Projects


Projects

Brokerage

Ring road slum2Intermediaries are increasingly influential mediators in the process of accessing healthcare, with important implications for the forms of care that users seek and receive. This research examines their growing role in healthcare systems.

Corporatisation and regulation

John Isaac - World Bank - Doctor at hospital performing operation on womanCorporatisation and Regulation in the Private Healthcare Sector in India (CRiPS) is concerned with the expansion and changing face of private sector hospital care and related diagnostic services through an organised, and increasingly transnational, healthcare industry.

Private investment

Toshiyuki IMAI - Hospital corridorThe healthcare sector presents significant opportunities for private sources of finance and significant investment is now being channelled into the rapid growth of corporate healthcare chains, particularly in emerging economy countries. We consider the scale and form of the investments being made, and the implications for incentives and equity in healthcare systems.

Real estate

med cit colour

A plethora of plans for “medicities” or “health cities” in different Indian states were announced in the press media in the period from 2007 onwards. They were to provide large scale “one-stop-shops” of super-speciality medical services supplemented by diagnostics and other aspects of healthcare and lifestyle consumption. We examine these imagined healthcare places, and the political economy of their development.

The global healthcare economy

Christian Junker - Plane taking offHere we analyse the emergence and evolution of global healthcare markets. Healthcare is increasingly seen as sector that can deliver significant financial returns on investment, particularly through international trade in health-related services. As a result some governments are actively promoting healthcare as a strategy for national economic development. We study the social change and tensions that accompany this immersion in global markets.

Vouchers and cash transfers

WHO - Dengue voucherVoucher and cash transfers are expected to promote health by offsetting some associated financial costs or by increasing household income or providing financial incentives to increase healthy behaviours. We examine the design and effects of these policy initiatives to determine their role in creating and promoting healthcare markets, and the implications for equity.

 

Blog posts

Corporatisation and regulation


Picture credit: John Isaac / World Bank, via Flickr

Corporatisation and Regulation in the Private Healthcare Sector in India (CRiPS) is concerned with the expansion and changing face of private sector hospital care and related diagnostic services through an organised, and increasingly transnational, healthcare industry. Using a detailed case study in Maharashtra State, India, the research aims to: examine the implications of these emerging forms of healthcare delivery and their business and management practices for the healthcare sector and for practitioners and users of their services; consider the nature of past attempts at effective private sector regulation; and to advance the development of a social accountability framework for regulation of the sector.

CRiPS is a collaboration between King’s College London and Support for Advocacy and Training to Health Initiatives (SATHI), a civil society organisation based in Pune, India. SATHI’s mission is to contribute to the building of the movement for ‘Health For All’ through collective action and research in India. CRiPS is funded by the UK Medical Research Council as part of the Health Systems Research Initiative.

Project team

Professor Susan Murray and Dr Indira Chakravarthi (lead investigators), Shweta Marathe, Deepali Yakkundi, Dr Abhay Shukla, Dr Benjamin Hunter, Dr Arun Gadre, Dr Sanjay Nagral

Image result for mrc health systems research initiativekcl-logo

 

Real estate


Picture credit: Benjamin Hunter

Urban transformations offer significant opportunities for real estate development and the building of healthcare facilities has been given high profile in modernisation discourse alongside condominiums, shopping malls, hotels and IT parks. Industrial or agricultural land use is being converted to accommodate construction of vast ‘medicities’ or ‘health cities’ – comprising super-speciality hospitals focused offering cutting edge technology for specific conditions (cardiology, nephrology, endocrinology, joint replacement), medical training facilities and laboratories. But who really benefits from these transformations?

We examine these imagined healthcare places and the political economy of their development. To date our work has focused on India, where a plethora of plans for “medicities” in different states have been announced in the press media since 2007. They aim to provide large-scale “one-stop-shops” of super-speciality medical services supplemented by diagnostics and other aspects of healthcare and lifestyle consumption. Most healthcare in this situation is provided by private healthcare facilities that require private insurance or high out-of-pocket expenditure that leads to debt and impoverishment for many Indian families each year.

Publications

Murray SF., Bisht, R. and E. Pitchforth. (2016) Emplacing India’s “medicities”. Health & Place, 42:69-78

Vouchers and cash transfers


Picture credit: WHO/TDR/Andy Crump

Prospective users of health services in many countries face financial costs for transport and treatment and opportunity costs of receiving care, and such costs are well-documented barriers for the uptake of healthcare services. “Demand-side” financing in the health sector – such as voucher and cash transfers – was introduced to promote health by offsetting some associated financial costs or by increasing household income or providing financial incentives to increase healthy behaviours.

We examine the design and effects of these policy initiatives to determine their role in creating and promoting healthcare markets, and the implications for equity. This includes open access papers on the implementation of vouchers and cash transfers, and reviewing their effects. Together with Jasmine Gideon (Birkbeck), we recently published a critique and framework for gender analysis in the study of vouchers and public-private partnerships more widely (see blog here).

Publications

Hunter BM and SF Murray (2017) Demand-side financing for maternal and newborn health: what do we know about factors that affect implementation of cash transfers and voucher programmes? BMC Pregnancy and Childbirth, 17:262

Gideon J, Hunter BM, and SF Murray (2017) Public-private partnerships in sexual and reproductive healthcare provision: establishing a gender analysis. Journal of International and Contemporary Social Policy, 33(2):166-180

Hunter, BM, Harrison, S, Portela, A, and D Bick (2017) The effects of cash transfers and vouchers on the use and quality of maternity care services: A systematic review. PLoS ONE 12(3): e0173068

Private investment


Picture credit: Toshiyuki IMAI, via Flickr

The healthcare sector presents significant opportunities for private sources of finance. There are well-documented gaps in healthcare system resources and the push towards achieving universal health coverage is in practice characterised by expansion of healthcare infrastructure. The healthcare sector in most settings has historically offered relatively few commercial opportunities for the benefit of formal for-profit organisations, yet significant investment is now being channelled into the rapid growth of corporate healthcare chains, particularly in emerging economy countries. We consider the scale and form of the investments being made, and the implications for health equity.

Publications

Chakravarthi I, Roy B, Mukhopadhyay I, Barria S. 2017. Investing in health: healthcare industry in India. Economic and Political Weekly, 52(45): 50-56

Hunter BM, Murray SF. 2015. “Beyond aid” investments in private healthcare in developing countries. BMJ (Commentary) 351: h3012

Brokerage


Picture credit: Benjamin Hunter

People face difficult decisions when they try to access healthcare, yet they often lack reliable information with which to make those decisions. Many people instead rely on their previous experiences, advice from friends and family, and direction from doctors. These situations provide profitable opportunities for intermediaries – often described as ‘brokers’ – to guide how people use healthcare.

We examine how brokers emerge in the healthcare sector and the roles they occupy for mediating access to healthcare. Our work considers the personal strategies used to consolidate and extend brokerage roles, and the implications for how people seek healthcare. A template for our approach is set out in a recent paper on healthcare brokerage in urban slum communities in Uttar Pradesh, India.

Publications

Hunter, BM. (2018) Brokerage in commercialised healthcare systems: A conceptual framework and empirical evidence from Uttar Pradesh. Social Science & Medicine, 202:128-135

The global healthcare economy


Picture credit: Christian Junker, via Flickr

Hospitals and insurers are important sites of production for domestic economies. They are large employers and their commercial activities provide significant tax revenue. The potential for lucrative revenue generation has led some countries to actively promote global trade in healthcare services as an economic strategy.

This research analyses the global healthcare economy and its constituent markets. We consider the role of social change in shaping the interaction between economic development and healthcare, in particular the role of communication, mobility, and cross-cultural interactions in the enactment of global healthcare markets.

Publications

Murray SF. 2016. “Commercialization in maternity care: uncovering trends in the contemporary health economy” In J. Gideon (ed.) Handbook on Gender and Health. Cheltenham: Edward Elgar Publishing

Murray SF, Bisht R, Baru, R, Pitchforth E. 2012. Understanding health systems, health economies and globalization: the need for social science perspectives. Globalization and Health, 8:30