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Beyond Scaling Up: The challenge of India's marketised health stystem


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This presentation was given at the 'Beyond Scaling Up: Pathways to Universal Access' workshop which was held at the Institute of Development Studies, Brighton on the 24-25 May, 2010. This event was co-sponsored by the Future Health Systems Research Programme Consortium and the STEPS Centre. Kanjilal presented on the challenge of highly marketised health systems in India.

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Beyond Scaling Up: The challenge of India's marketised health stystem

  1. 1. New Challenges in India's Highly Marketized Health System<br />Barun Kanjilal<br />Indian Institute of Health Management Research<br />Beyond Scaling up<br />IDS<br />May 24, 2010<br />1<br />
  2. 2. Background<br />“Big bang” economic reform package in 1990s<br />Macroeconomic reforms to address microeconomic inefficiency and incentive failure <br />From an inward-looking, centrally-planned economy towards one which is integrated in global market place <br />2<br />
  3. 3. Transition in health system since 1990s<br />Very rapid spread of private actors – mostly unregulated <br />Expansion of opportunities for modern medicines and innovations in market linkage<br />Government getting marginalized in both provision and financing of curative care<br />Relatively stagnant institutional and social framework leading to distorted market relation and complexities<br />3<br />
  4. 4. The complex rural health care market<br />Private Qualified<br />Providers<br />Drug Detailers/<br />Medical<br /> Representatives<br />RMPs<br />(unlicensed)<br />Peoples’ health<br />Government <br />Providers<br /> Formal Informal<br />
  5. 5. Expanding share of private sector: India <br />5<br />Inpatient care<br />Outpatient care<br />Source: NSSO reports (42nd, 52nd, and 60th round)<br />
  6. 6. ….and outstanding growth of drugs market<br />Source: Report of the National Commission on Macroeconomics and Health. MoHFW, GOI, 2005 <br />
  7. 7. Opportunities for innovation<br />Changing pattern of consumer behaviour<br />Competitive advantage in knowledge, manpower and technology transfer<br />Astounding growth of ICT (600 million mobile users)<br />Increasing stakeholders’ interest in taking risk especially in providing rural health care (NRHM)<br />Evidences against Schumpeterian hypothesis (that the large scale corporations are more powerful engines of innovations) <br />
  8. 8. Changing responses in health market <br /><ul><li> Government – Feeble response, caught unguarded
  9. 9. Private formal – Phenomenal growth in inpatient care with latest technology, using market failure to its advantage
  10. 10. Private informal - Revival of informal providers aligned to a neo-liberalized environment
  11. 11. Voluntary – In the crossfire, yet to come up with a definite social business model
  12. 12. People - Facing a new set of vulnerabilities, insecurities, and inequalities – responding with despair and anger. </li></li></ul><li>Key issues from FHS research<br />Innovation – really for whom? How to minimize ‘rent seeking’?<br />Example: JSY and other demand side financing for MCH care<br />How to propel innovations in social and institutional overheads to make the system transparent, accountable, and pro-poor? <br />Example: PPP models without local involvement <br />How to direct innovations to correct market distortion? <br />Example: Low cost Pharmacy in government hospitals <br />How to use ICT for addressing asymmetric information ? <br />
  13. 13. Thank you!<br />10<br />