Has the Indian Government Financed and Governed Public Healthcare Effectively?

The Discussion Map charts important debates from the pages of EPW.

In 2014, the National Sample Survey Office released a preliminary report on the state of healthcare in India. In their 2015 article, T Sundararaman and V R Muraleedharan analyse the report, arguing that the previous decade witnessed an improvement in healthcare provisions in rural areas, but virtually none in urban areas. They found that despite charging one-fourth of the average costs of care in private hospitals, costs of care in public hospitals are “prohibitively” high. They add that health insurance financed by public schemes does not offer effective financial protection and that benefits of the coverage fail to reach the poorest.

Alok Kumar et al respond to Sundararaman and Muraleedharan, arguing that while the government has increased investment in health by “four times,” there is stagnation in rural areas and decline in urban areas in the number of patients who access hospitalised care in government facilities. Therefore, they question whether public funds have been effectively spent. The authors write that people generally prefer private care providers if they have the financial means and an adequate choice of providers.

Sundararaman and Muraleedharan reply to Kumar et al, stating that the very claim that government spending on healthcare has increased four-fold requires scrutiny. Besides, they argue, that a “rupee spent as public health expenditure buys a large bundle of public goods of which subsidy on patient care is a small part.”


A few other works that are broadly related to this discussion:

  1. Public Health in India, EPW Engage, 2020
  2. Out-of-pocket Expenditure on Healthcare among the Urban Poor in India, Ajay K Singh et al, 2020
  3. Follow the Money: What is Going On in the Healthcare Sector? EPW Engage, 2017
  4. Investing in Health: Healthcare Industry in India, Indira Chakravarthi et al, 2017
  5. Aspiring for Universal Health Coverage through Private Care, ​Bijoya Roy, 2017  

Ed: To contribute to a more comprehensive discussion map, please share links to other relevant articles in the comments section or write to us at edit@epw.in with the subject line—"Healthcare and Finance."

Curated by Abhishek Shah [abhishekshah@epw.in]

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