Better Health Systems for India's Poor : Findings, Analysis, and Options

by Peters, David H.

• ISBN13: 9780821350294
• ISBN10: 0821350293
• Edition: 1st
• Format: Paperback
• Copyright: 2002-05-01
• Publisher: World Bank

Summary

Whilst many people in India continue to suffer and die from preventable infections, malnutrition and childbirth complications, the rise of more recent health threats such as the AIDS epidemic are placing India's health care system under increasing pressure. This report focuses on health sector reform and evaluates policy options. It addresses two main questions: how can India meet the health care needs of its poor; and how the public and private health sectors can be structured to better finance and deliver services.

Table of Contents

Foreword	xv
Preface	xvii
Acknowledgments	xxi
Acronyms and Abbreviations	xxv
Overview	1	(2)
The Indian Health System	3	(5)
Which Way Forward?	8	(9)
Options at a Glance	17	(6)
Part 1: Raising the Sights for India's Health System	23	(108)
A Crossroads	25	(14)
Objectives of the Health System and the Health Transition	27	(1)
The Current Policy Context	28	(1)
Historic Vision and Current Realities	29	(3)
Focusing on Four Critical Activities in the Health System	32	(1)
The Approach to Reform	32	(7)
Problems of the Public and Private Sectors	39	(14)
Current Structure of the Public Sector	39	(1)
Problems of the Public Sector	40	(4)
Structure of the Private Sector	44	(5)
Problems with the Private Sector	49	(3)
Notes	52	(1)
Policy Actions for Critical Health System Activities	53	(32)
Health System Oversight	55	(9)
Public Health Service Delivery	64	(5)
Ambulatory Curative Services	69	(5)
Inpatient Curative Services and Health Insurance	74	(9)
Concluding Remarks	83	(1)
Notes	84	(1)
Putting It Together: Raising the Sights of India's Health System	85	(46)
Different Choices for Different Parts of India	86	(6)
Choices for the Central Government	92	(4)
Choices for the States	96	(17)
Putting It All Together: The Case of Maternal Health	113	(5)
Specific Actions for Consideration across India	118	(5)
An Agenda for the Future	123	(1)
Concluding Remarks	124	(2)
Appendix	126	(2)
Notes	128	(3)
Part 2: Theory and Evidence	131	(206)
Health System Framework	133	(18)
The Descriptive Framework: Health System Actors, Functions, and Outcomes	135	(7)
Framework for the Consideration of Government Intervention	142	(2)
A Framework for Deciding How to Intervene: Make-Buy-Regulate-Inform	144	(4)
Notes	148	(3)
The Functioning of the Private Sector Market	151	(50)
Context: The Private Health Sector in India	155	(2)
Methods	157	(2)
Ambulatory Care	159	(12)
Inpatient Care	171	(15)
Concluding Remarks	186	(1)
Appendix	187	(11)
Notes	198	(3)
Setting National Health Care Priorities and Ensuring Equitable Delivery of Public Sector Services	201	(32)
Do Centrally Sponsored Schemes Meet India's Health Care Needs?	201	(11)
Households' Use of Personal Health Services	212	(5)
How Well Are Public Health Services Reaching the Poor?	217	(12)
How Does the Pattern of Public, Spending Affect Health Outcomes?	229	(1)
Appendix	230	(1)
Notes	231	(2)
Financing Health	233	(32)
Health Sector Spending	233	(7)
Financing Mechanisms	240	(15)
Conclusions	255	(2)
Appendix	257	(7)
Notes	264	(1)
Health System Outcomes	265	(72)
Health Status	269	(17)
Financial Protection	286	(7)
Responsiveness to the Public	293	(5)
Concluding Remarks	298	(2)
Appendix	300	(21)
Notes	321	(2)
Appendixes
A Studies Conducted for the Present Report	323	(4)
B Background Papers	327	(4)
C Major Recommendations of National Health Policy Reports since Independence	331	(4)
D Efforts to Address the Role of Private Providers in National Tuberculosis Control Programs	335	(2)
Bibliography	337