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Reform Goes Global |
PROLOGUE
China And India: Reform Goes Global
A long-standing question in development is whether or not, as a nation’s income rises, the population’s health improves along with it. In the case of China and India, the answer has been no. The economic reforms that transformed China since 1978 clearly unleashed a boom—but they also had the perverse effect of destroying the nation’s public health system. Most notably, much of the population was left uninsured and facing high financial risk from inadequate care.
India hasn’t experienced such wrenching changes, but its public health system has actually stagnated even as incomes have grown. Increased wealth has led to frustration that the health system simply hasn’t kept up.
As these two countries now contemplate major health reforms, both propose to invest more public funds in health care, equal to one to two percentage points more of gross domestic product. But although more money is a necessary condition for improving health and health care, it’s not a sufficient one. Reforms will clearly require other, more difficult changes, including increased regulation of the health sector and new modes of delivering care.
In the papers that follow, the authors look back on what happened—and what issues India and China face as they craft their health reforms. Winnie Yip and Ajay Mahal of the Harvard School of Public Health trace how both countries got to this point, and the health care access and financial challenges their populations now face. Jin Ma, Mingshan Lu, and Hude Quan of the Shanghai Jiaotong University and the University of Calgary describe the Chinese economic changes of the past thirty years and their effects on the health system. Perspectives by Pranab Bardhan (on Yip and Mahal) and by William Hsiao (on Ma, Lu, and Quan ) underscore the importance of incentives.
Greater regulation of the health sector to improve the quality of care is the focus of the paper by Gerald Bloom (Institute of Development Studies, U.K.), Barun Kanjilal (Institute of Health Management Research, India), and David Peters (Johns Hopkins Bloomberg School of Public Health). As for new modes of health care delivery, Aman Bhandari (Centers for Medicare and Medicaid Services), Sandra Dratler (University of California, Berkeley), Kristiana Raube (UC Berkeley), and R.D. Thulasiraj (Lions Aravind Institute of Community Ophthalmology, India) describe a low-cost specialty care model that might be adopted across different services and countries.
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