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Foreword
finely probe these schemes, uncovering their progress, potential, and shortcomings. Arguably, these recent arrivals represent a pioneering—at least in the Indian context—but still emerging platform that can be one of the key tools for achieving India’s stated goal of universal health coverage. However, finishing the job started will be more difficult. In this respect, the authors make a significant contribution by specifying the operational changes that will be required to transform them into more robust platforms for contributing to universal coverage. Policy makers and planners should pay close attention to these recommendations. The road ahead will not be easy. In preparation for the 12th Five Year Plan (2012–17), the central government is planning to significantly increase public spending on health to spearhead the march toward universal coverage. This is certainly a welcome initiative, considering the historically low levels of government financing for health. But it is not only a question of giving the health system more money. How best to spend these new resources to secure more effective services is also an issue that needs to be addressed. These health insurance schemes can spearhead changes in the broader system of finance and delivery at the tertiary and secondary levels in the march toward universal coverage. How to direct the new funding is already the subject of intense debate. For example, some call for expanding public delivery systems operated by the states while others call for extending coverage through governmentsponsored health insurance. This may be a false dichotomy, and the authors intelligently avoid this trap. What is clear is that the country can ill afford to move ahead on parallel tracks—expanding financing of both the demand and supply sides without a clear notion of coordination and future convergence. To their credit, La Forgia and Nagpal recommend a blended approach, one that strengthens the links of government health insurance to public delivery but ties funding to performance. Yet the authors maintain the essential and innovative features pioneered by this new generation of health insurance schemes in terms of patient choice of provider, private participation, defined (and delivered) benefits, and the separation of purchasing from provision. This approach is well grounded in current Indian reality but also draws on international experience. Clearly, there is a huge role for the public delivery system in India, but it needs a shot in the arm, in terms of both financing and incentives for improved performance. This book provides the analytic basis and policy recommendations for reorienting how India pays for and delivers health care, connecting the dots between the supply- and demand-side