TY - JOUR
T1 - Regulating India's health services
T2 - To what end? What future?
AU - Peters, David H.
AU - Muraleedharan, V. R.
N1 - Funding Information:
International Development (DFID) for the Future Health Systems: Innovations for equity research programme consortium. This document is an output from projects funded by DFID for the benefit of developing countries. The views expressed are not necessarily those of DFID. We thank the Health Policy Unit of the London School of Hygiene and Tropical Medicine, for supporting the study on regulation in health care in Tamil Nadu by one of the authors, The World Bank, for supporting research on the legal framework, consumer redress, and quality of health care that made this paper possible, and the guest editors, Gerry Bloom and Hilary Standing, for their suggestions on previous drafts of the paper.
PY - 2008/5
Y1 - 2008/5
N2 - India has a comprehensive legal and regulatory framework and large public health delivery system which are disconnected from the realities of health care delivery and financing for most Indians. In reviewing the current bureaucratic approach to regulation, we find an extensive set of rules and procedures, though we argue it has failed in three critical ways, namely to (1) protect the interests of vulnerable groups; (2) demonstrate how health financing meets the public interests; (3) generate the trust of providers and the public. The paper reviews the state of alternative approaches to regulation of health services in India, using consumer and market based approaches, as well as multi-actor and collaborative approaches. We argue that poor regulation is a symptom of poor governance and that simply creating and enforcing the rules will continue to have limited effects. Rather than advocate for better implementation and expansion of the current bureaucratic approach, where Ministries of Health focus on their roles as inspectorate and provider, we propose that India's future health system is more likely to achieve its goals through greater attention to consumer and other market oriented approaches, and through collaborative mechanisms that enhance accountability. Civil society organizations, the media, and provider organizations can play more active parts in disclosing and using information on the use of health resources and the performance of public and private providers. The overview of the health sector would be more effective, if Indian Ministries of Health were to actively facilitate participation of these key stakeholders and the use of information.
AB - India has a comprehensive legal and regulatory framework and large public health delivery system which are disconnected from the realities of health care delivery and financing for most Indians. In reviewing the current bureaucratic approach to regulation, we find an extensive set of rules and procedures, though we argue it has failed in three critical ways, namely to (1) protect the interests of vulnerable groups; (2) demonstrate how health financing meets the public interests; (3) generate the trust of providers and the public. The paper reviews the state of alternative approaches to regulation of health services in India, using consumer and market based approaches, as well as multi-actor and collaborative approaches. We argue that poor regulation is a symptom of poor governance and that simply creating and enforcing the rules will continue to have limited effects. Rather than advocate for better implementation and expansion of the current bureaucratic approach, where Ministries of Health focus on their roles as inspectorate and provider, we propose that India's future health system is more likely to achieve its goals through greater attention to consumer and other market oriented approaches, and through collaborative mechanisms that enhance accountability. Civil society organizations, the media, and provider organizations can play more active parts in disclosing and using information on the use of health resources and the performance of public and private providers. The overview of the health sector would be more effective, if Indian Ministries of Health were to actively facilitate participation of these key stakeholders and the use of information.
KW - Consumer protection
KW - Health financing
KW - Health services
KW - India
KW - Regulation
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U2 - 10.1016/j.socscimed.2008.01.037
DO - 10.1016/j.socscimed.2008.01.037
M3 - Article
C2 - 18313189
AN - SCOPUS:41949109792
SN - 0277-9536
VL - 66
SP - 2133
EP - 2144
JO - Social Science and Medicine
JF - Social Science and Medicine
IS - 10
ER -