Federalism, Decentralization, and Health Care Policy Reform in India

  •  Divya Pahwa    
  •  Daniel Beland    


This article explores how the Indian federal structure impacts health care. India has a history of central planning
and concentration of power at the federal level. This concentration of power has left state and local levels of
government in a subordinate position. Such a situation has distorted incentives, and a by-product of this has been
a rather disorganized health care system. Disorganization and fiscal limitations have become major obstacles to
large-scale reform of India’s health care system. However, reform is necessary. As argued, a stronger, more
decentralized, and better regulated public health care system should improve human welfare in India, while
fostering the development of a stronger sense of national identity derived from shared, universal social

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