Regulatory challenges associated with the rapid spread              of health markets in India                     Barun K...
Background “Big bang” economic reform package in  1990s Macroeconomic reforms to address  microeconomic inefficiency and...
Transition in health market since1990s Very rapid spread of private actors – mostly  unregulated Expansion of opportunit...
Expanding share of private sector ininstitutional care: India         % of hospitalised cases seeking care from private   ...
Institutional care (cont’d) Increasing corporatization coupled with  medical arms race Facilitated by favorable governme...
Dominance of private providers in                           outpatient care: IndiaSource: NSSO reports (42nd, 52nd, and 60...
Outpatient care (cont’d) Dominated by private providers (77%) Most of them are unrecognized village doctors  (RMP) opera...
….and outstanding growth of pharma            marketSource: Report of the National Commission on Macroeconomics and Health...
Pharma market (cont’d) Fast penetration of MNCs Increasing buy-outs of leading Indian  generic drug companies by MNCs. ...
Changing responses in health market• Government – Feeble response, caught unguarded• Private formal – Phenomenal growth in...
Regulatory challenges Wide variation in provider‟s quality and prices Ambiguity in regulation role of the state  governm...
Thank you!             12
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Regulatory challenges associated with the rapid spread of health markets

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Dr Barun Kanjilal of IIHMR gives an overview of the regulatory challenges associated with the rapid spread of health markets in India to the Health System Reform in Asia conference held in Hong Kong in early December 2011. He notes in particular the important role that informal providers have played in delivering health services in the wake of government reforms.

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Regulatory challenges associated with the rapid spread of health markets

  1. 1. Regulatory challenges associated with the rapid spread of health markets in India Barun Kanjilal Indian Institute of Health Management Research December 10, 2011 Health System Reforms in Asia Conference, Hong Kong 1
  2. 2. Background “Big bang” economic reform package in 1990s Macroeconomic reforms to address microeconomic inefficiency and incentive failure From an inward-looking, centrally-planned economy towards one which is integrated in global market place 2
  3. 3. Transition in health market since1990s Very rapid spread of private actors – mostly unregulated Expansion of opportunities for modern medicines and innovations in market linkage Government getting marginalized in both provision and financing of curative care Relatively stagnant institutional and social framework leading to distorted market relation and complexities 3
  4. 4. Expanding share of private sector ininstitutional care: India % of hospitalised cases seeking care from private hospitals 61.8 58.3 56.9 56.2 40.3 39.7 Pre-reform Early-reform Late-reform Pre-reform Early-reform Late-reform (1986-87) (1995-96) (2004) (1986-87) (1995-96) (2004) Rural Urban 4
  5. 5. Institutional care (cont’d) Increasing corporatization coupled with medical arms race Facilitated by favorable government policies Unimpressive role of Government as a market player and a regulator 5
  6. 6. Dominance of private providers in outpatient care: IndiaSource: NSSO reports (42nd, 52nd, and 60th round) 6
  7. 7. Outpatient care (cont’d) Dominated by private providers (77%) Most of them are unrecognized village doctors (RMP) operating in „underground‟ or „informal‟ market. A complex design of interface between formal and informal providers 7
  8. 8. ….and outstanding growth of pharma marketSource: Report of the National Commission on Macroeconomics and Health. MoHFW, GOI, 2005
  9. 9. Pharma market (cont’d) Fast penetration of MNCs Increasing buy-outs of leading Indian generic drug companies by MNCs. Technological innovations coupled with high barriers to access medicines 9
  10. 10. Changing responses in health market• Government – Feeble response, caught unguarded• Private formal – Phenomenal growth in inpatient care withlatest technology, using market failure to its advantage• Private informal - Revival of informal providers aligned to aneo-liberalized environment• Voluntary – In the crossfire, yet to come up with a definitesocial business model• People - Facing a new set of vulnerabilities, insecurities,and inequalities – responding with despair and anger.
  11. 11. Regulatory challenges Wide variation in provider‟s quality and prices Ambiguity in regulation role of the state governments Failure of Self-regulating bodies and civil societies Sluggish change in institutional arrangements Need to go beyond traditional regulatory structure. 11
  12. 12. Thank you! 12

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