The health care system in India has evolved over a substantial period of time, meriting a thorough documentation of its history, politics, ethics and changing perspectives. The title of this book, therefore, arouses a fair deal of expectation. Economists, like many other scholars alleging loyalties to mainstream disciplines, tend to lack an interdisciplinary approach in their chronicles of social sector issues. To that extent, the subtitle of the book reflects the “business” of the book more accurately — Towards Measuring Efficiency in Delivery of Services.
Having said that, however, full credit is due to the author for having put together a comprehensive resource material on the availability and scope of statistical and econometric methods that can be applied to secondary datasets which are available to a researcher seeking to apply standard notions of economic efficiency to the Indian health care system. This self-edited volume is organised into six chapters and draws upon the author’s earlier work on this subject. The introductory chapter discusses the issues and challenges faced by the health system. A brief review of empirical studies measuring economic efficiency using data, envelopment analysis and frontier estimation techniques is followed by three core chapters describing the model, its estimation and the econometric findings.
The core econometric model is a straightforward stochastic frontier model where the health output (e.g., life expectancy) is produced by a health system, as determined by a set of inputs (e.g., per capita health facilities available) and an error term representing the technical inefficiency of the health system, apart from the usual stochastic error term. A health system is technically efficient if its output level is on the “frontier”, which represents the benchmark for performance. The closer it is to the frontier, the less inefficient it is. The book also provides useful descriptive statistics on the data used. Panel data for the period 2000-2005 is applied to this economic measure of efficiency for 14 states, representative of high, middle and low income states. District-level analysis has been done for five states — Punjab, Haryana, Karnataka, Madhya Pradesh and West Bengal. Disparity in technical efficiency is subsequently explained by non-health-related parameters such as per capita income, literacy and urbanisation, among other factors. District-level and state-level data has been painstakingly compiled from various secondary sources. The issue that arises here is that different datasets vary in their sampling frames. This aspect is an important point to keep in mind in comparing across datasets, and in interpreting and drawing insights, particularly in arriving at generalisations that can obliterate context-specific issues.
Emphasis is placed on the disparities in health facility planning, in explaining differences in the technical efficiency of the health system across states and districts. On the one hand, such an approach has the distinct advantage of lending substantial scope for the use of hard data for conventional statistical and econometric modelling. It also leads to the confirmation of hypotheses that are popularly held, such as the concentration of resources in urban as compared to rural areas. On the other hand, it limits the scope for taking a holistic approach to the understanding of the larger picture of efficiency in functioning of health systems. In particular, the institutional and political economy aspects, which researchers are today increasingly seeking to build into their models through the construction of innovative explanatory variables. Interestingly, the author does mention several of these institutional aspects in terms of the limitations and constraints these pose in the functioning of the health system performance. This book is a useful read for those interested in applying quantitative methods to secondary data in the health sector in India.
The discerning reader would gain from perusing the substantial work done on the health care system in India across disciplines, including the book under review, for obtaining a holistic and richer picture of the health care system in India.
HEALTH CARE SYSTEM IN INDIA
Brijesh C Purohit
187 pages; Rs 600