Unintended Effects of Policy Interactions in the Health Sector: A Case of Kerala, India

Abstract

The governments of developing countries, including India, are pursuing policy mixes in collaboration with the private sector to strengthen the public health system. However, little is known about the interaction of public policies with different instrument logics. We conducted a contextual analysis of two health policies with different instrument logics—emergency care and social health insurance programme—for over a decade in Kerala, employing primary and secondary data, government reports, newspaper articles, and published and unpublished literature. Our analysis suggests that the competition between policies has led to policies working at crossroads. The low political salience of emergency care has led to the diversion of resources and attention to government health insurance programmes. Thus, emergency care is increasingly facilitated at private facilities, shifting the government’s role from service delivery to financing. Our findings also highlight that the interaction effects among health policies receive limited attention among researchers and practitioners. These findings are relevant to countries of similar economies undergoing New Public Management reforms leading to the weakening of the public system in dealing with health functions such as emergency care.