied block with a
future provision of another floor above. This block accommodates an emergency wing

and a small diagnostic unit at ground floor. The hospital being situated at the busy

highway prone to accidents, an emergency wing was of outmost necessity. Next in the
priority list was the wards as the old wards were have to be demolished to create space
for this block. So the upper three floors has been designed to house wards for about
100 patients. Each floor comprises five wards of six beds each besides two private
rooms and other necessary infrastructure. Since the site is heavily congested on three
sides, the wards are located on the fourth front side so that the patients can have a view
of the lively G.T. Road and the city silhouette in the background.

IVY hospital

Ivy Hospital, Khanna is located at G.T Road, Khanna. Currently, Ivy Khanna is serving
to the Industrial belt of Khanna, Mandi Gobindgarh, Sirhind & catering to patients from
as far as Samrala. It has been inaugurated by Mr. Gurtej Singh, CEO of Ivy Healthcare.
Current facilities include OPD services for Anaesthesiology, Cardiology, Dental, ENT,
General & Laparoscopic Surgery, Gynaecology & Obstetrics, Neurology & Spine
Surgery, Orthopaedics, Pediatrics, Psychiatry, Radiology, Urology .The departments are
managed by a team of highly qualified and experienced doctors and paramedical staff
who have trained at premier institutes of the country. The Ivy Healthcare group is
expanding at fast pace and new facilities are being developed at strategic locations
across North India. Ivy Healthcare group is committed to a strong code of ethical
conduct and subscribes to honest and transparent medical services. We aim to be the
largest and most respected healthcare provider in the region.

Jain Multispecialty hospital

 The Jain Hospital is one of the Largest Multidisciplinary Health Care Hospitals
in Khanna that Provides New Hope and Solution to the People Seeking for It.
Jain Hospital Khanna is Always Committed to Provide World-class Health Care
Services at an Affordable Price and Has Attained Success in Touching the
Innumerable Lives. Jain Hospital is a 52 Bedded, Multidisciplinary Hospital that
Has Appointed Highly Qualified and Experienced Doctors that Provide
Outstanding Treatment to Patients at 24/7. Jain Hospital And Research Centre
 Private Limited is an unlisted private company incorporated on 23 June, 2016. It
is classified as a private limited company and is located in Kanpur, Uttar
Pradesh. It's authorized share capital is INR 5.00 lac and the total paid-up capital
is INR 5.00 lac.
Khanna nursing home

Khanna is one of the leading hospitals with 40 beds. The best healthcare professionals
provide comprehensive healthcare. It provides advanced levels of care in over different
specialists including general physician, ENT, Gynecologists and obstetrician,
Orthopedics. It is incorporated on 28 May 2015. It is classified as Non-govt company and is
registered at Registrar of Companies, Chandigarh. Its authorized share capital is Rs. 100,000
and its paid up capital is Rs. 100,000. It is inolved in Human health activities
Khanna Multispeciality Hospitals Private Limited's Annual General Meeting (AGM) was
last held on N/A and as per records from Ministry of Corporate Affairs (MCA).
Directors of Khanna Multispeciality Hospitals Private Limited are Babli Khanna and
Ranjeet Khanna.

Indo German hospital

HomeopathicHospital.
Treatment: - Must observe the general hygienic rules. The diet must be nutritious.
Our mode of treatment is something different from other systems. We individualize one
patient from another through symptoms .After proper scanning of symptoms we select
remedy. Hepatitis treatment, Hepatitis c treatments are favourably treatable.

Sohana hospital

Sohana Hospital has been among the leading hospitals for eye and dental treatment for
over two decades. The hospital is most trusted by people seeking quality treatment for
varying conditions and the first choice of people in North India for any kind of eye
problem. Whether they want to remove their specs or get their cataract treated, they
don't give a second thought to choosing our services over others. They have the latest
machines that help in the precise diagnosis of eye problems with no chances of
inaccuracy and experienced doctors use these machines in forming the right diagnosis
and planning the treatment for the patients. Not only this, patients often look forward to
us when they suffer from dental issues. From root canal treatment to advanced
procedures like dental implants, we offer all types of dental treatment services. Our
dentists have the expertise in performing all kinds of dental treatments with proficiency.

Chapter 2 – Literature Review

Gilbert (1992)- Customer satisfaction is the major device for critical decision making in
selecting a healthcare services the quality of services delivered to the customers should
meet their perceptions.

Nandaraj and Manjunath (2007)- as per their study to improve the quality services of
the hospitals, the accreditation certification process is must and it provides international
recognition and guaranteed quality to healthcare units apart from this it not only give
care and protection to the patients but also improve quality and attract the new markets.

Chandrakanth Singh (2018)- in their article titled “Customer Perception towards

Private Hospital” examines the patient’s perception towards the private hospitals. This
study explores the treatment quality, staff performance, and service quality of the
hospitals to find out the suitable strategies for increasing the patients satisfaction in
private hospital. This article highlights that the private nursing homes must have the
kind and committed professionals. More importantly there should be nurses and
paramedical staff who are able to provide tender loving care unlike many developed
countries. It has been proven that a well-treated patient in both ways medically and
behaviorally, recovers much faster.

Dheepa (2015)- She tried to map the patient’s satisfaction towards the quality of
services offered by the Government controlled hospitals in Western districts of
Chandigarh, India and revealed that though the performance of the public hospitals
were somewhat satisfactory, but still, there existed a huge window of opportunities
which if catered well can create immense opportunity and increase satisfaction levels of
the patients northwards.

By M. Moos, C. Miller -Fifteen community-based health departments that were

recognized for their commitment to providing individual medical care were thoroughly
examined. The majority of the study material came from interviews with leaders and
practitioners in the local medical field. The interactions between community health
departments and private providers fell into three categories. One pattern had two or
more independent, self-contained, parallel public and private healthcare systems with
minimal intentional connections between them. In a different pattern, the public and
private sectors interacted with one another and purposefully relied on one another to
exchange services. In a third pattern known as accommodating, the public and private
sectors coordinated with one another to construct complementary initiatives that
maintained service separation.

E .Friedman As to the 1986 edition of Hospital Statistics published by the American

Hospital Association, there were 1616 government-owned short-term general and
"other" hospitals in the United States in 1985, which excluded mental, respiratory, and
tuberculosis hospitals. These hospitals were controlled by state and municipal
governments. Their occupancy rate was 62.8% on average, which did not differ much
from the national average for all hospitals. There were still 226 state and local long-term
psychiatric hospitals and 34 state and local short-term psychiatric facilities, despite the
fact that there were only seven public hospitals for tuberculosis and respiratory diseases
remaining in the nation. The problem of patients whose service reimbursement is
insufficient or nonexistent still plagues public hospitals. In 1986, Dun & Bradstreet Credit
Services reported that the sharpest income decline was observed by state, county, and
municipal hospitals.

Mireia Jofre-Bonet - This paper studies the interaction of private and public health
care providers. I present a model, which acknowledges that consumers differ in their
income levels. Health care is provided by a public firm maximizing social welfare and/or
private providers maximizing profits. The decision process of firms consists of three
stages: entry choice, selection of health care quality and quantity produced. With mixed
provision, in equilibrium, the private provider serves the high quality demand, and the
public supplier serves the low quality demand. Mixed provision results in a welfare
improvement compared to the strictly private regime, and is less costly than a purely
public regime.
A. Culyer, B. Jönsson - The proper balance between the private and public sectors in
health care, and the means of financing these sectors, are matters of particular concern
in Western industrialized nations. This study focuses on the workings of individuals or
groups within the various mixed systems in Europe, and examines how they respond to
the different institutional incentives that confront them and how they interact with one
another. In their search for the optimal behaviour model of health care institutions, the
contributors compare the efficiency of public and private dentistry, homes for the elderly,
child care and hospitals. They also explore the problems involved in measuring the
economic size and equity of health care sectors in different countries. The contributors
are Nick Bosanquet, John A. Cairns, Julian Le Grand, Tor Iversen, Ken Judge, Martin
Knapp, Robert E. Leu, Jaana-Marja Muurinen, Niels Christian Pedersen, Jean-Pierre
Poullier, Matthew Rabin, and Harri Sintonen.

D. Giusti, B. Criel, X. de Bethune In most settings, a 'public' health service refers to a

service which belongs to the state. The term 'private' is used when health care is
delivered by individuals and/or institutions not administered by the state. In this paper it
is argued that such a distinction, which is based on the institutional or administrative
identity of the health care provider, is not adequate because it takes for granted that the
nature of this identity automatically determines the nature of the service delivered to the
population. A different frame of classification between public and private health services
is proposed: one which is based on the purpose the health service pursues and on the
outputs it yields. A set of five operational criteria to distinguish between health services
guided by a public or private purpose is presented. This alternative classification is
discussed in relation to a variety of existing situations in sub-Saharan Africa (Mali,
Uganda, Zimbabwe). It is hoped that it can be used as a tool in the hands of the health
planner in order to bring more rationality in the current altercation between the public
and the private health care sector.

C. Keegan, A. Brick, Maev-Ann Wren This analysis examines the extent to which
activity in public hospitals is privately financed and provides an overview of service
delivery across public and private hospitals in Ireland in 2015. This analysis was
conducted in light of a Sláintecare proposal to remove private practice from public
hospitals and the establishment of an Independent Review group to examine this
proposal in detail. Overall we find that just under 16 per cent of cases were privately
financed in public hospitals in 2015. Across public and private hospitals, fewer than one-
in-four private day patient episodes were estimated to have taken place in public
hospitals. In comparison, over 50 per cent of private in-patient bed days were recorded
in public hospitals. These findings suggest that the private hospital system appears to
have primarily specialised in the delivery of elective care. It is unclear therefore whether
the majority of private inpatients in public hospitals, who are emergency in-patients,
could access the care they may require in private hospitals. It is acknowledged that a
barrier to more detailed comparative analysis is the lack of a centralised administrative
system to collect private hospital activity data. a. Economic and Social Research
Institute, Dublin ESRI working papers represent un-refereed work-in-progress by
researchers who are solely responsible for the content and any views expressed
therein.

S. Kaabi, B. Varughese, Rajvir Singh A public healthcare system is one in which the
government governs and controls all healthcare services. It offers high-quality medical
care to all citizens, regardless of their ability to pay. The benefits of public healthcare
against the private healthcare system showed that the former reduces overall
healthcare and administrative costs. It helps in standardising the services and creates a
healthier workforce, prevents future costs, and guides the population to make better
choices. In contrast, private healthcare maintains a business-driven culture and creates
unfair competition for non-profit organizations. It considers healthcare as a commodity
rather than a right of every citizen and may use its considerable economic power to
exert undue influence on healthcare policies. Countries with the best healthcare in the
world provide free or universal healthcare. These countries regard healthcare as a
social good rather than an economic good and provide universal care, which means that
healthcare must be affordable and accessible to all the citizens. Considering the ethical
issues in the for-profit healthcare system, as well as the drawback of private health
insurers, it is advocated that health insurance must be administered by non-profit
healthcare providers.
S.Hooda This study analyses the extent, growth and regional distribution of private
healthcare providers in India and draws some implications. Evidence shows that,
presently, nearly 10.4 lakh private health enterprises consisting of hospitals/clinics,
medical/dental/diagnostics centres, homeopathy/unani/ayurveda centres, nursing
homes and social service centres, are providing a wide range of healthcare services in
the country. While the private sector has grown since independence, it picked up pace
in the 2000s—the liberalised phase of Indian healthcare sector. However, growth has
largely been urban-centric, developed regions, and/or areas/districts where existence of
public facility is already high. Private sector has failed in mending the deficiency gaps in
health services provision across states, districts and rural-urban regions. The number of
small informal practitioners has declined over the years, while that of large formal
providers have increased. The Indian private hospital sector is shifting towards
corporatisation, with the majority currently concentrated in only a few districts of some
states. The number of allopathic providers is growing rapidly as compared to AYUSH
providers. A large number of practitioners are unskilled (without formal degree) and are
not registered under any act/legislation. Over the years, the private sector has
overtaken the healthcare provision and delivery market; however, services are not cost-
effective. This has resulted in high healthcare cost and high out- of-pocket health
payment burden in the country.

Rajendra Kondepati This paper presents an operational research conducted to

strengthen the service delivery of public health system in East Godavari District in
Andhra Pradesh. This research was motivated by a situation where the poor were found
opting for private hospitals despite prodding from government staff during a Dengue
outbreak in July 2013 in a coastal village. Broadly, the research found that the
underlying causes were the distorted incentive structure of doctors, organizational
issues and gaps in supply chain of medicines. This paper presents a quantitative as well
as qualitative analysis on the various factors which render the public hospitals
unattractive for poor patients who are not rich enough to afford public hospitals. Further,
it presents operational suggestions to make public hospitals more competitive and
policy level changes for compensation system to doctors and organization of public
health care to reorient the incentive structure of health personnel towards better service
delivery at government hospitals.

Kaushal (2016)- He did a study to measure the perception of patients towards the
offered service quality of public hospitals in Eastern Punjab, India which revealed that
the patients were somehow satisfied with them. The tangibility, reliability, easier
formalities, and personal & impartial attention are the key affecting parameters of
generating satisfaction.
Jain (2015)- He did a study on patient satisfaction in zonal public hospital of
Chandigarh, India and found that comparatively the aged as well as the female patients
were more satisfied in comparison to others while availing various services of the
hospitals.
Thangaraj (2016)- He studied about the health care quality and the related perception of
patients at the private hospitals in the Chandigarh city in India, where he revealed that
comparatively the people gave positive feedbacks about the private health care
initiatives and the service quality dimensions had significant and optimistic impacts on
the perceptions towards the hospitals. The study also found that the technology and
infrastructure could be a game changer for hospitals.

Ajarmah (2015)- he did a comparative study between the service quality offered by the
accredited and non-accredited hospitals in Chandigarh and revealed that the accredited
hospitals enjoyed a favorable image than the non-accredited hospitals majorly in terms
of tangibility, followed by others like empathy, responsiveness, assurance, and reliability
etc. But on an overall manner both the hospital types were providing acceptable levels
of quality.

Shafiq (2017)- he assessed the prevailing service quality in 9 nos. of hospitals across
Punjab and Chandigarh by using the famous service quality scale and found significant
gaps between the expectations and perception levels of the customers. They also
stated the validation of all the 5 variables of the service quality scale applicable there.

R. Bhat, Nishant Jain -This paper analyses financial performance of private hospitals.
The study is based on financial statement data of private hospitals for the years 1999 to
2004. Using 25 key financial ratios, the study finds six key financial dimensions. These
are: fixed assets age, current assets efficiency, operating efficiency, financial structure,
surplus/profit appropriation, and financial profitability/operating cost ratio. The findings
suggest that over the years hospitals have shown marginal improvement in financial
performance. Though the total amount of debt is not high, it is the cost of debt and
ability to service the debt which is making debt burden high for hospitals. The financial
risks in this sector are high because of lower profitability and lower operating
efficiencies. We discuss the implications of the results.

Chandan kumar -This paper attempts to highlight the differences in utilization of health
care services provided by the public and private sectors in India. In addition, it also
explores a marked regional pattern in utilization of health services. Using the largescale
national survey data (DLHS RCH-II, 2002-04 and 60 th round National Sample Survey,
2004), the authors have selected socio-economic as well as demographic factors
determining health treatment seeking behavior, in terms of availing services from public
or private sources, which have been addressed with objectivity. Furthermore, selected
states of India have been ranked on the basis of extent of inequality (in terms of
economic status) in utilization of health services from public and private sources. The
paper, in its totality, advocates for economically affordable and better quality health care
services for the masses.

Feras Alkaa (2011)- he conducted a research to study the healthcare units and study
the quality of patient satisfaction and patient trust. It also aims to test the socio
demographic variables in determining healthcare quality. On the other hand, the study
indicated better quality in private hospitals compared to public hospitals.

Cronin & Taylor (1992) Connor (1994)- in healthcare units, the patients satisfaction
level is considered to be the major indicator in order to assess the service quality of a
healthcare organization.

Rajendran (2010)- he identified that the patients and attendants treat the interpersonal
aspect of care as the most important one, as they cannot fully evaluate the technical
quality of healthcare services. The study also revealed that the hospital service
providers have to understand the needs of both patients and attendants in order to
gather a holistic view of their services.

Sharmila (2013)- her study indicates that service quality in private hospitals is meeting
patients satisfactions and private hospitals are delivering better healthcare services in
comparison to government hospitals. The result can be used by the hospitals to
reengineer and redesign creatively their quality management processes and the future
direction of their more effective healthcare quality strategies.

Sambasivan and Vennilashree (2018)- in their article titled “A Study of Patient

Perceptions of Service Quality and satisfaction in Health Care and Hospital Services in
Chandigarh City” conducted a study to assess the satisfaction of patients who have
utilized the health services provided by private hospitals and to identify factors related to
patient satisfaction. To accomplish this research, primary data were collected by the
authors from different respondents of various private hospitals in Chandigarh city with
assistance from employees of those hospitals through 756 questionnaires. The
collected data are verified for the reliability using the tool Cronbach’s Alpha coefficient.
The study concludes that the private hospitals play an important role in health care
system and role in the healthcare delivery system of India. Through a wide network of
healthcare facilities, this sector satisfied the needs of both rural and urban population
and has been expanding widely to meet the ever-increasing demands of the customers.
The quality of services is decided by the facilities available in the hospitals.

Radha (2018)- in their article titled “Patient’s perception towards the private hospitals
with the customer perception towards the private hospitals. The survey was done by
using a structured questionnaire for a sample size of 200 outpatients, out of which 105
are male and 95 are female patients. The researcher mainly focused on customer’s
perception about private hospitals and analysed the consumer level of awareness and
problems about private hospitals. This study concludes that people generally prefer
private hospitals by considering the factors such as timeliness, infrastructure, before
and after time services, extra care, advance techniques etc. Hospitals industry today
plays a big role in making the welfare of the public. Doctors come second after the God.
So both organization should take care of their social responsibility towards the society
first and profit afterward.

Rekha and Sharma (2017)- in their article titled “A Comparative Study of Patients
Satisfaction Level in Government and Private Hospitals ” aimed at to explore the
patient’s satisfaction level on the treatment of both the private and Government
hospitals. The patients expressed the lack of coordination among different departments
in Government hospitals. Patients from private hospital were not happy with fee
structure, built-in hospital medical store and canteen expenses. But the maximum
number of patients of private hospitals were found satisfied with the quality of service
and hygiene environment. The study concludes that the management of Government
hospitals should be assigned to the administrative professionals without any political or
bureaucratic interference and to maintain the quality standards of healthcare units. The
accreditation certification process should be encouraged in private as well as
Government hospitals.

A. Jilani, G. Azhar, N. Jilani, A. Siddiqui - This paper aims to critically analyze the
role of private providers of healthcare in India, especially the unqualified medical
practitioners. Due to the critical shortage of human resource for health, unqualified
practitioners play an important role in the delivery of healthcare to a large section of
society. But their role is often ignored in policy decisions. This paper also makes some
practical recommendations on the inclusion of this semi skilled health manpower in the
areas which are underserved by the conventional health care infrastructure. We tried to
address the issues of cost and quality of care by private providers. We also examined
the increasing role of corporate multispecialty hospitals in large metropolitan urban
areas.

U. Shah- This research paper attempts to collate literature from various sources, in an
attempt to answer three pertinent questions related to healthcare in India. Firstly, what
is it meant by ‘private sector’ in healthcare delivery system of India, secondly how has
the private sector evolved over the decades and what has been the role of the
government in propelling the growth. Finally, the paper tries to highlight some of the
factors that have promoted the growth of private sector in India with specific reference
to quality of medical care. The paper explicitly indicates that the deficiencies in the
public health delivery system of India, was the key to growth of private infrastructure in
healthcare. The shift of hospital industry for ‘welfare orientation’ to ‘business orientation’
was marked by the advent of corporate hospitals, supported by various policy level
initiatives made by the government. Today, there are over 20 international healthcare
brands in India with several corporate hospitals. However, a large section of the ‘private
healthcare delivery segment’ is scattered and quality of medical care continues to
remain a matter of concern. This paper tracks the various government initiatives to
promote private investment in healthcare and attempts to explore the reasons for
preference of the private sector. Surprisingly, in contrast to contemporary belief, quality
of medical care doesn’t seem to be the leading cause for preference of the private
sector. Except for a few select corporate and trust hospitals, quality of medical care in
private sector seems to be poor and at times compromised.

Swapnarag Swain - The purpose of this paper is to compare perceived service quality
of public/government and private medical college hospitals.This study identifies 13
dimensions of perceived hospital service quality. The comparative study indicates better
performance of public/government hospitals across the technical dimensions of
perceived service quality, whereas private hospitals report better performance across
majority of the functional dimensions. In the Indian healthcare system, public hospitals
provide low-cost healthcare targeted toward low to middle socio-economic population
whereas, large corporate private hospitals provide high-cost healthcare targeted toward
high-income group. So the comparison between them produces an obvious result
indicating better service quality in private hospitals. Present study minimizes this gap by
comparing the service quality of public and private medical college hospitals. Medical
colleges ensure access to health services for a larger group of people. Thus, similarity
in the segment of population receiving medical services in public and private medical
colleges is higher, making the comparison of perceived service quality fairer.

O, D,& M Stated that, in today's highly competitive climate, hospitals are increasingly
acknowledging the importance of service quality. This research compares public and
private hospitals in terms of service quality. The SERVQUAL instrument seems to be a
good tool for measuring and monitoring hospital service quality. The SERVQUAL
instrument seems to be a valuable tool for measuring and monitoring service
quality in hospitals, allowing employees to identify areas for improvement from the
customers' viewpoint.

Sanjay Basu1, Andrews1, & Kishore, 2012 Comparing

public and commercial
healthcare systems in low- and middle-income nations revealed strengths and
deficiencies in both sectors for each of the WHO's six primary concerns. The
research found that private healthcare systems lacked publicly accessible data,
provided poor service, and were less responsive to patients' concerns. The
results were inconsistent.
Zarger (2016)- He did a research in the state of Punjab, India on assessment of service
quality dimensions and proposed for a balancing strategy between skilled staffs and
cost of treatment in the healthcare sector. In that research they identified the factors of
affordability and quality of staffs to be the most important parameters of service quality.

Kurt R. Brekke, Lars Sørgard -This paper studies the interaction between public and
private health care provision in a National Health Service (NHS), with free public care
and costly private care. The health authority decides whether or not to allow private
provision and sets the public sector remuneration. The physicians allocate their time
(effort) in the public and (if allowed) in the private sector based on the public wage
income and the private sector profits. We show that allowing physician dual practice
'crowds out' public provision, and results in lower overall health care provision. While
the health authority can mitigate this effect by offering a higher wage, we find that a ban
on dual practice is more efficient if private sector competition is weak and public and
private care are sufficiently close substitutes. On the other hand, if private sector
competition is sufficiently tough, a mixed system, with physician dual practice, is always
preferable to a pure NHS system.

Singh, 2013 private hospitals provide better patient care than state institutions.
Managers at hospitals may use this survey to identify patients' views on the quality of
treatment and their degree of satisfaction.

Pandirkar, 2021 found a link between hospital services and customer happiness.
Patients at private hospitals are happier than those in public hospitals. Peer to peer
quality has a big influence on customer satisfaction and could help patients. Private
hospitals want highly educated, competent, and experienced staff. Medical security is
the most critical aspect of patient care. Customer satisfaction has been impacted by the
doctor's consultation and treatment quality. Hospital administrative facilities also
influence patient behavior. Patients love it when they can get maximal service