  In India, households' use of primary health-care services presents a puzzle.
Even though most private health-care providers have no formal medical
qualifications, a significant fraction of households use fee-charging private
health-care services, which are not covered by insurance. Although the absence
of public health-care providers could partially explain the high use of the
private sector, this cannot be the only explanation. The private share of
health-care use is even higher in markets where qualified doctors offer free
care through public clinics; despite this free service, the majority of
health-care visits are made to providers with no formal medical qualifications.
This paper examines the reasons for the existence of this puzzle in India.
Combining contemporary household-level data with archival records, I examine
the aggressive family planning program implemented during the emergency rule in
the 1970s and explore whether the coercion, disinformation, and carelessness
involved in implementing the program could partly explain the puzzle.
Exploiting the timing of the emergency rule, state-level variation in the
number of sterilizations, and an instrumental variable approach, I show that
the states heavily affected by the sterilization policy have a lower level of
public health-care usage today. I demonstrate the mechanism for this practice
by showing that the states heavily affected by forced sterilizations have a
lower level of confidence in government hospitals and doctors and a higher
level of confidence in private hospitals and doctors in providing good
treatment.
