Financing health improvements in India

Health Affairs

Volumn 27, Issue 4, 2008, Pages 978-990

  Deolalikar, Anil B ^a   Jamison, Dean T ^b   Jha, Prabhat ^c   Laxminarayan, Ramanan ^d,e  

^a UNIVERSITY OF CALIFORNIA   (United States)

^b HARVARD UNIVERSITY   (United States)

^c ST MICHAEL'S HOSPITAL   (Canada)

^d RESOURCES FOR THE FUTURE   (United States)

^e PRINCETON UNIVERSITY   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

FINANCIAL MANAGEMENT; HEALTH CARE COST; HEALTH CARE SYSTEM; INDIA; POPULATION RESEARCH; REVIEW;

DELIVERY OF HEALTH CARE; FINANCING, GOVERNMENT; FINANCING, ORGANIZED; HEALTH EXPENDITURES; HUMANS; INDIA; INSURANCE, HEALTH;

EID: 48149106362     PISSN: 02782715     EISSN: 02782715     Source Type: Journal    
DOI: 10.1377/hlthaff.27.4.978     Document Type: Review

References (47)

1. Empowered Action Group (EAG) states designated by the Government of India are Bihar, Chattisgarh, Jharkhand, Madhya Pradesh, Orissa, Rajasthan, Uttar Pradesh, and Uttaranchal. The eighteen focus states include the EAG states as well as Arunachal Pradesh, Assam, Himachal Pradesh, Jammu and Kashmir, Manipur, Mizoram, Meghalaya, Nagaland, Sikkim, and Tripura.
2. The Disease Control Priorities Project-India follows on related butmore global efforts. See D.T. Jamison et al., eds., Disease Control Priorities in Developing Countries, 2d ed. (Oxford and New York: Oxford University Press, 2006).
3. See also R. Laxminarayan et al., "Advancement of Global Health: Key Messages from the Disease Control Priorities Project," Lancet 367, no. 9517 (2006): 1193-1208.
4. The DCPP-India report, "Choosing Health: An Opportunity for India," preliminary materials from a workshop in January 2007, is available from the Centre for Global Health Research at http://www.cghr.org/dcpp.htm (accessed 20 March 2008).
5. D.E. Bloom et al., "Why Has China's Economy Taken Off Faster than India's?" Working Paper (Boston: Harvard School of Public Health, 2006).
6. In Sri Lanka, infant mortality declined from 18 deaths per 1,000 live births in 1991 to 13 in 2001 - a rate of decline that exceeded the rates experienced by both Bangladesh and Nepal.
7. P. Jha, "Avoidable Mortality in India: Past Progress and Future Prospects," National Medical Journal of India 15, no. 1 Supp. (2002): 32-36.
8. Note that these data aremerely indicative, since the NFHS data are not representative at the level of districts.
9. Scheduled Castes (SCs) and Scheduled Tribes (STs) are Indian communities that are explicitly recognized by the Constitution of India as requiring special support to overcome centuries of discrimination.
10. A.B. Deolalikar, Attaining the Millennium Development Goals in India: Reducing Infant Mortality, Child Malnutrition, Gender Disparities, and Hunger-Poverty and Increasing School Enrollment and Completion? (New Delhi: Oxford University Press, 2005).
11. T.W. Croghan, "Road Less Traveled: Four Developing Countries Blaze New Trails to Better Health," RAND Review 30, no. 3 (2006): 26-30.
12. Of course, public spending on health will reduce private spending by the poor only if it actually improves service delivery to the poor. Also, it is assumed that public spending is not financed out of taxes, which fall disproportionately on the poor.
13. Note that external assistance does constitute a sizable share of national disease control programs for TB, HIV/AIDS, and malaria.
14. By "public spending on health,"we mean spending by the central and state governments on hospitals and dispensaries; medical education, training, and research; public health; family welfare (family planning); and the National Rural Health Mission (NRHM). It excludes government spending on the health care of its own employees, including those in Railways and Defense.
15. Deolalikar, Attaining the Millennium Development Goals.
16. Nearly 25 percent of Indian households report spending 5 percent or more of their total annual expenditures on out-of-pocket health payments, representing among the highest incidences of catastrophic health payments in Asia. See E. van Doorslaer et al., "Effect of Payments for Health Care on Poverty Estimates in Eleven Countries in Asia: An Analysis of Household Survey Data," Lancet 368, no. 9544 (2006): 1357-1364.
17. See, for example, S. Anand and M. Ravallion, "Human Development in Poor Countries: On the Role of Private Incomes and Public Services," Journal of Economic Perspectives 7, no. 1 (1993): 113-150;
18. B. Bidani and M. Ravallion, Decomposing Social Indicators Using Distributional Data (Washington: World Bank, 1995);
19. D. Filmer and L. Pritchett, "The Impact of Public Spending on Health: Does Money Matter?" Social Science and Medicine 49, no. 10 (1999): 1309-1323;
20. and V. Swaroop and A.S. Rajkumar, Public Spending and Outcomes: Does Governance Matter? (Washington: World Bank, 2002). Rajkumar and Swaroop find that public spending on health is significantly associated with child and infant mortality reduction, but only for countries with good governance (as measured by a corruption index and a variable reflecting the "quality of the bureaucracy").
21. S. Gupta et al., Does Higher Government Spending Buy Better Results in Education and Health Care? (Washington: International Monetary Fund, 1999). These authors find that the association between child deaths and public spending on health is twice as strong for the poor as for the nonpoor.
22. R. Duggal, Cost of Health Care: A Household Survey in an Indian District (Bombay: Foundation for Research in Community Health, 1989).
23. M. Uplekar, "Implications of Prescribing Patterns in Private Doctors in the Treatment of Pulmonary Tuberculosis in Bombay, India," Research Paper no. 41 (Cambridge, Mass.: Takemi Program in International Health, Harvard School of Public Health, 1989);
24. Deolalikar, Attaining the Millennium Development Goals;
25. K. Van der Veen, "Government and Private Health Care: Two Competing Institutions," in Managing Rural Development: Health and Energy Programmes in India, ed.H. Streefkerk and T.K. Moulik (New Delhi: Sage Publications, 1991);
26. and R. Bhat, "The Private/Public Mix in Health Care in India," Health Policy and Planning 8, no. 1 (1993): 43-56.
27. Van Doorslaer et al., "Effect of Payments for Health Care on Poverty Estimates."
28. Ibid.
29. DCPP-India, "Choosing Health."
30. J.L. Bobadilla et al., "Design, Content, and Financing of an Essential National Package of Health Services," Bulletin of the World Health Organization 72, no. 4 (1994): 653-662.
31. J.F. Finlay et al., "A New Canadian Health Care Initiative in Tanzania," Canadian Medical Association Journal 153, no. 8 (1995): 1081-1085;
32. and J.L. Bobadilla et al., "National Package of Health Services," in Macroeconomics and Health: Investing in Health for Economic Development, ed. J. Sachs (Geneva: World Health Organization, 2001).
33. A. Mahal et al., "Who 'Benefits' from Public Sector Health Spending in India? Results of a Benefit Incidence Analysis for India," Background Paper prepared for D.H. Peters et al., Better Health Systems for India's Poor: Findings, Analysis, and Options (Washington: World Bank Human Development Network, 2002).
34. A. Gumber, "Burden of Disease and Cost of Ill Health in India: Setting Priorities for Health Interventions during the Ninth Plan," Margin 29, no. 2 (1997): 133-172.
35. The related issue of providing incentives to health careworkers to work in remote areas is addressed in another paper in this series.
36. A.B. Deolalikar, D.T. Jamison, and R. Laxminarayan, "India's Health Initiative: Financing Issues and Options," Discussion Paper no. 07-48 (Washington: Resources for the Future, October 2007).
37. There has been considerable devolution of health service delivery to panchayati raj institutions (PRIs) in Karnataka and Kerala. In Kerala, local health workers are not only employed by local governments but also accountable to them. In other states, PRIs receive funds to pay district- and lower-level health workers' salaries but have little control in their hiring or termination.
38. These data are only broadly indicative, since the "public health and family welfare" category includes several expenditures (for example, health education and drug control) unrelated to public health and excludes expenditures onwater and sanitation by the PRIs. In some states, health workers' salaries account for nearly 90 percent of government health expenditure.
39. Deolalikar, Attaining the Millennium Development Goals; and R. Duggal, "Healthcare in India: Changing the Financing Strategy," Social Policy and Administration 41, no. 4 (2007): 386-394.
40. DCPP-India, "Choosing Health."
41. Mahal et al., Who 'Benefits' from Public Sector Health Spending in India?";
42. and A. Mahal et al., "The Poor and Health Service Use in India," Background Paper prepared for Peters et al., Better Health Systems for India's Poor.
43. Some of the disease control programs are partially funded on matching grant basis, but most are fully funded by the central government. A useful example is the Local Government Performance Program (LGPP) in the Philippines. See M. Palabrica-Costello, N. Ogena, and A.N. Herrin, "Policy and Program Implications of the Matching Grants Program in the Philippines" (Manila: Population Council, 2003).
44. Registrar-General of India and Centre for Global Health Research, "Causes of Death in India: Special Survey of Deaths 2001-3" (New Delhi: Registrar-General, 2007);
45. and P. Jha et al., "Prospective Study of One Million Deaths in India: Rationale, Design, and Validation Results," PLoS Medicine 3, no. 2 (2006): e18.
46. J. Chow, S. Darley, and R. Laxminarayan, "Cost-Effectiveness of Disease Interventions in India," Discussion Paper no. 07-53 (Washington: Resources for the Future, December 2007).
47. R. John, "Price Elasticity Estimates for Tobacco Products in India," Health Policy and Planning 23, no. 3 (2008): 200-209.