The role of the health system

Health systems are developed and invested in with the express goal of ensuring a basic minimum of health care for all. This chapter points out that health systems are emergent from the sociopolitical and cultural power distribution in a given society and thus reflect these in its structure, design and functioning. As the Health System Knowledge Network (of the Commission on Social Determinants of Health) pointed out, health systems can contribute to the reduction of health inequities or indeed to their sustenance or even worsen. It is also pointed out that apart from the material effects of the health system, any such system also sends out messages to the users (and indeed those who cannot use it) regarding the way they are seen by those in power. The health system, by the way it functions, can support or challenge the larger sociopolitical arrangements. Given this perspective and the evidence of inequity presented in the previous four chapters it is clear that the health system in India is not playing the role it is expected to. It is from this perspective that the chapter reviews and engages with the literature on out-of-pocket expenditure, and health systems utilisation, structure, design and financing. The chapter identifies a few mechanisms from the literature reviewed and recommends the need for a multi-level framework to adequately understand the role played by health systems in health inequity.