Practices, regulation and accountability in the evolving private healthcare sector: lessons from Maharashtra State, India

这项研究是关于私营部门医院护理和相关诊断服务的扩展和变化的面貌，通过一个有组织的，越来越跨国的医疗保健行业。它回应了最近发表在《柳叶刀》上的一篇论文所表达的关注，即卫生服务内部的激励结构可能会如何扭曲，以满足该行业的经济利益，以及监管俘获和剥夺社区和公民权力的风险。该研究小组由来自伦敦国王学院的社会科学家和来自印度的公共卫生研究人员和健康权利活动家组成。为了探讨这个问题，我们将对印度马哈拉施特拉邦的医疗保健行业进行详细的案例研究，该地区有许多不断扩大的医疗保健中心。我们的目标是首先研究这些新兴形式的医疗保健服务及其业务和管理实践对医疗保健部门、医疗从业者和医疗保健用户的影响。由于没有中央登记册，我们会整理各种登记册和商业媒体报道的资料，绘制设施地图；我们将采访广泛的医疗从业者、管理人员、设施所有者、监管机构、政策制定者、患者组织和健康权利倡导者；我们将举办一个“见证者研讨会”，探讨国家医疗保健公司化的当代历史。第二，我们将审议过去在管理国家私营医疗部门方面的尝试的性质、成功和失败。为此，我们将举行利益攸关方磋商和证人研讨会，探讨最近的法规、实施中的障碍和扭曲。该项目的最后阶段将是制定和倡导“社会监管”机制，例如从基于权利的角度让患者和公民参与监督规章制度的执行，并为其他低收入和中等收入国家吸取经验教训。

This research is about the expansion and changing face of private sector hospital care and related diagnostic services through an organised, and increasingly transnational, healthcare industry. It responds to concerns, expressed in a recent paper in the Lancet, about how incentive structures within health services may become distorted to meet the economic interests of this industry, and about the risks of regulatory capture and disempowerment of communities and citizens. The research team is composed of social scientists from King's College London and public health researchers and health rights activists from India. To explore this issue, we will construct a detailed case study of the sector in Maharashtra State, India which has many expanding healthcare hubs. Our objectives are first to examine the implications of these emerging forms of healthcare delivery and their business and management practices for the healthcare sector, for medical practitioners and for healthcare users. As there is no central register, we will conduct a mapping of facilities by collating information from various registers and business media reports; we will interview a wide range of medical practitioners, managers, facility owners, regulators, policy makers, patient organisations and health rights advocates; and we will conduct a 'witness seminar' to explore the contemporary history of corporatisation of healthcare in the State. Second, we will consider the nature, successes and failures of past attempts at regulation of the private medical sector in the State. For this we will hold a stakeholder consultation and a witness seminar exploring recent regulations, and obstacles and distortions in implementation. The final stages of the project will be to develop and advocate for mechanisms of 'social regulation', such as patient and citizen involvement in monitoring of enforcement of rules and regulations from a rights-based perspective, and to draw lessons for other low and middle income countries.