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SUMMARYIndia's far‐reaching civil service pension reforms in 2008 provided its fragmented and diffuse pension system a unifying organizing framework. The design and architecture of the reformed civil service program, the National Pension System, was subsequently extended to those employed in private formal and informal sectors. The article assesses India's pension reforms and identifies challenges for the National Pension System in providing old‐age income security. The article also presents estimates for universal social pension scheme and argues that its implementation is constrained by political factors and not necessarily by fiscal constraints. Copyright © 2014 John Wiley & Sons, Ltd.

The book assesses the policy actions of select Asian governments (China, India, Hong Kong, South Korea, Singapore and Thailand) to address critical health system functions from a policy design perspective. The findings show that all governments in the region have made tremendous strides in focussing their attention on the core issues and, especially, the interactions among them. However, there is still insufficient appreciation of the usefulness of public hospitals and their efficient management. Similarly, some governments have not made sufficient efforts to establish an effective regulatory framework which is especially vital in systems with a large share of private providers and payers. A well-run public hospital system and an effective framework for regulating private providers are essential tools to support the governance, financing, and payment reforms underway in the six health systems studied in this book.

Abstract
Fee-for-service remains a popular mode of paying for healthcare despite widespread knowledge of its ill effects. This has resulted in a gap between policy knowledge (understood as consensus among experts) and policy practice (actual policy measures to implement the consensus) in healthcare. The existing literature attributes such gaps to a range of factors, including the stakeholders' different interests, incentives, ideas, and values. Our focus on this debate is through the lens of policy capacity, specifically the ability of public actors to utilize policy knowledge and inform policy practice. We show that the observed knowledge–practice gap is rooted in the complexity of healthcare payment reforms. While actors agree on the problematic condition, there is a deep disagreement on what to do about it. Agreeing on and adopting alternate payment arrangements are challenging because reformers need to anticipate and respond to the future while accommodating the interests of the current providers who benefit from the status quo. In such instances, the capacity of public actors to devise reforms and overcome resistance to them is critical. We argue that the knowledge–practice gap in healthcare payments exists because of deficiencies in the analytical abilities of governments to devise workable alternate arrangements and shortcomings in their political capacity to overcome the resistance to proposed reforms. Put differently, we argue that no amount of evidence or consensus among stakeholders is sufficient when the analytical and political capacities to act on the evidence are lacking. The arguments are illustrated with reference to payment reforms in South Korea and Thailand.

After decades of neglect, in 2008, the Indian government launched a national health insurance programme to address the needs of the bulk of the population that could not afford healthcare. This was followed by the launch of another national programme in 2018 that further expanded insurance coverage. These schemes envision a large single-payer, insurance-based system covering about 110 million families. The central objective of this article is to assess the government's capacity to implement these ambitious programmes. We employ the policy capacity framework developed by Wu et al. to examine the types of capacities needed to achieve desired objectives in the health sector. The central argument of the article is that there are critical capacity deficits, especially along operational dimensions. Our conclusions are generalisable to other middle-income countries currently in the process of implementing similar prospective-payment health policy reforms.Points for practitionersThis article highlights the need for governments to prioritise the capacity for implementing health policy reforms. Efforts to achieve and sustain universal healthcare are contingent not only on appropriate policy design, mobilising required resources and building political support, but also on overcoming capacity deficits in implementation. The framework presented in this article serves as a useful tool for governments to diagnose strengths and weaknesses in the specific types of capacities (analytical, operational, and political) needed for universal health coverage.

AbstractThe past two decades have witnessed unprecedented policy effort to improve access to medical services and strengthen financial protection from catastrophic healthcare expenditure. Despite billions of dollars in health spending, many – especially across the developing world – continue to remain vulnerable to financial impoverishment. What accounts for this poor performance? To respond to this question, we turn to the design literature in public policy, which emphasises the role of policy tools or combination of tools in addressing a social problem. In this paper, we focus on two inter-related aspects of the design orientation to explain outcomes: a) the appropriateness of the policy tool and b) the capacity of government agencies. We apply a framework, which integrates vital questions on both these aspects along three common dimensions (analytical, operational and political) to assess healthcare reforms in India and Thailand. The case studies illustrate the importance of both these aspects of the design orientation in explaining outcomes, and show how they are commonly overlooked in the health and social policy literatures, and in reforms underway.

SummaryHealthcare reforms often result in disappointing failures due to the misguided goals they pursue and the flawed means they employ. The paper proposes that effectiveness—defined as universal access to essential healthcare at a cost affordable to society—is a worthwhile and achievable objective. But to realize effectiveness, reformers need to discard their a priori preferences for markets or governments and instead select a range of policy tools targeting different problems. The paper will argue that a concerted use of regulatory, fiscal, informational and organizational tools shaping the behaviour of healthcare providers, insurers and users can achieve effective healthcare. The paper will highlight the use and misuse as well as non‐use of these tools in China to shed light on tools' approach to health policy reforms. Lessons from China are highly relevant to developing countries around the world trying to reform their health sector. Copyright © 2017 John Wiley & Sons, Ltd.

Rapid ageing of the population globally represents an unprecedented historical trend. As pension and healthcare costs are positively correlated with rising incomes, ageing, urbanization, and a shift from communicable to life-style diseases, managing these costs is a major challenge. There are many linkages between healthcare and pension arrangements - in terms of costs, exposure to risks, and as they jointly impact on crucial policy decisions. This paper discusses the rationale for coordination between various programs to better manage the cost of ageing. The current difficult macroeconomic environment, including fiscal stringency conditions, strengthens the case for such coordination.