Towards Mitigating Overcrowding in Urban Indian Healthcare Facilities: Stakeholder Perception Analysis for Existing and Potential New Patient Referral Mechanisms

Background: Public healthcare delivery in India faces several operational challenges, including congestion and long wait times at higher-level facilities and low utilization of lower-level facilities. Effective referral mechanisms can help address these issues. However, before designing and implementing potential new referral mechanisms, it is essential to understand patient and provider views. The objective of this study is to quantitatively assess patient and provider perceptions of both existing and potential new referral mechanisms and their association with patient socioeconomic and demographic attributes. Methods: A cross-sectional survey was conducted to record and examine patient referral mechanisms – from patient and provider perspectives - currently operational at public healthcare facilities in an urban Indian district. Patient and doctor perceptions regarding potential new referral mechanisms were also assessed, such as medical referral with noncompliance penalties for out-of-turn visits to higher-level facilities, and operational referral, which involves referring patients to same-tier facilities with lower patient loads. Multinomial logistic regression was conducted using the data collected to identify statistically significant associations between patient perceptions and socioeconomic and demographic attributes. Results: Survey results provided quantitative evidence of nonadherence to existing referral mechanisms by a significant proportion of patients, and logistic regression analyses showed statistical associations between patient socioeconomic and demographic variables and their willingness towards implementation of potential new referral mechanisms. Conclusions: Based on study findings, existing referral mechanisms can be strengthened, and potential new referral mechanisms, with appropriate refinements, can be introduced to mitigate overcrowding, care provision delays, and other operational challenges in Indian healthcare delivery.