Public Vs Private Healthcare Disparities In South Asia: A Comprehensive Analysis
DOI:
https://doi.org/10.58676/sjmas.v3i8.146Keywords:
Health system reform, Access and affordability, South Asia, Public vs private health, Healthcare disparitiesAbstract
Background: South Asia’s healthcare systems—particularly in India, Pakistan, and Bangladesh—show significant disparities between public and private sectors in terms of access, quality, and affordability. With high disease burdens and low health spending, these inequities hinder equitable healthcare delivery, especially for rural and low-income populations.
Materials and Methods: This six-month study used a mixed-methods design, combining quantitative analysis of national health surveys (2017–2021) and global databases (WHO, World Bank) with qualitative data from case studies of twelve healthcare facilities and thirty semi-structured interviews with health workers. The data were analyzed using SPSS for statistical trends and NVivo for thematic coding.
Results: The findings revealed that rural populations rely 40–60% more on public services, while the wealthiest are 3.5 times more likely to use private care. Private hospitals had superior infrastructure but showed high rates of overtreatment, while public facilities outperformed in areas like TB treatment and vaccinations. Private care costs were 3.2–4.2 times higher, leading to catastrophic health expenditures for up to 18% of users.
Conclusion: The study concludes that healthcare disparities in South Asia stem from chronic underinvestment in the public sector, weak regulation of private providers, and uneven geographic distribution of services. A three-pronged strategy—strengthening public investment, enforcing private sector accountability, and expanding hybrid models—is essential, supported by a 15-indicator system to monitor access, quality, and financial protection.
References
Ahmed, S. M., & Evans, T. G. (2013). Harnessing pluralism for better health in Bangladesh. The Lancet. https://doi.org/10.1016/S0140-6736(13)62147-9
Balarajan, Y., Selvaraj, S., & Berman, P. (2011). Health care and equity in India. The Lancet, 377(9764), 505–515. https://doi.org/10.1016/S0140-6736(10)61894-6
Berman, P., Ahuja, R., & Bhandari, L. (2010). The impoverishing effect of healthcare payments in India. Health Affairs, 29(9), 1647–1654. https://doi.org/10.1377/hlthaff.2009.0086
Chatterjee, M., & Paily, V. P. (2022). How do we get there? Indian Journal of Medical Ethics, 7(1), 32–39. https://doi.org/10.20529/IJME.2022.005
Das, J., & Hammer, J. (2014). Quality of primary care in low-income countries. Journal of Economic Perspectives, 28(3), 113–134. https://doi.org/10.1257/jep.28.3.113
Garg, C. C., & Karan, A. K. (2021). Reducing out-of-pocket expenditures to reduce poverty. Economic and Political Weekly, 44(16), 54–60.
Government of Bangladesh. (2022). Health Care Financing Strategy 2022–2032. Ministry of Health and Family Welfare.
Government of India. Ministry of Health and Family Welfare. (2021). Annual health report.
Government of Pakistan. Planning Commission. (2020). Vision 2025: Health Sector Plan.
Centre for Disease Research, Bangladesh. (2022). Health systems challenges in Bangladesh: Evidence for policy.
Karan, A., Yip, W., & Mahal, A. (2021). Extending health insurance to the poor in India. Bulletin of the World Health Organization, 95(7), 500–506. https://doi.org/10.2471/BLT.16.178327
National Institute of Population Research and Training (NIPORT). (2020). Bangladesh Demographic and Health Survey 2017–18.
National Institution for Transforming India (NITI Aayog). (2021). Health systems for a new India: Building blocks.
Pakistan Bureau of Statistics. (2020). Pakistan Demographic and Health Survey 2017–18.
Qadeer, I., & Reddy, S. (2022). Medical tourism and its impact on equity in South Asia. The Lancet Regional Health – Southeast Asia, 3, 100–115. https://doi.org/10.1016/j.lansea.2022.04.003
Rao, K. D., Petrosyan, V., Araujo, E. C., & McIntyre, D. (2021). Progress towards universal health coverage in BRICS. Bulletin of the World Health Organization, 92(6), 429–435. https://doi.org/10.2471/BLT.13.127951
Sen, G., & George, A. (2021). Systematic hierarchies and systemic failures. Social Science & Medicine, 64(11), 2240–2249. https://doi.org/10.1016/j.socscimed.2007.01.018
World Bank. (2023). South Asia health sector review. https://www.worldbank.org/en/region/sar
World Health Organization. (2021). World health statistics 2021: Monitoring health for the SDGs.
World Health Organization. (2022). Universal health coverage in South-East Asia: Progress and challenges.
World Health Organization. (2023). Global Health Observatory data repository. https://www.who.int/data/gho
World Health Organization, & World Bank. (2022). Tracking universal health coverage: 2021 global monitoring report.
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Radha Krishnan Irene Oswalda, Dr Ghassan Salibi, Prof Nikolaos Tzenios
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
