The impacts of corporatisation of healthcare on medical practice and professionals in Maharashtra, India

A heterogeneous private sector dominates healthcare provision in many middle-income countries. In India the contemporary period has seen this sector undergo corporatisation processes characterised by emergence of large private hospitals and the takeover of medium-sized and charitable hospitals by corporate entities. Little is known about the operations of these private providers and the effects on healthcare professions as employment shifts from practitioner-owned small and medium hospitals to larger corporate settings. This article uses data from a mixed-methods study in two large cities in Maharashtra, India, to consider the implications of these contemporary changes for the medical profession. Data were collected from semi-structured interviews with 43 respondents who have detailed knowledge of healthcare in Maharashtra, and from a witness seminar on the topic of transformation in Maharashtra’s healthcare system. Transcripts from the interviews and witness seminar were analysed thematically through a combination of deductive and inductive approaches. Our findings point to a restructuring of medical practice in Maharashtra as training shifts towards private education and employment to those corporate hospitals. The latter is fuelled by substantial personal indebtedness, dwindling appeal of government employment, reduced opportunities to work in smaller private facilities, and the perceived benefits of work in larger providers. We describe a ‘re-professionalisation’ of medicine encompassing changes in employment relations, performance targets and constraints placed on professional autonomy within the private healthcare sector, that is accompanied by trends in cost inflation, medical malpractice, and distrust in doctor-patient relationships. The accompanying ‘re-stratification’ within this part of the profession affords prestige and influence to ‘star doctors’ while eroding the status and opportunity for young and early career doctors. The research raises important questions about the role that government and medical professionals’ bodies can, and should, play in contemporary transformation of private healthcare, and the implications of these trends for health systems more broadly

Medical technology in India: Tracing policy approaches

Medical devices and equipment have become an indispensable part of modern medical practice. Yet these medical technologies receive scant attention in the Indian context, both at the health policy level and as an area of study. There has been little attempt to systematically address the issue of equipment based medical technologies and how to regulate their use. There is paucity of primary data on the kind of medical equipment and techniques being introduced, on their need and relative usefulness, reliability, patterns of utilization, on their production, procurement, distribution, costs, and accessibility. This article reviews some of the policy issues relating to equipment based medical technology in India, in light of the specific choices and policies made during and after the colonial period in favour of modern medicine and a technology-based public health system, attempts at self-sufficiency and the current international environment with respect to the medical equipment and health-care industry

Corporate presence in healthcare sector in India

Various forms of privatization have been the preferred policy option for the health sector reform which was initiated in the 1990s in India under the neo-liberal regime. Rigorous study of privatization processes and of the private sector in general remains inadequate. This research attempts to fill this gap by examining the extent and nature of corporate presence in India in the delivery of healthcare services. It poses some concerns in light of experiences of other countries. The first section of the paper covers the private hospitals sector. The second part looks at the diagnostics sector. The concluding section discusses the implications of such developments for healthcare services in the country

Demand-side financing and promotion of maternal health: what has India learnt?

Use of demand-side financing has become increasingly common in maternal healthcare and India has been a leading example with large-scale programmes such as the Janani Suraksha Yojana and Indira Gandhi Matritva Sahyog Yojana. This paper undertakes a systematic review of the evidence to consider how demand-side financing has been used and whether there has been any impact on maternal health service utilisation, maternal health, or other outcomes. The findings suggest that a relatively narrow focus on achieving targets has often overburdened health facilities, while inadequate referral systems and unethical practices present overwhelming barriers for women with obstetric complications. The limited evidence available also suggests that little has been done to challenge the low status of poor women at home and in the health system

Decentred regulation: the case of private healthcare in India

In order to progress towards more equitable social welfare systems we need an improved understanding of regulation in social sectors such as health and education. However, research to date has tended to focus on roles for governments and professions, overlooking the broader range of regulatory systems that emerge in contexts of market-based provisioning and partial state regulation. In this article we examine the regulation of private healthcare in India using an analytical approach informed by ‘decentred’ and ‘regulatory capitalism’ perspectives. We apply these ideas to qualitative data on private healthcare and its regulation in Maharashtra (review of press media, semi-structured interviews with 43 respondents, and three witness seminars), in order to describe the range of state and non-state actors involved in setting rules and norms in this context, whose interests are represented by these activities, and what problems arise. We show an eclectic set of regulatory systems in operation. Government and statutory councils do perform limited and sporadic regulatory roles, typically organised around legislation, licensing and inspections, and often prompted by the judicial arm of the state. But a range of industry-level actors, private organisations and public insurers are involved too, promoting their own interests in the sector via the offices of regulatory capitalism: accreditation companies, insurers, platform operators and consumer courts. Rules and norms are extensive but diffuse. These are produced not just through laws, licensing and professional codes of conduct, but also through industry influence over standards, practices and market organisation, and through individualised attempts to negotiate exceptions and redressal. Our findings demonstrate regulation in a marketised social sector to be partial, disjointed and decentred to multiple loci, actively representing differing interests. Greater understanding of the different actors and processes at play in such contexts can inform future progress towards universal systems for social welfare