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Political competition and public healthcare : evidence from India

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Kailthya, Subham and Kambhampati, Uma (2022) Political competition and public healthcare : evidence from India. World Development Journal, 153 . 105820. doi:10.1016/j.worlddev.2022.105820 ISSN 0305-750X.

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Official URL: https://doi.org/10.1016/j.worlddev.2022.105820

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Abstract

In this paper, we examine the causal effect of political competition on public provision of healthcare. Specifically, we investigate whether the effect of political competition on more visible public goods (e.g. health centre access) differs from its impact on less visible public goods (e.g. health centre capacity such as doctors, medical supplies, etc.). Using granular data from three recent waves of the Indian District Level Household Survey (DLHS) during 2002–2013 and an instrumental variable approach, we find that incumbents respond to electoral competition, measured as the effective number of parties (ENP), by trading-off less visible health centre capacity for more visible access to health centres. We provide suggestive evidence that focusing on more visible health centres boosts the incumbent party’s re-election prospects providing a clear motive for incumbent’s action. In addition, we examine the effect of election-year cycles and the role of political alignment in healthcare provision and find compelling evidence of a political economic mechanism at work. By contrast, political competition has no measurable impact on key health outcomes. We conduct several robustness checks to ensure that our estimates are reliable. Thus, our results suggest that electoral competition must be accompanied by strong checks on accountability to improve health outcomes.

Item Type: Journal Article
Subjects: R Medicine > RA Public aspects of medicine
Divisions: Faculty of Social Sciences > Economics
Library of Congress Subject Headings (LCSH): Medical care -- Political aspects -- India, Medical policy -- Political aspects -- India
Journal or Publication Title: World Development Journal
Publisher: Elsevier
ISSN: 0305-750X
Official Date: May 2022
Dates:
DateEvent
May 2022Published
7 February 2022Available
17 January 2022Accepted
Volume: 153
Article Number: 105820
DOI: 10.1016/j.worlddev.2022.105820
Status: Peer Reviewed
Publication Status: Published
Access rights to Published version: Restricted or Subscription Access
Date of first compliant deposit: 26 January 2022
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