This presentation was given at the 'Beyond Scaling Up: Pathways to Universal Access' workshop which was held at the Institute of Development Studies, Brighton on the 24-25 May, 2010. This event was co-sponsored by the Future Health Systems Research Programme Consortium and the STEPS Centre. Kanjilal presented on the challenge of highly marketised health systems in India.

1. New Challenges in India's Highly Marketized Health System Barun Kanjilal Indian Institute of Health Management Research Beyond Scaling up IDS May 24, 2010 1

2. Background “Big bang” economic reform package in 1990s Macroeconomic reforms to address microeconomic inefficiency and incentive failure From an inward-looking, centrally-planned economy towards one which is integrated in global market place 2

3. Transition in health system since 1990s Very rapid spread of private actors – mostly unregulated Expansion of opportunities for modern medicines and innovations in market linkage Government getting marginalized in both provision and financing of curative care Relatively stagnant institutional and social framework leading to distorted market relation and complexities 3

4. The complex rural health care market Private Qualified Providers Drug Detailers/ Medical Representatives RMPs (unlicensed) Peoples’ health Government Providers Formal Informal

5. Expanding share of private sector: India 5 Inpatient care Outpatient care Source: NSSO reports (42nd, 52nd, and 60th round)

6. ….and outstanding growth of drugs market Source: Report of the National Commission on Macroeconomics and Health. MoHFW, GOI, 2005

7. Opportunities for innovation Changing pattern of consumer behaviour Competitive advantage in knowledge, manpower and technology transfer Astounding growth of ICT (600 million mobile users) Increasing stakeholders’ interest in taking risk especially in providing rural health care (NRHM) Evidences against Schumpeterian hypothesis (that the large scale corporations are more powerful engines of innovations)

9. Private formal – Phenomenal growth in inpatient care with latest technology, using market failure to its advantage

10. Private informal - Revival of informal providers aligned to a neo-liberalized environment

11. Voluntary – In the crossfire, yet to come up with a definite social business model

13. Thank you! 10