In the recent past the impact of structural adjustment in the Indian health care sector has been felt in the reduction in central grants to States for public health and disease control programmes. This falling share of central grants has had a more pronounced impact on the poorer states, which have found it more difficult to raise local resources to compensate for this loss of revenue. With the continued pace of reforms, the likelihood of increasing State expenditure on the health care sector is limited in the future. As a result, a number of notable trends are appearing in the Indian health care sector. These include an increasing investment by non-resident Indians (NRIs) in the hospital industry, leading to a spurt in corporatization in the States of their original domicile and an increasing participation by multinational companies in diagnostics aiming to capture the potential of the Indian health insurance market. The policy responses to these private initiatives are reflected in measures comprising strategies to attract private sector participation and management inputs into primary health care centres (PHCs), privatization or semi-privatization of public health facilities such as non-clinical services in public hospitals, innovating ways to finance public health facilities through non-budgetary measures, and tax incentives by the State governments to encourage private sector investment in the health sector. Bearing in mind the vital importance of such market forces and policy responses in shaping the future health care scenario in India, this paper examines in detail both of these aspects and their implications for the Indian health care sector. The analysis indicates that despite the promising newly emerging atmosphere, there are limits to market forces; appropriate refinement in the role of government should be attempted to avoid undesirable consequences of rising costs, increasing inequity and consumer exploitation. This may require opening the health insurance market to multinational companies, the proper channelling of tax incentives to set up medical institutions in backward areas, and reinforcing appropriate regulatory mechanisms.

Over five decades of independence, India has made rapid strides in various sectors. However, its performance in social sectors and particularly the healthcare sector has not been too rosy. Being the State's responsibility the healthcare has traditionally been influenced by individual State's budgetary allocation. Consequently inter-state disparity in availability and utilization of health services and health manpower are distinctly marked. This has implications for achievement of Health for All for the nation as a whole. Keeping in view the significance of studying inter-state variations in healthcare, this study focuses on the performance of healthcare sector in 15 major States in India. This is attempted through a comparative analysis of various parameters depicting availability of health services, their utilization and health outcomes. Our analysis depicts the prevalence of considerable inequity favoring high income group of States. In terms of healthcare resources, for instance, it indicates that the high income States hold a superior position in terms of: per capita government expenditure on medical and public health, total number of hospitals and dispensaries, per capita availability of beds in hospitals and dispensaries and health manpower in rural and urban areas. These parameters of availability have an impact on utilization levels and health outcomes in these States. A comparative profile of high and low income States as well as middle and low income States, both in rural and urban areas, reaffirms a greater financial burden in availing treatment at OPD and inpatient in low income States. In line with the higher financial burden and low per capita health expenditure, the health outcome indicators also depict a disconcerting situation in regard to low income States. These States are marked by lower life expectancy and higher incidence of diseases as well as high mortality rates. In this regard, demand as well as supply side constraints are observed which restrain the optimum utilization of existing health services. Among the low income States the main constraints on the demand side include illiteracy, malnutrition, and lack of infrastructure in accessing the facilities. Certain state specific supply side factors add significantly to under-utilization in low income States. In some of the States, however, corrective actions have been initiated to overcome the problem of the quality and low utilization of health facilities. In due course of time, it is likely that proper implementation of these measures may result in improved utilization level of existing health services, which may be useful to improve health status indicators. Nonetheless, overcoming the current levels of regional disparities in healthcare across three income groups of States may also require additional resources. The latter could be mobilized through assistance of donor agencies and appropriate mix of social and private insurance. Ultimately mitigating the problem of regional disparities in healthcare and protecting the poor and vulnerabl...

Social sector expenditure in India captures a number of important aspects including health, nutrition, education, water supply, sanitation, housing and welfare, among others. Over a period of time, besides budgetary outlay on this sector, private sector has also played a considerable role. Thus, efficiency of expenditure in this sector by state government has to be reckoned both in terms of relative levels of various aspects across the states and in terms of comparable benchmarks for different aspects of the sector. This paper attempts an analysis of social sector efficiency focusing on two major aspects: health and education. Unlike other studies on the Indian context, this analysis focusing on major states in India uses both non-parametric and parametric approaches. Although both approaches provide benchmarks to judge relative efficiency across states, the former provides a yardstick more at an aggregative level without parametric restrictions, whereas the latter is used for major focus on health care aspects. Results of free disposal hull analysis are suggestive of a considerably more scope for improvement in efficiency of public expenditure in health relative to education. Our results of stochastic frontier analysis indicate considerable state level disparities which could be reduced through a mix of strategies involving reallocation of factors (namely, manpower and supply of consumables) within the sector, mobilizing additional resources possibly through enhanced budgetary emphasis, or encouraging more private sector participation. Based on our results, this may enhance efficiency by nearly 20% in health care sector and increase availability and equity across low performing and poorer states like Madhya Pradesh and Uttar Pradesh.

This paper attempts a sub‐state level analysis of health system efficiency, focusing on West Bengal, a low income Indian state. Using a stochastic frontier model, it provides an idealized yardstick for evaluation. Our results suggest that overall efficiency of the public health delivery system remains low due to considerable disparities across districts. This is owing to differentials in availability and utilization of inputs such as the per capita availability of hospitals, beds, and manpower, and adversely affects life expectancy. Overcoming these factoral disparities may help the deficient districts to improve life expectancy. It may require a considerable increase in medical and public health expenditure in rural areas in the state and especially calls for resource mobilization to improve infrastructure facilities and maintain essential supplies at primary health centers. This could be attempted partly through funds from the National Rural Health Mission (NRHM) and by improving rural sanitation in poorer districts.

Population aging is occurring rapidly in India, and the implications of an aging society are likely to be experienced in an adverse manner unless immediate steps are taken to provide social security for all of India's older population. Current provision by central and state governments is grossly inadequate. This article analyzes the major Indian states across three income groups and describes the differences and inequalities across states and rural/urban areas with regard to income, living arrangements, pension benefits, etc. The efforts by central and state governments to meet the needs of older persons are outlined and critiqued. Suggestions are made for the establishment of more equitable income security, and health and social services schemes.