Social Choice and Political Economy of Health

The National Health Policy, 2017 can be credited for an alternative vision towards the development of the health sector in India, but it falls short of expectations on certain counts. The core idea of strategic purchasing from the private sector is relevant, but can be incompatible with the existence of a robust public sector, particularly when reforms for enhancing the competitiveness of the public sector are undermined. Thus, the NHP essentially reopens the fundamental debate regarding the role of social choice mechanisms while deciding upon policy instruments and desirable outcomes. This has profound implications for the political economy of the health sector and can unintentionally catapult health as a salient feature in electoral politics.

Several policy agendas of the present government have been appreciated for their ambitious developmental plans and targets. TheSwachh Bharat Abhiyan, for example, aims to achieve an open defecation free India by 2019 as a tribute to the 150th birth anniversary of Mahatma Gandhi. However, the National Health Policy (NHP), 2017 (Government of India 2017a) invites criticism for various reasons. The Draft National Health Policy (DNHP), 2015 was in the pipeline for a couple of years and, perhaps, has benefited from the feedback and suggestions from various stakeholders. The DNHP’s approach towards the health sector was much aligned with the strategies under the Twelfth Five Year Plan and the recommendations of the High Level Expert Group (HLEG) 2011. In contrast, the NHP takes a road less travelled and envisions a huge strategic role for the private sector. Nevertheless, it falls short of expectations on certain important fronts. This article critically reviews the NHP with a focus on identifying policy concerns for substantive engagements. We describe the goals and principles of the NHP, followed by an appraisal of the policy objectives, apparently informed by a weak companion report (Government of India 2017b). Further, we discuss the substantive concerns underlying the NHP with specific reference to strategic purchasing and its implications. We argue that strategic purchasing can be incompatible with a robust public sector because of a dominant social preference for the private sector. Overall, we conclude that the NHP has profound implications for the political economy of the health sector and can, unintentionally, catapult health as a salient feature in electoral and redistributive politics.

The NHP reckons four major contextual changes that perhaps motivated the overall policy approach: (i) increasing burden of non-communicable diseases (NCDs) and certain infectious diseases, (ii) robust growth of healthcare industry, (iii) high incidence of catastrophic healthcare spending by households, and (iv) an enhanced growth-enabled fiscal capacity of India. These changes are representative of the ongoing demographic, economic, epidemiological and nutritional transition in India, but it is debatable whether or not (or to what extent) the NHP should reflect the status and concerns of the healthcare industry. The interpretative understanding of, for instance, a double-digit growth of the healthcare industry, is rather ambiguous, particularly because how such growth has benefited health and healthcare is left unexplained. Nevertheless, such phenomenal growth of the private healthcare industry, in India and elsewhere, does remind us of the immense financial worth of health and human life.