These include a steadily urbanising population, growth in chronic, non-communicable diseases that are costly to treat, increasing demand for sophisticated health services from middle-income Indians and a large, poorly regulated private sector. The report says limited primary care and lack of integrated referral services hinder the capacity of the urban healthcare system to improve health. Moreover, urban public hospitals are chronically overcrowded and handicapped by a lack of administrative autonomy, a shortage of professional managers and absence of community involvement.

It says private health insurance is controlled by a set of non-competitive state-owned corporations that are poorly regulated and whosepolicies exclude numerous consumers. Employees' State Insurance Scheme (ESIS), the largest mandatory insurance programme, covers only a fraction of patients who are potentially eligible and does not function as an insurer or purchaser, but instead operates directly as an unpopular health service for lower-income workers. The report, titled A Fine Balance: Some Options for Private and Public Healthcare in Urban India, says the public, private and non-governmental organisation (NGO) sectors should work together in the future.

It lists reform options. These include a greater investment by the Central and state governments in the financing of healthcare, stronger accountability for services funded and less involvement in the direct provision of care.

The report envisages continued and ideally greater investment by the Central and state governments in the financing of healthcare. There is also need for stronger accountability for services funded, but more targetted involvement in the direct provision of care,it says. In addition, the report outlines proposals to de-monopolise the private health insurance market and eliminate subsidies for middle-income Indians. This will encourage participation from professionals, small business people and others who would remain outside of any mandatory insurance programme, it adds.

In order to facilitate these reforms in finance and delivery, the report recommends enhancing regulatory and self-regulatory capacity and further educating the public and purchasers about the price and quality of health services.

In addition, investment in intellectual capital is necessary to expand the number of Indians with skills in healthcare finance, evaluation and management. In addition to the analytic report, the World Bank supports several state health system projects in Andhra Pradesh, Karnataka, Maharashtra, Punjab, Orissa and West Bengal, along with numerous disease control, nutrition and reproductive health programmes in India.

-- IANS