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The Role of the Health System

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Health Inequities in India

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Abstract

Health systems are developed and invested in with the express goal of ensuring a basic minimum of health care for all. This chapter points out that health systems are emergent from the sociopolitical and cultural power distribution in a given society and thus reflect these in its structure, design and functioning. As the Health System Knowledge Network (of the Commission on Social Determinants of Health) pointed out, health systems can contribute to the reduction of health inequities or indeed to their sustenance or even worsen. It is also pointed out that apart from the material effects of the health system, any such system also sends out messages to the users (and indeed those who cannot use it) regarding the way they are seen by those in power. The health system, by the way it functions, can support or challenge the larger sociopolitical arrangements. Given this perspective and the evidence of inequity presented in the previous four chapters it is clear that the health system in India is not playing the role it is expected to. It is from this perspective that the chapter reviews and engages with the literature on out-of-pocket expenditure, and health systems utilisation, structure, design and financing. The chapter identifies a few mechanisms from the literature reviewed and recommends the need for a multi-level framework to adequately understand the role played by health systems in health inequity.

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Notes

  1. 1.

    Path dependence means that the way decisions are made at a given point in time is dependent on past decisions made and knowledge trajectory, which in turn influences the competence and knowledge-base of decision-makers. In other words, history matters for current decision-making situations and has a strong influence on strategic planning.

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  1. Centre for Technology and Policy (CTaP) IIT-M, Chennai, India

    Rakhal Gaitonde

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  1. Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India

    T.K. Sundari Ravindran

  2. Centre for Technology and Policy (CTaP), Indian Institute of Technology Madras, Chennai, Tamil Nadu, India

    Rakhal Gaitonde

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Gaitonde, R. (2018). The Role of the Health System. In: Ravindran, T., Gaitonde, R. (eds) Health Inequities in India. Springer, Singapore. https://doi.org/10.1007/978-981-10-5089-3_8

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