Fiscal Devolution and Redesign of Health Spending: Understanding the Health Financing Environment in India
The health system in India is currently undergoing a significant transformation. Over the past decades, programs sponsored by the central government have formed a large component of the Indian public health system expenditure, but this is changing. The central government has now redesigned the system to devolve increased untied resources to the states. Some key questions arise from this decentralization of responsibility. Will this new model prioritize programmatic interventions in healthcare? Will it balance the role of the Center and states in driving more efficient outcomes? Will it help achieve effectiveness in fiscal spending, monitoring, and accountability?
On December 16, the Ministry of Health and Family Welfare of India and the National Institute of Public Finance and Policy are bringing together key voices from India and across the world to an open dialogue on health financing in India, in New Delhi. Supported by the Bill & Melinda Gates Foundation, the World Bank, and ACCESS Health International, the dialogue will explore the evolving health financing environment and aim to understand global experience and lay the foundation for a sound approach to health policy in India. The consultation is aimed at examining the role that health financing can play in addressing the healthcare needs of the Indian population, both from the perspective of health outcomes and financial protection.
The consultation includes keynote speeches by Dr. Recep Akdag, the former Turkish Minister of Health, on lessons learned in economic efficiency from the prioritization of health investments in Turkey; Stefan Kapferer, Deputy Secretary-General for the Organisation for Economic Co-operation and Development (OECD), on making health a federal and provincial priority; Dr. Jaime Galvez Tan, former Secretary of the Philippines Department of Health, Undersecretary and Chief of Staff, on lessons from the Philippines in managing a fiscal devolution to protect health investments and in promoting inter state equity; and Viroj Tangcharoensathien, a senior expert from the Ministry of Public Health in Thailand, on efficiency and performance linkages in health financing.
Turkey, Philippines, and Thailand, in particular, are best practice examples of countries that have successfully realized health reforms through significant increases in health expenditures as a percentage of their gross domestic product (GDP).
The consultation will also include panel discussions on lessons learned from global evidence and to capture key opportunities for India:
Fiscal Devolution and Implications for Health, moderated by Girindre Beeharry, director, Bill & Melinda Gates Foundation, India
The discussion will focus on the role of health investments in improving health and broader development outcomes; the role of the Center and states in the context of fiscal federalism, implications for health investments at the state level, stewardship role for the Center in addressing national priorities and issues associated with low income states, the architecture of central transfers for health, and the role of the Center and states in monitoring and accountability.
Improving the Efficiency of Health Spending, moderated by Dr. Rekha Menon, practice manager of the South Asia region for the Health, Nutrition, and Population Global Practice at the World Bank
The discussion will focus on the design of public health programs to achieve effectiveness; correlation of public spending with diseases and their financial burdens; prerequisites for expanding programs to purchase services; the correlation between design of purchasing and the functioning of health systems; benefits of prepayments in addressing issues of increasing resources, financial protection, and better functioning health systems; and the appropriate balance between purchasing and provisioning, from the perspective of the Indian government.
New Directions for Health Financing Policy in India, moderated by Shereen Bhan, managing editor of CNBC TV-18
The discussion will focus on restructuring health expenditure by the government to yield results, best instances from Indian states in prioritizing health expenditure, the potential risks of inadequate expenditure by state governments, the role of the government in the design and use of financing; the evolution of the health planning and financing space as a result of devolution and other reforms, and the way forward for India.
It is now an opportune moment to think differently about healthcare financing systems and models aimed at improving healthcare outcomes.
Follow @ACCESSHI and the hashtag #IHFPA as we live tweet the event, starting at 9 am IST on Wednesday, December 16.