Just starting a new project on public private partnerships in health in India. This is a huge topic, so trying to figure out what to focus on is important and difficult. Reminds me of the travails of health care reform in the US. Thinking about the National Rural Health Mission in India, I wonder if it doesn't share some of the problems of the current US reform effort -- trying to do too many things at once. In the Indian case, it seems that targeting maternal and early child health has the virtue of focus, simplicity and high social payoffs. Focusing on specific health issues and population segments like this may be the way to go forward. One other thing that strikes me about health care is its complexity. It covers so many different types of services, that lumping everything together makes it hard to say precisely what changes are needed. Providing good antenatal and postnatal care for mothers and babies is very different from treating chronic and lifestyle conditions such as diabetes and cardiovascular disease.
One difference between India and the US is the prevalence of health insurance in the latter. Both countries probably need to expand coverage, and make the system more cost effective, but the starting point is very different. In this context, it was interesting to hear Warren Buffet say that a lot of the debate in the US was really about reforming health insurance, rather than health care. Of course the two are connected, since the insurance system affects care choices. But more conceptual clarity in addressing separately the care process and the payment system might help.
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