The Impact of Socioeconomic and Political Factors on the Provision of Health Care in India
The political economy of health care provides a necessary backdrop to an understanding of health policymaking in India. This context provides the possibility of answering questions such as why different numbers of different cadres of medical personnel are trained; why some areas of health provision are well funded while others get little more than a pittance; why some health facilities are underused while others are swamped with demand; and why some systems of health care financing are used and not others. In this chapter we discuss this context, rather than the details of outcomes, for which other sources are available (cf. Jeffery, 1986a, 1986b).
The political economy of health care is an attempt to specify the ways in which economic interests and political processes structure the provision of health services. It can take many forms. At one extreme lie economistic models, based either on neoclassical economics or vulgar Marxism, in which the political processes are seen to follow directly from economic determinants. At the other extreme lie politicist models where political forces, either national or international, are in the driver's seat ( Staniland, 1985). An example of neoclassical economics would be Mahbub ul-Haq's argument for Pakistan that health provisions could be left to market forces ( Jeffery, 1974); an example of Marxist economics would be Djurfeldt and Lindberg Pills Against Poverty ( 1975). Lipton's "urban bias" arguments lie near the politicist end of the spectrum, with his argument that indigenous practitioners are supported as a way of keeping good medical services for town-dwellers ( 1977); so are those accounts by doctors or administrators which conclude that "political will" is the answer, or focus on corruption.