ISSN (Print) - 0012-9976 | ISSN (Online) - 2349-8846

Articles By Healthcare in India

Quality Issues in the Health Management Information System

The status of the Health Management Information System in Bihar is presented and the reasons affecting the quality of data at different levels, from the health sub-centre to the state level, are examined. The quality of HMIS data is poor because of inadequate primary records, data duplication, and other process errors.

Utilisation of Health Facilities for Childbirth and Out-of-pocket Expenditure

Using data from the household surveys on health conducted by the National Sample Survey Office between 2004 and 2014, the utilisation patterns of health facilities for childbirth and the associated
out-of-pocket expenditure are analysed. The findings reveal that the utilisation of public facilities for childbirth increased three times in rural areas and almost one and a half times in urban areas between 2004 and 2014, but that most deliveries took place in district hospitals. Also, the average medical expenditure on childbirth in government health facilities declined by 36% in rural areas and by 5% in urban areas. Considerable interstate variations in regard to oop expenditure on drugs, diagnostics and transportation were also witnessed. Though government policies to promote institutional births have improved the utilisation of public facilities and reduced the overall oop expenditure, more needs to be done for the benefits to reach the vulnerable sections, especially in urban areas.

Enhancing Affordable Pharmaceutical Healthcare

The Indian intellectual property regime has often met with severe criticism from the United States as India strives to balance the need to provide affordable healthcare with a thriving market for a competitive pharmaceutical industry. In this context, the nexus between compulsory licensing, competition law and patent law merits a closer examination and it is debatable whether a strong competition law framework is indeed the way forward.

AYUSH and Health Services

Maharashtra’s policies for AYUSH (Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy) professionals are discriminatory, allowing them to engage in “mixed practice” and recruiting them either as paramedics or as administrators in the general health services system, without ensuring equal status with their allopathic counterparts. It is in this context that the nature of engagement of AYUSH professionals with the state health system is examined.

Measuring Catastrophic Healthcare Expenditure

Catastrophic household healthcare expenditure is a prominent policy concern. The National Health Policy 2017 takes explicit cognisance of this issue and presents an empirical formulation to examine its incidence and patterns. However, the policy needs to account for household size variations to counter an implicit bias that tilts the estimates to reflect a higher concentration of catastrophic expenditure among the rich. This concern is illustrated using health data from the 71st round of the National Sample Survey. Further, a minor modification to unravel the socio-economic gradient in catastrophic healthcare expenditure has also been discussed.

Is Drug Development in India Responsive to the Disease Burden?

Although the Indian pharmaceutical industry has played an important role in the development of generic medicines, it is not clear whether drug development, which is dominated by the private sector, is informed of the disease burden and public health priorities. An attempt is made to address this question by juxtaposing the therapeutic focus of the drugs approved for marketing and the new chemical entities in the pipeline with the disease burden across age groups.

National Health Policy, 2017

The National Health Policy, 2017 reflects the perfunctory attitude towards public health, so deeply entrenched among the mandarins of the health ministry. The policy paves the way for the contraction of public healthcare systems, thereby reducing the government’s involvement in the delivery of health services, and facilitates the dominance of the private sector in curative care. However, in the absence of a robust public healthcare system, the goal of achieving “healthcare for all” becomes even more onerous.

 

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.