Devadasan and colleagues in this issue highlight a number of important issues concerning the future of India’s health care system. At one level, the paper brings to the fore the important issues of providing adequate risk protection in health, the increasing need to focus on quality of health care, and to take patient and community perspectives into consideration. The paper also reveals the inter-connected but unpredictable relationships between health financing strategies and the supply and demand of health care.
The authors employ a study design that involves assessing patient satisfaction after a hospitalization for insured and uninsured patients, which limits the certainty of conclusions about the potential causal relationships between the use of community health insurance (CHI), patient satisfaction, and other aspects of quality of care. Providing protection from the financial risks of ill health is a growing priority to both reduce poverty and improve access to health care for Indians. CHI is clearly not a panacea for all the health financing and delivery challenges in India. Although Devadasan and colleagues did not find a significant association between CHI enrollment and patient satisfaction in their study, this does not mean that CHI is not worth pursuing. Rather, it raises the need to pay closer attention to how strategies are actually implemented, and to consider multiple perspectives and consequences when re-design programmes.