PROVIDER CREATED DEMAND AND COST OF TREATING NON-FATAL ROAD TRAFFIC INJURIES IN KERALA, INDIA

Context: Provider-created demand has been found to be a component of out-of-pocket payments and consequent financial burden. Road traffic injuries are a classic case of medical uncertainty where treatment interventions could be induced especially when the provider's income is dependent on the quantity of care provided. The debate on the existence and form of SID continues unabated for the last three decades with no clear signs of a consensus. The paper argues that under conditions of uncertainty and imperfect competition in health care market, SID is quite likely and it is possible to detect. Methods: Three hundred non-fatal road traffic injury cases from seventeen hospitals (from public sector, private for-profit and not-for-profit sectors) were selected from three districts in Kerala, India. Besides, via case-study method appropriateness of treatment prescribed by the provider and utilized by the patient is evaluated. Using them, under-consumption or under-prescription of treatment or over treatment also assessed. Results & Discussion: Firstly, higher level of service intensity was found in private sector compared to the public sector, even when the length of treatment for inpatients is higher in public hospitals. More than 76 percent of the patients who received less than 10 doses of medicines are in the public sector and 17 percent in private sector. Secondly, service intensity based on physician recommendation and use of scan across public and private providers finds that 52 percent of the entire scans were recommended by public sector. While 29 percent scans were prescribed by private health services and 19 percent by public and private sectors together. Thirdly, using a checklist and observation form, after controlling for co-morbidity and hospitals with similar facility with public and private ownership, two cases with clinically similar injury conditions were selected. While private health facilities were over- treating patients, public hospitals under-treat patients.