Public healthcare

Healthcare for India’s Poor: The Health Insurance Way by Sonalini Khetrapal, New Delhi, Gurugram: Academic Foundation, 2019; pp 192, `1,195.

Public and Private Healthcare and Health Insurance in India by Brijesh C Purohit, New Delhi, California, London and Singapore: Sage Publications, 2020; pp xiii + 283, ₹1,195 (hardcover).

India Policy Finance and Policy Report: Health Matters edited by Jyotsna Jalan, Sugata Marjit and Sattwik Santra, New Delhi: Oxford University Press, 2020; pp xvi + 166, ₹1,495 (paperback).

Mental health is not just about absence of mental illness. It is critical that the government takes long-term economic and mental health policy measures to ensure employment, basic amenities and public health, without which mental healthcare cannot address the debilitating effects of ongoing structural violence on a majority of citizens.

Building on an earlier publication using the same data set plus case studies of three facilities, the reasons for the low utilisation of public health facilities in Uttar Pradesh despite the prohibitively high costs of care in the private sector are explored. The likelihood of choosing a public provider for hospitalisation care was 4.8 times higher in the poorest quintile and 3.4 times as high for women. Where access to public sector services is an issue, many go without any treatment and this could appear in the data to be a higher proportion of private sector utilisation. Inadequate facility density is one barrier to access. Facilities, which are by policy designed to offer very limited types of services—to collect user fees and prescribe drugs and diagnostics to be bought outside, and with no continuity of care between primary and secondary levels—lead to the diminishing of credibility of the public healthcare services. When services are available and there are incentives that facilitate access, like for childbirth, the choice shifts in favour of public services. Market-defined perceptions of what is good healthcare and an understaffed and demoralised workforce also contribute to poor utilisation.

Public health human resources is a crucial component of any public health system. The creation of a new public health cadre would result in better public health management and workers who are able to deal with changing public health priorities.