110 SOCIAL SCIENTIST India was initiating economic reforms and there was a move to cut back on welfare spending. To that extent the significant utilisation of the private sector as revealed by the NSS survey strengthened those who believed that the state must cut back on public spending on health services, especially curative services, and called for greater role for the private sector to fill the gap created by the rolling back of the public sector. The utilisation of private services is viewed as a choice that people make and as evidence of a willingness to pay for services. The logic that seems to follow is, "if people are willing to pay for health care, then what is wrong with privatisation?" Many proceeded to argue that if people are willing to pay then the government should have no problem in reducing its expenditure on curative services and introduce measures for cost recovery through "user fees" in public institutions. The subscribers to this view point used available data both at the macro and micro level to build and substantiate their case. This view gained political acceptance at both the national and international levels. It found echo in the WDR and in the "confidential" country report, of the World Bank which sought to initiate reforms in the health sector. Our analysis of the structure and utilisation of health services shows, however, that in most states the public sector is the major provider of curative services. Moreover, the private and voluntary sectors are marked by uneven spread and regional variations. If there are cutbacks in the public sector then it is likely to distort the provision of services even further. Since the private sector is largely comprised of small establishments which are mostly urban based, it will further aggravate rural-urban inequalities. In addition it would not be able to provide the required in-patient services. There are some states where there has been significant growth of the private sector, these services are at best supplementing public services. It is important to realise that with the cutback of public services, the private and voluntary sectors will not immediately move in to fill in the gap. The private and voluntary sectors will move only into those areas where they can show results/profits. Since the majority of the lower socio-economic groups are dependent on public provisioning, any slashing of investments in this sector will further marginalise this group. Therefore, a cutback of public services will only result in greater disparities of access in terms of rural-urban differentials, advanced and backward areas and across classes. NOTES AND REFERENCES 1. Ferranti, David, "Paying for Health Services in Developing Countries", World Health Forum, Vol. 6, 1985.