100 SOCIAL SCIENTIST utilisation of health services in India. The paper is divided into three sections. The first section examines available data to look at the structures of health care provision by the public, private and voluntary sectors across states. The second section uses the 42nd Round of the NSS to examine the utilisation patterns for both out-patient and in-patient care across states. The third section is a discussion of the trends observed and the implications of the Bank's recommendations for provision and utilisation of health services. II In India, health services are provided by public, private and voluntary bodies. The state has played an important role by investing in institutions for delivery of services, training of medical and paramedical personnel and for medical research. While the fifties and sixties was the growth period for public expenditure, it has stagnated during the last two decades.3 On the curative side, this is reflected in the marginal growth of hospitals and primary health centres across principal states. (Tables 1& 2) Table 1 Growth of Hospitals and Beds For Selected States (Urban) Sl. No.States1956198819901992 Hasp Beds Hosp Beds Hosp Beds Hosp Beds 1. Andhra Pradesh 448 32210 450 32684 450 32684 436 36672 2. Bihar 207 21985 228 26072 222 25839 222 25839 3. Gujarat 1142 35163 1324 37200 1433 41364 1595 47192 4. Haryana 79 7079 70 6936 70 6460 71 6460 5. Punjab 146 11438 149 12540 149 12540 140 12223 6. Kerala 130 25517 422 32651 422 32561 597 32953 7. Maharashtra 1373 84037 1659 83909 1659 83909 1759 99300 8. Tamil Nadu 293 39395 278 41579 319 44545 319 445455 9. Uttar Pradesh 652 44693 652 44693 652 44693 652 44693 10. West Bengal 276 45172 278 45880 279 46367 282 46872 Source: Govt. Of India, Ministry of Health, Health Information of India, various year. In the majority of states there has been no significant increase in hospitals and beds from the mid-eighties to the early nineties. Given the increase in population during this period, even the marginal increase is inadequate to meet the growing demand for services. This trend holds true for both urban and rural areas. Between 1991-93 there has been an increase in the number of rural hospitals and this is primarily due to the inclusion of Community Health Centres which have a bed strength of thirty. Andhra Pradesh is the only state that has registered an almost five fold increase in rural hospitals and this seems to be due to the inclusion of private and voluntary hospitals.