Globalization and the Health of a Megacity

Bisht, Ramila; Virani, Altaf

doi:10.1093/acprof:oso/9780199463374.003.0005

Cited by 3 publications

(7 citation statements)

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“…On the one hand, P3s have been welcomed by its proponents as an answer to the inadequacy, inefficiency and incompetence of traditional public service provision (Borins 1995). In the health sector, for example, they have been known to improve the performance and quality of healthcare and allied services (Bisht and Virani 2016;Liu, Hotchkiss, and Bose 2008;L€ onnroth, Uplekar, and Blanc 2006). On the other hand, critics have questioned their lack of democratic accountability, negative effects on equity and access, and diminutive effects on the role of the state (Baru and Nundy 2008;Bisht and Virani 2016).…”

Section: Goal Ambiguity As An Impediment To Effective Designmentioning

confidence: 99%

“…In the health sector, for example, they have been known to improve the performance and quality of healthcare and allied services (Bisht and Virani 2016;Liu, Hotchkiss, and Bose 2008;L€ onnroth, Uplekar, and Blanc 2006). On the other hand, critics have questioned their lack of democratic accountability, negative effects on equity and access, and diminutive effects on the role of the state (Baru and Nundy 2008;Bisht and Virani 2016). Because policies are complex in their manifestations, policymakers have to tread a fine balance in determining optimal design configurations.…”

Section: Goal Ambiguity As An Impediment To Effective Designmentioning

confidence: 99%

“…P3s in India's health sector are a case in point. Many of the existing projects are mired in controversy and face allegations of perverse provider behavior, breach of contract and inequitable access (Bisht and Virani 2016;Donaldson, Sethi, and Sharma 2008;SAMA 2012). Ironically though, P3s continue to be the preferred strategy for public health infrastructure creation in under-served areas, despite majority evidence of ineffectiveness (Datta 2009;Karpagam et al 2013;Planning Commission 2012).…”

Section: Goal Ambiguity As An Impediment To Effective Designmentioning

confidence: 99%

“…The effects of such neglect are evident from case-study evidence on current and past P3 projects. In their case-study of SWAN Municipal General Hospital -Mumbai's first BOT project for hospital care, Bisht and Virani (2016) show how P3s can yield unequal outcomes for different groups of stakeholders. 3 The project was set up when the city government was purportedly under financial strain and did not have the resources to refurbish an existing public maternity hospital that had been used for obstetric care by generations of women from the nearby slums.…”

Section: P3 Performance In India's Health Sector and The Policy Substmentioning

confidence: 99%

“…While P3s have been found to lower production costs for the private partner, there is little evidence about the positive effects on overall costs of health service delivery for the government (Bisht and Virani 2016;Liu, Hotchkiss, and Bose 2008;Mills 1998). Contracting-out of health services has been known to boost performance in terms of higher outputs, widen the range of services and improve the quality of healthcare provided to private patients (Bisht and Virani 2016;Liu, Hotchkiss, and Bose 2008;L€ onnroth, Uplekar, and Blanc 2006). However, evidence about the equity impact of P3s, particularly in terms of access and utilization of health services is mixed.…”

Section: Integrating Diverse Perspectives In P3 Design: Why and How?mentioning

confidence: 99%

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Notions of policy effectiveness and implications for policy design: insights from public-private partnerships in India

Virani

2019

Policy Design and Practice

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The objective of policy design is to devise policies for the achievement of predetermined policy goals. Their effectiveness hinges on a determination of what constitutes policy success, and assessments of the suitability of different design configurations in attaining the intended outcomes. Failure to clearly specify policy goals and ascertain policy success (or failure) can thus render them ineffective. Goal ambiguities are particularly problematic in the context of collaborative policy instruments like Public-Private Partnerships (P3s) due to the multiplicity of stakeholder interests. Using the example of P3s in India's healthcare sector, this paper points to inherent contradictions in the policy expectations of different actors, and how policies which neglect an appreciation of the agendas of diverse constituencies are inherently unworkable and produce outcomes which are inequitable and inconsistent with their underlying motivations. By situating these cases against the academic discussion on frame-multiplicity and policy success, the paper highlights why policymakers must consider these different, sometimes conflicting ideas of effectiveness, and how they can be reconciled through proactive design efforts, so that policies are sustainable and effective in meeting their overarching goals.

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Section: Goal Ambiguity As An Impediment To Effective Designmentioning

confidence: 99%

Section: Goal Ambiguity As An Impediment To Effective Designmentioning

confidence: 99%

Section: Goal Ambiguity As An Impediment To Effective Designmentioning

confidence: 99%

Section: P3 Performance In India's Health Sector and The Policy Substmentioning

confidence: 99%

Section: Integrating Diverse Perspectives In P3 Design: Why and How?mentioning

confidence: 99%

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Notions of policy effectiveness and implications for policy design: insights from public-private partnerships in India

Virani

2019

Policy Design and Practice

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Horses for Courses: Moving India towards Universal Health Coverage through Targeted Policy Design

Maurya

Virani²,

Rajasulochana

2017

Appl Health Econ Health Policy

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The debate on how India's health system should move towards universal health coverage was (meant to be) put to rest by the recent National Health Policy 2017. However, the new policy is silent about tackling bottlenecks mentioned in the said policy proposal. It aims to provide universal access to free primary care by strengthening the public system, and to secondary and tertiary care through strategic purchasing from the private sector, to overcome deficiencies in public provisioning in the short run. Yet, in doing so, it ignores critical factors needed to replicate successful models of public healthcare delivery from certain states that it hopes to emulate. The policy also overestimates the capacity of the public sector and downplays the challenges observed in purchasing secondary care. Drawing from literature in policy design, we emphasize that primary, secondary and tertiary care have distinct characteristics, and their provision requires separate approaches or policy tools depending on the context. Public provisioning, contract purchasing and insurance mechanisms are different policy tools that have to be matched with the context and characteristics of the policy arena. Given the current challenges of India's health system, we argue that tertiary care services are most suitable for insurance-based purchasing, while the public sector should concentrate on building the required capacities to dominate the provisioning of secondary care and fill gaps in primary care delivery, for India to achieve its universal coverage ambitions.

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The design roots of policy problems: Unpacking the role of procedural tools in design fitness and resilience

Virani¹,

Bali

Cashore

et al. 2023

Public Administration

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While policy design scholars have made significant conceptual and empirical advances in identifying and evaluating procedural tools, there has been a little focus on understanding how they interact with the more traditional “substantive” elements of a policy mix and their critical functions in policy mix designs. As a result, there is uncertainty about how procedural tools affect policy effectiveness—at adoption or over time. To address this gap, we propose a framework for deconstructing policy mix designs to examine how procedural tools interact with substantive tools in ways that either contribute to or undermine design “fitness” and “resilience.” The framework's diagnostic utility is illustrated by its application to unpack healthcare arrangements in Singapore and India, which reveals design “fault lines” that policy researchers and practitioners need to be aware of. We conclude by offering research directions for further investigating the role of procedural tools in shaping policy dynamics and outcomes.

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Globalization and the Health of a Megacity

Cited by 3 publications

References 0 publications

Notions of policy effectiveness and implications for policy design: insights from public-private partnerships in India

Notions of policy effectiveness and implications for policy design: insights from public-private partnerships in India

Horses for Courses: Moving India towards Universal Health Coverage through Targeted Policy Design

The design roots of policy problems: Unpacking the role of procedural tools in design fitness and resilience

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