ABSTRACT
India’s healthcare system encompasses a diverse array of sectors and actors that are deeply interconnected. However, existing analyses often focus on specific components in isolation, overlooking their complex interactions. This chapter advocates for a comprehensive and integrated perspective, emphasising the need to view the healthcare ecosystem as a whole. Seven key sectors constitute this ecosystem: healthcare users and communities, public healthcare services, public health governance bodies, private healthcare providers, public–private schemes, medical industries, and financial systems related to healthcare. These sectors interact dynamically, influencing outcomes and driving systemic changes.
We highlight the interplay of financialisation and corporatisation within healthcare, which reshapes public health systems and exacerbates inequities. For instance, the corporatisation of healthcare influences public health policy, prioritises public–private partnerships, and accelerates the digitalisation of health records, often to the detriment of equitable access. Similarly, transnational financial flows and development finance institutions, while aiming to improve healthcare access, frequently support the expansion of commercial corporate hospitals, contributing to healthcare disparities.
At the same time, public healthcare services remain constrained, grappling with challenges such as inadequate funding, shortage of specialist doctors, and systemic inefficiencies. Public–private interactions, including national- and state-level health insurance schemes, also raise concerns about their impact on public health infrastructure and equity.
This chapter argues for addressing the two ends of the healthcare spectrum – users and communities, on the one hand, and financial systems, on the other – both of which are often treated as peripheral to the system. By integrating these components into the analysis, a more holistic understanding of India’s healthcare ecosystem emerges, offering critical insights for advancing publicness in healthcare. This approach underscores the need for systemic reforms that prioritise inclusivity, equity, and sustainability in shaping India’s healthcare landscape.
