T17aP11 - Public Hospital Reforms in India, China and South East Asia: Consequences for Accountability and Governance

Topic : Sectorial Policy - Health

Panel Chair : Rama Baru - rama.v.baru@gmail.com

Panel Second Chair : YINGYAO CHEN - yychen@shmu.edu.cn

Panel Third Chair : Madhurima Nundy - madhurima.nundy@gmail.com

Objectives and Scientific Relevance of the panel

Over the last four decades most low and middle income countries in Asia have introduced a range of reforms in public health institutions, especially hospitals at the secondary and tertiary levels of care. The motivations for reforms in diverse socio-political contexts share some common features with the objective of rationalizing cost and improving efficiency and effectiveness of public hospitals. Some of these shared features include the introduction of user fees; contracting out and in of clinical and non clinical services; casualization of workers to include medical, paramedical and support staff; introduction of paying clinics; autonomisation of public hospitals leading to the redefinition of the ‘public’ in public hospitals.

The main objective of this panel is to invite papers that address the a) the motivation for reforms: fiscal and budgetary pressures prompting governments everywhere to search for ways to improve efficiency and rein in healthcare costs; b) the different ways of pursuing those goals by a mix of strategies and instruments (not just market principles); and c) the consequences of those reforms on hospital workers, patients, management and others.
A number of interesting questions that the papers could address are: (a) whether these reforms have given rise to multiple structures of authority within public hospitals? (b) What are the consequences of fragmentation of authority for the functioning of the hospital? (c) What does contracting in and out of services imply for governance and quality of services? (d) What are the implications of casualization of health workers for governance? (e) Who is responsible and accountable for these workers- the contracting agents or hospital administrators? (d) Is there a potential role conflict between permanent and casualised workers? (e) How do the differential working conditions and wages affect motivation and morale of workers? (f) How does this affect the organizational culture and behavior of health workers towards patients? (g) What are the challenges for governance in the context of fragmented roles, authority and power within a hospital? (h) What are the consequences of these reforms for patient care?


Call for papers

We invite papers that adopt a multi and interdisciplinary perspective that address the complexities involved in governing public hospitals that have introduced reforms. The papers submitted to the panel maybe descriptive and /or analytical that discuss the process, content and experience of public hospital reforms in India, China and South East Asia. These papers could have a country focus or may adopt a comparative perspective between two or more countries of public hospital reforms. The papers must provide broadly a historical overview, content and process of reforms; the role of international agencies (if any) in furthering the reform agenda; restructuring of financing and structures for governance; innovations in regulations for the management of public–private partnerships in the hospital. The papers must reflect on the reform process and the challenges it poses for governance of the hospital. It should broadly address the following questions :

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