Health reforms and utilization of health care in three states of India: Public Health Prospects


  • Kasturi Sen
  • Samir G. Roy Emeritus Professor, Population Studies Unit Indian Statistics Unit, Kolkata, WB, India
  • Shuba Kumar Smarth NGO Chennai, India
  • Professor KV Narayana Centre for Economic and Social Science (CESS) Hyderabad, India
  • Anju Priyadarshi Research Scientist and Statistician, India


Health sector reforms were introduced in several states of India in 1991. The rationale was to increase choice and competition, to improve quality and access to health care Such demand-led incentives were integral to macro-economic stabilization programs world-wide during the 1990s. For a majority of the population of India, health care costs linked to commercialisation of health services were forcing households into serious debt. Using primary data on patterns of utilisation of health services (2002), this paper reports from a systematically collected empirical evidence base, to explore the preliminary impact of changes to the health sector from 1991 to 2000 in West Bengal (WB), Tamil Nadu (TN), and the hospital sector of Andhra Pradesh (AP). The overall aim is to provide historical context to the experience of reforms for poor and vulnerable groups and to understand current discourses on the health system in India, focused on “managed care” through a universal health insurance programme. We explore linkages between the past and present on disinvestment in public provision and its long-term consequences for equity of access to health care in the three states, and elsewhere in the country.



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