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Health Affairs, 27, no. 4 (2008):
977
doi: 10.1377/hlthaff.27.4.977 © 2008 by Project HOPE |
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Paying For Care |
PROLOGUE
Paying For Care
On the threshold of health reforms, China and India face different problems. China needs to fix a system that was allowed to break down; India must improve a system that never worked very well at all. Both, however, have decided that part of the solution is to spend a great deal more on health. Beyond that, they still face a number of difficult questions: What health services to buy, and for whom? How to divide resources and responsibilities among different levels of government? What’s the best way to lower individuals’ out-of-pocket spending, which equals a staggering 80 percent of total health spending in India and 60 percent in China? Since most of the increased funding for health will have to come from public sources, which agencies should control it?
These wouldn’t be easy decisions for any nation, since they carry significant political, economic, and ethical implications. But they’re likely to be especially hard in countries where huge differences exist between urban and rural areas, different income groups, and disparate states or localities. The papers that follow explore the choices from multiple vantage points.
Anil Deolalikar (University of California, Riverside), Dean Jamison (Harvard University), Prabhat Jha (Centre for Global Research, Toronto, Ontario), and Ramanan Laxminarayan (Resources for the Future) discuss the services the National Rural Health Mission (NRHM), India’s vehicle for increased public spending, should buy—and where the agency should concentrate its efforts. Nirvikar Singh (UC Santa Cruz) examines India’s complex center-state-local fiscal relations, emphasizing how funds provided at one level of government don’t necessarily translate into adequate services or good health at another level. A Perspective by Julian Schweitzer (World Bank) emphasizes that the NRHM will not reach its goals with money alone.
Ashoke Bhattacharjya (Johnson and Johnson Medical Asia Pacific) and Puneet Sapra (Cordis Corporation, a Johnson and Johnson company) discuss how private insurance—currently a very small but rapidly growing phenomenon in both countries—could be part of the solution. It could free governments to direct more public funds to the poor. A Perspective by Mark Pauly (Wharton School, University of Pennsylvania) notes that the two greatest challenges for health insurance are appropriate regulation and controlling drug costs—the latter a particular problem in China, where public facilities are now pressed to earn most of their revenue from drugs and diagnostics. Finally, Bo Zhou, Li Yang, Qingmin Sun, Haijuan Gu, and Bin Wang (Nanjing Medical University) illustrate how this incentive affects the hospitalization of cancer patients.
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