Second Best Governance? Governments and Governance in the Imperfect World of Health Care Delivery in China, India and Thailand in Comparative Perspective

Abstract

The objective of the paper is to assess the usefulness of conceptions of different modes of governance for understanding policy outcomes by studying the experience with hierarchical and non-hierarchical governance modes in the health care sector in China, India, and Thailand. The paper shows their experience with non-hierarchical modes to have been largely disappointing and that all three, but especially Thailand, are in the process of reverting to a more hierarchical mode of service delivery. The conclusion from this study is that non-hierarchical governance is not a substitute for or an improvement upon hierarchical governance in health care due to the many market and government failures that afflict the sector and affect the ability of different governance modes to function effectively. The hierarchical mode of government is also imperfect but less so than the alternatives in delivering health care.

The Views of Public Service Managers on the Implementation of National Health Insurance in Primary Care

“…11 While this report showed mixed success across the 10 pilot-sites, the authors highlighted shortfalls in critical governance components. These findings were similar to those from shared learning from several countries implementing UHC [12][13][14] that underscored the role of district and sub-district-level managerial awareness, engagement and alignment with the principles as well as the processes of NHI implementation. The authors proceeded to provide strategic recommendations for phase 2 that parallel those of the updated National Strategic Plan: collective participation with a focus on consensus orientation, transparency, accountability, responsiveness and efficiency within governing structures 15 made possible through prioritization of district health system managerial capacitation.…”

The views of public service managers on the implementation of National Health Insurance in primary care: a case of Johannesburg Health District, Gauteng Province, Republic of South Africa

“…It is recommended that future strategies for NHI implementation include specific engagement and capacitation of the managers of all 52 districts within South Africa to prepare for contracting at that level. In the current (second) phase of NHI implementation, National policy should employ validated frameworks [ 10 , 16 , 17 ] of health system governance and utilise existing bodies, such as the OHSC, to establish and enforce accurate indices of decentralised governance and health within each DHMO and their respective CUPS. Managerial capacitation could be targeted through human resource for health interventions [ 7 , 14 , 26 ] such as managerial fellowships, mentoring, internships and succession-planning.…”

“…A recent external evaluation of phase 1 was released in 2019 [ 2 ] which showed mixed results across the sites. The authors noted several shortfalls in critical governance components, similar to those in several countries already implementing UHC [ 7 , 12 , 16 ], due to an inadequate decentralision of governance. The findings of this review support previous studies showing that a recurrent obstacle to NHI implementation is its dependence on the detached and centralized governance model [ 17 ].…”

Health care reforms in India: Getting it wrong

“…Therefore, the government has to intervene to shape economic behaviour of these agents through a series of incentives that encourage desired outcomes whilst penalising any form of economic malfeasance. The overarching framework of incentives and controls will need to be accomplished through offsetting hybrid tools (rather than state- or market-centred tools) to achieve the balance between incentives and controls (Ramesh et al., 2015). Without such a governance framework, and the will and capacity to apply it, the goal of achieving effectiveness will remain elusive.…”