Unintended Effects of Policy Interactions in the Health Sector: A Case of Kerala, India
| Author | Maurya Dayashankar,Sibasis Hense |
| DOI | http://doi.org/10.1177/00195561221121035 |
| Published date | 01 March 2023 |
| Date | 01 March 2023 |
| Subject Matter | Articles |
Unintended Effects of
Policy Interactions in
the Health Sector: A
Case of Kerala, India
Maurya Dayashankar1 and Sibasis Hense2
Abstract
The governments of developing countries, including India, are pursuing policy
mixes in collaboration with the private sector to strengthen the public health sys-
tem. However, little is known about the interaction of public policies with dif-
ferent instrument logics. We conducted a contextual analysis of two health poli-
cies with different instrument logics—emergency care and social health insurance
programme—for over a decade in Kerala, employing primary and secondary data,
government reports, newspaper articles, and published and unpublished literature.
Our analysis suggests that the competition between policies has led to policies
working at crossroads. The low political salience of emergency care has led to the
diversion of resources and attention to government health insurance programmes.
Thus, emergency care is increasingly facilitated at private facilities, shifting the
government’s role from service delivery to financing. Our findings also highlight
that the interaction effects among health policies receive limited attention among
researchers and practitioners. These findings are relevant to countries of similar
economies undergoing New Public Management reforms leading to the weakening
of the public system in dealing with health functions such as emergency care.
Keywords
Policy interaction, public health, emergency care, new public management
reforms
Introduction
Strengthening the health system in general and the public health system in par-
ticular, never received much attention from the governments in the past, as seen
Article
Indian Journal of Public
Administration
69(1) 138–150, 2023
© 2022 IIPA
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DOI: 10.1177/00195561221121035
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1 Department of Social Sciences, Institute of Rural Management Anand, Gujarat, India.
2 Deptartment of Public Health & Community Medicine, Central University of Kerala, Kasargoad,
Kerala, India.
Corresponding author:
Sibasis Hense, Department of Public Health & Community Medicine, Central University of Kerala,
Kasargoad, Kerala 671316, India.
E-mail: sibahense@gmail.com
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