Health Sector Reforms (HSR) is a global phenomenon that has sought to introduce a variety of market principles in the health service systems since the 1980s. Informed by the ideas of New Public Management, these reforms have introduced several initiatives in order to improve the economic efficiency and effectiveness of public institutions. The major initiatives include the introduction of user fees, promoting public-private partnerships, providing public subsidies for growth of the private sector and decentralization of public services. The scope and depth of reforms has varied across developed and developing countries. In several low and middle income countries, the reforms were accelerated by the active presence of the World Bank and IMF’s Structural Adjustment Policy. Soft loans were offered to these countries to implement many of the initiatives of health sector reform. In this presentation, we propose to showcase the experience of HSR in three countries in Asia to highlight the variations. These include China, India and Vietnam that have different socio-political and health service development contexts. The Chinese reforms that began in the 1980s have primarily focused on reforming public hospitals with a robust public health insurance coverage and little involvement of the World Bank and IMF. In India and Vietnam there is poor public health insurance coverage and the World Bank has played an active role in furthering the agenda of HSR. After more than three decades of HSR, there has been growing concern of growing inequities in access to health services and rising out of pocket expenditures in all these countries. This has posed a major challenge for addressing the rising inequities and achieving universal health care.
About the Speaker:
Dr Rama Baru is a Professor at the Centre of Social Medicine and Community Health, Jawaharlal Nehru University, New Delhi. Her research focus is on health policy, international health, privatisation of health services and inequalities in health. She is the author of Private Health Care in India:Social Characteristics and Trends and more r has edited a volume on School Health Services in India: The Social and Economic Contexts, both published by Sage. Her recent edited volume Medical Insurance Schemes for the Poor: Who Benefits? critically engages with the role of insurance for access to medical care. She has published extensively in journals and scontributed to everal edited volumes. She was awarded the Balzan Fellowship by the University College, London and the Indo-Shastri Canadian Fellowship. Dr Baru is the regional editor for South Asia for Global Social Policy published by Sage. She has served as a member of research committees for the Government of India, the Indian Council for Medical Research and the World Health Organisation.