Book_Health Care

A Fine Balance:
Some Options for Private and Public Health Care in Urban India
jointly with David C. Naylor, Prabhat Jha and John Woods, The World Bank, Washington DC, 1999, pp I – ix and 1-38.

Health systems around the world are currently confronted with question of how public policy can engage the private sector to promote efficient and health care delivery. In India, the private sector
absorbs 80 percent of total health care expenditures. The share of private health care spending far exceeds that in most Western countries, and is also well above the worldwide average for low-income countries. Most of this private expenditure currently occurs on an out-of-pocket basis, suggesting a substantial opportunity to reshape the configuration of Indian health care through innovations in prepayment of services. At the same time, India's urban population is steadily increasing and faces both communicable and chronic diseases. This dual disease burden has created a need for both the private and public sectors to better organize health services in India's rapidly grow ing cities.
In this report, the authors examine India's policy options for improving the private-public mix for urban sustainable health care. Its timing is propitious. The Government of India (GOI) has begun to consider new policies in health care finance, in light of ongoing concern about the organization of health services in India's burgeoning urban areas. This paper was designed as a statement by the authors, rather than a formal Government of India-World Bank report, a deliberate approach that fully enables the authors to provoke a thoughtful debate. The GOI has requested the World Bank to further assist it in examining options for developing private-public part nerships for health service delivery This report should help to inform that process and catalyze more definitive assessments of some policy options. More generally, this report is also an important contribution to the ongoing debate over how to optimize the quality efficiency, and equity of India's urban health care services.