Rising Private Sector and Falling ‘Good Health at Low Cost’: Health Challenges in China,Sri Lanka,and Indian State of Kerala

Despite having a captivating history of outstanding health achievements during the second half of the 20th century, China, Sri Lanka, and the Indian state of Kerala face several health challenges, particularly in the context of a shift in financing health care from a predominantly public-sector to a market-oriented provision. Over the 1990s, these “good health at low cost” (GHLC) regions faced widening health inequities and adverse health outcomes in relation to social, economic, and geographical marginalization, compared to another GHLC country, Costa Rica, and to Cuba, which have a similar history of health and economic profile. While the historical process of health development in China, Sri Lanka, and Kerala is closely entangled with the interrelated policies on health and allied social sectors with an abiding public-sector support, the retreat of the state and resultant increase in private-sector medical care and out-of-pocket spending resulted in widening inequities and medical impoverishment. Investigating the public health challenges and associated medical care-induced impoverishment, this article argues that the fundamental root causes of health challenges in these regions are often neglected in policy and in practice and that policymakers, planners, and researchers should make it a priority to address health inequities.