Introduction: A system perspective

To western readers, analyzing a new healthcare system in the East might seem daunting. Indeed, it takes some of us decades to master an understanding of the healthcare system of our country of origin. Nevertheless, there are several methods for approaching an analysis of another country's healthcare system. These include exposition of some (hopefully) invariant principles regarding healthcare that apply across contexts, analysis of what a system of health might look like, comparison with the US system (with which many are already familiar), comparison with other emerging systems such as that of China, application of existing frameworks for healthcare system analysis, appraisal of the major transitions underway in the country's demographic, socioeconomic, political, and epidemiologic profile, and an analysis of the country's public health issues. The chapter analyzes India's healthcare system using each of these methods.

Some invariant principles of healthcare systems

The iron triangle

One way to analyze a healthcare system is in terms of a set of principles that are (or at least seem to be) invariant across cultural contexts. One such principle is the “iron triangle” depicted in Figure 1.1. The logic of this triangle is that there are inevitable societal trade-offs in pursuing any of the goals (vertices) in the triangle. If the triangle is an equilateral triangle, and thus each angle is 60°, policy initiatives that expand one angle beyond 60° force one or both of the other two angles to contract below 60°.