Health Policy and Legislation

Road traffic fatalities constitute 16.6% of all deaths, making this the sixth leading cause of death in India, and a major contributor to socio-economic losses, the disability burden, and hospitalisation. An attempt to measure catastrophic levels of health expenditure on accidental injuries, road traffic accidents, and falls, finds that the burden of out-of-pocket expenditure is the highest for such injuries. The financial burden is particularly high for poorer households in rural areas, and those seeking treatment at private health facilities with no health insurance. Public health facilities for trauma care and health coverage for low-income groups could help these vulnerable households.

In this article, we focus on the efficiency of the healthcare system at the district level for Bihar. Although relatively an economically and socially disadvantaged state, the infant mortality rate in Bihar is very close to the all-India average. We explore the reasons for the differential performance of different districts by using data envelopment analysis. The efficiency rankings from our results indicate a mix of inefficiency, inadequacy of inputs, and the presence of an optimal targeting of funds under the National Rural Health Mission to low-performing districts.

The National Health Accounts is a global tool that provides a snapshot of the flow of funds in a country’s health system by financing sources, providers of healthcare and healthcare functions. The Indian government’s Ministry of Health and Family Welfare released the NHA estimates for 2013–14 in August 2016 providing details of these expenditures by health financing schemes, providers and functions. This article comments on some of the major advances and gaps in the latest NHA estimation methodology and in the presentation of results.

The recent move of the government to extend the Employees’ State Insurance Scheme for domestic workers clearly shows the callousness of the initiative and the non-committal approach of the state to the concerns of domestic workers. For the first time, a discriminatory approach within the ESI scheme to a specific category of workers is noticeable.

C S Verma (verma.cs@gmail.com) is a senior fellow and Shivani Singh (ssshivani15@gmail.com) is a research associate at the Giri Institute of Development Studies, Lucknow. Alok Ranjan (alokranjancmc@ gmail.com) is a junior research fellow at the Indian Council of Medical Research and T Sundararaman (sundar2016@gmail.com) teaches at the School of Health Systems Studies, Tata Institute of Social Sciences, Mumbai.