Health Outcomes and Policy in India

Borooah, Vani (2018): Health Outcomes and Policy in India. Published in: Health and Well-Being in India No. Palgrave Macmillan (May 2018): pp. 1-28.

Abstract

After reviewing health outcomes and policy in India, this chapter concludes that there are at least six sets of issues to be addressed with regard to improving the quantity and quality of health services, and ipso facto improving health outcomes, in India. First, the amount of resources earmarked for health needs to increase. Second, health resources need to be used in a fair and just manner and, in particular, complaints relating to egregious health outcomes need to be addressed. Predominant in this set of issues is oversight and regulation of private sector health provision. The third set of issues relates to the allocation of health resources and, in particular, to the imbalance in the allocation of health resources between towns and villages. A fourth issue is the accessibility of rural areas since it is the most remote areas that have the lowest density of health workers. Another issue is the more efficient use of health workers in order to make them more productive. Finally, Indian health policy is stronger on rhetoric and aspiration than it is on action and implementation. The successful implementation of policy requires the explicit recognition that objectives are often competing (primary versus tertiary care) and the acknowledgement that, with budgetary constraints, one cannot have more of one without having less of the other. The first role of policy is to then choose the optimal mix of objectives with respect to these trade-offs. Secondly, policies come up against vested interests which agitate (often with the support of opposition politicians) and litigate against proposed changes. Lastly, policies in India are made against a background of poor governance with the predatory presence of corruption looming over every policy initiative. In implementing, rather than simply articulating, policy it is important to address these governance issues

• Item Type: MPRA Paper
• Language: English
• Keywords: Health, Prevention, Cure, India, Resources, Private versus Public Provision
• Subjects: I - Health, Education, and Welfare > I1 - Health > I11 - Analysis of Health Care Markets; I - Health, Education, and Welfare > I1 - Health > I13 - Health Insurance, Public and Private; I - Health, Education, and Welfare > I1 - Health > I18 - Government Policy ; Regulation ; Public Health

References

Anand, S. and Fan, V. (2016), The Health Workforce in India, Human Resources for Health Observer series No. 16, World Health Organisation: Geneva.

Balsari,S., Simon, G., Nair, R., Saunik, S., Phadke, M. (2017), “Task-Shifting in Health Care: the Risks of Integrated Medicine in India”, The Lancet (Global Health), 5: 963-64.

Bansal, S. (2016), “WHO Report Sounds Alarm on ‘Doctors in India”, The Hindu, 18th July 2016.

Borooah, V.K., Mishra, V.K., Naik, A.K., and Sabharwal, N.S. (2016), “Capturing Benefits from Public Policy Initiatives: Inter-Group Differences in Access to and Usage of the Rashtriya Swasthya Bima Yojana Health Insurance Cards, Amity Journal of Economics, 1: 1-17.

Borooah, V.K. (2016), “Deconstructing Corruption: A Study of Cash-for-Favours in Rural India”, Journal of South Asian Development, 11: 1-37.

Caldwell, J.C. (1979), “Education as a Factor in Mortality Decline: an Examination of Nigerian Data”, Population Studies, 33: 395-413.

Caldwell, J.C. (1986), “Routes to Low Mortality in Poor Countries”, Population and Development Review, vol. 12, pp. 171-220.

Chatterjee, T. (2017), ” Mamata imposes strict regulations on private hospitals, to target schools & colleges soon”, Hindustan Times http://www.hindustantimes.com/kolkata/mamata-imposes-strict-regulations-on-private-hospitals-to-target-schools-colleges-soon/story-4bl6NOd5IFzLL6gSSgYW0O.html (accessed 5 January 2018).

Deaton, A. (2013), The Great Escape: health, wealth, and the origins of inequality, Princeton, NJ: Princeton University Press.

Desai, S., Dubey, A., and Vanneman, R. (2015), India Human Development Survey-II University of Maryland and National Council of Applied Economic Research, New Delhi. Ann Arbor, MI: Inter-university Consortium for Political and Social Research.

Devadasan, N., Seshadri, T., Trivedi, M., Criel, B. (2013), “Promoting Universal Financial Protection: Evidence from the Rashtriya Swasthya Bima Yojana (RSBY) in Gujarat, India” , Health Research Policy and Systems, 11: 1-29.

Dhillon, A. (2017), “India Trains Quacks to Ease Doctor Shortage” http://www.scmp.com/lifestyle/health-beauty/article/2060490/india-trains-quack-doctors-rudiments-medicine-amid-big (accessed 4 January 2018).

Dreze, J. and Khera, R. (2010), “The BPL Census and a Possible Alternative”, Economic and Political Weekly, 45: 54-63.

Dreze, J. and Sen, A.K. (2013), An Uncertain Glory: India and Its Contradictions, Penguin Books: London.

Duggal, R. (2015), “Saving the Employees’ State Insurance Scheme”, Economic and Political Weekly, 50: 17-20. EPW (2017), “Predatory Private Providers”, Economic and Political Weekly, 52: 8.

Ghosh, S. (2014), “Publicly-Financed Health Insurance for the Poor: Understanding RSBY in Maharashtra”, Economic and Political Weekly, 49: 93-9.

Ghosh, A. (2017), “The Missing Healing Touch”, Indian Express, 2 December 2017. Grover, M. (2014), “Time to Reform the Central Government Health Scheme”, Economic and Political Weekly, 49: 24-5.

Gwatkin, D.R. (1980), “Indications of Change in Developing Country Mortality Trends: the end of an era?”, Population and Development Review, 6: 615-44.

HLEG (2011), High Level Expert Group Report for Universal Health Coverage in India, Planning Commission of India, New Delhi.

Hobcraft, J. (1993), “Women’s Education, Child Welfare and Child Survival: A Review of the Evidence”, Health Transition Review, 3: 159-173.

IIPS (2000), National Family Health Survey 1998-9 (NFHS -2), International Institute for Population Studies: Mumbai.

Jilani, A., Azhar, G., Jilani, N., and Siddiqui, A. (2009), “Private providers of Healthcare in India: A policy analysis”, The Internet Journal of Third World Medicine, 8: 1-5.

Joshi, V. (2016), India’s Long Road: The Search for Prosperity, Penguin India: Gurgaon.

Karan, A., Yip, W., and Mahal, A. (2017), “Extending Health Insurance to the Poor in India: An Impact Evaluation of Rashtriya Swasthya Bima Yojana on Out of Pocket Spending on Health Care”, Social Science and Medicine, 181: 83-92.

Khera, R. (2017), “Impact of Aadhaar on Welfare Programs”, Economic and Political Weekly, 52: 62-70.

Li, Y., Wu, Q., Xu, L., Legge, D., Hao, Y., Gao, L., Ning, N., Wan, G. (2012), “Factors Affecting Catastrophic Health Expenditure and Impoverishment from Medical Expenses in China: Policy Implications of Universal Health Insurance”, Bulletin of the World Health Organisation, 90: 664-71.

Majumdar, A.D. (2017), “West Bengal assembly Passes Bill to Regulate Private Hospitals in the State”, Live Mint, http://www.livemint.com/Politics/panllrO5it26RoYW4DAmsK/West-Bengal-assembly-passes-bill-to-regulate-private-hospita.html (accessed 5 January 2018).

NHP (2017), National Health Policy 2017, Ministry of Health and Family Welfare: New Delhi.

Paliwal, A., Luoma,M., and Avila, C. (2014), Strengthening India‟s Public Health Workforce: A Landscape Analysis of Initiatives and Challenges, Health Finance & Governance Project, Abt Associates Inc: Bethesda, MD.

Patrinos, H. A. (2013), “The Hidden Cost of Corruption: Teacher Absenteeism and Loss in Schools”, Education for Global Development, The World Bank: Washington D.C.

Peters D, Yazbeck A, Ramana G, Sharma R, Pritchett L, Wagstaff A. (2001), Raising the Sights: Better Health Systems for India’s Poor, The World Bank: Washington, DC.

Phillip, C.M. (2017), “Health Insurance Scheme Ailing as Number of States Covered Falls to Fifteen”, Times of India, 7 November 2017 https://timesofindia.indiatimes.com/city/bengaluru/health-insurance-scheme-ailing-as-no-of-states-covered-falls-to-15/articleshow/61536768.cms , accessed 31 December 2017.

Preston, S.H. (1975), “The Changing Relation between Mortality and Level of Economic Development”, Population Studies, 29: 231-48.

Radwan, I., India - Private Heath Services for the Poor:Policy Note, Health Nutrition and Population Discussion Paper, The World Bank: Washington D.C. (file:///C:/Research/Palgrave%20Book%20Indian%20Health/Documents/Radwan%20India%20PrivateHealth%20for%20the%20Poor.pd) accessed 3 January 2018.

Ram, F., Mohanty, S., and Ram, U., (2009), “Understanding the Distribution of BPL cards: All India and Selected States”, Economic and Political Weekly, 44: 66-71.

Rao, K.S. (2017), Do We Care? India’s Health System, Oxford University Press: New Delhi.

Safi, M. (2017), “India Sanctions ‘Quacks’ to Ease Doctor Shortage”, The Guardian, 3rd January 2017.

Selvaraj, S. and Karan, A.K. (2012), “Why Publicly Financed Health Insurance Schemes are Ineffective in Providing Financial Risk Protection”, Economic and Political Weekly, 47: 60-68.

Sengupta, A., & Nundy, S. (2005), “The Private Health Sector in India: Is Burgeoning, but at the Cost of Public Health Care”. BMJ : British Medical Journal, 331(7526): 1157–1158.

Sharma, D.C. (2015), “India Still Struggles with Rural Doctor Shortages”, The Lancet, 386: 2381-82.

UN India (2015), Universal Health Coverage, http://in.one.un.org/task-teams/universal-health-coverage/ (accessed 23 December 2017).

Vasan, A., Pinto, E.P., Sreenivasa,V., and Vijaykumar,S. (2017), “Political Interests and Political Lobby Collude to Stifle Patient’s Interests in Karnataka,” Economic and Political Weekly, 52: 1-14 (16 December 2017).

WHO (2011), World Health Statistics Report 2011, World Health Organisation: Geneva.

WHO (2012), Optimizing Health Worker Roles to Improve Access to Key Maternal and Newborn Health Interventions Through Task Shifting. World Health Organization; 2012: Geneva.

WHO (2017), “Vector-Borne Diseases: Factsheet”, http://www.who.int/mediacentre/factsheets/fs387/en/ (accessed 4 January 2018).