Health care reforms in India: Getting it wrong

Health care reforms in India: Getting it wrong. Bali, A. S. & Ramesh, M. Public Policy and Administration, 30(3-4):300--319, July, 2015.

Paper doi abstract bibtex

India’s first health policy document in 1946 envisaged an ambitious health system comprising delivery of public health programs by the national governments and primary and secondary care by the state governments. Nearly seven decades later, neither of the ambitions have been realised. The delivery of public health programs is limited and uncoordinated, whilst primary and especially secondary care is of poor quality and unaffordable to the bulk of the population. This article assesses India’s health policy reforms and argues that at each juncture the policy instruments it utilised were inconsistent with the goals it was trying to achieve. The health care sector required more intervention than the central and state governments offered. The meagre funds allocated to public health programs and the unwillingness and inability of state governments to shoulder responsibility for primary and secondary care led to the dominance of the private sector in delivery, out-of-pocket financing, and fee-for-service payment to providers. Recent reforms have made some progress in addressing the lacunae but are handicapped by the pervasive dominance of the private sector which severely limits the choice of policy tools available to the government.

@article{bali_health_2015,
	title = {Health care reforms in {India}: {Getting} it wrong},
	volume = {30},
	issn = {0952-0767, 1749-4192},
	shorttitle = {Health care reforms in {India}},
	url = {http://ppa.sagepub.com/content/30/3-4/300},
	doi = {10.1177/0952076715590697},
	abstract = {India’s first health policy document in 1946 envisaged an ambitious health system comprising delivery of public health programs by the national governments and primary and secondary care by the state governments. Nearly seven decades later, neither of the ambitions have been realised. The delivery of public health programs is limited and uncoordinated, whilst primary and especially secondary care is of poor quality and unaffordable to the bulk of the population. This article assesses India’s health policy reforms and argues that at each juncture the policy instruments it utilised were inconsistent with the goals it was trying to achieve. The health care sector required more intervention than the central and state governments offered. The meagre funds allocated to public health programs and the unwillingness and inability of state governments to shoulder responsibility for primary and secondary care led to the dominance of the private sector in delivery, out-of-pocket financing, and fee-for-service payment to providers. Recent reforms have made some progress in addressing the lacunae but are handicapped by the pervasive dominance of the private sector which severely limits the choice of policy tools available to the government.},
	language = {en},
	number = {3-4},
	urldate = {2016-01-06},
	journal = {Public Policy and Administration},
	author = {Bali, Azad S. and Ramesh, M.},
	month = jul,
	year = {2015},
	keywords = {Health care reforms, Health governance, Health policy, India, Policy failure, Universal coverage},
	pages = {300--319},
	file = {bali2015.pdf:files/53625/bali2015.pdf:application/pdf;Snapshot:files/53195/300.html:text/html}
}

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