Understanding India, globalisation and health care systems: a mapping of research in the social sciences

Current globalisation is regarded as a new phase of world integration with increased density and frequency of international or global social interactions relative to local or national ones. In these new dynamics, nation states are influenced by transnational processes occurring on multiple economic, political and cultural levels [1]. Much public health literature still assumes a default model of a ‘healthcare system’ bounded by a nation state which to varying degrees takes responsibility for the four essential functions of service provision, resource generation, financing and stewardship [2], but there is increasing awareness that globalisation processes are shaping local health systems in important ways [3]. In this article we set out to map through the lens of India’s healthcare and its relationship to transnational health care systems, the current extent and form of the social science approaches to an understanding of this field.India is an illuminating case for which one would expect to find a considerable body of literature. The country has emerged as one of the so-called ‘Rising Powers’ which represent drivers of global economic and social change. Healthcare is one of India’s largest sectors in terms of revenue and employment, and is expanding rapidly. The private sector accounts for more than 80% of total healthcare spending within India [4]. Since ‘liberalisation’ of economic policies in the late 1980s, India has also become increasingly attractive to foreign investors with its low costs and large, English-speaking, workforce. During the 1990s, Indian healthcare grew at a compound annual rate of 16% and today the total value of the sector is more than $34 billion and projected to grow to nearly $40 billion by 2012. The consultancy group Pricewaterhouse Coopers’ Emerging Market Report on Healthcare in India[5] listed a number of ‘flourishing market opportunities’ for foreign as well as national companies: medical tourism (often combining elective surgery and