India provides examples of all three organizational forms. The services delivered by government
are hierarchical, with providers who are employed directly. At the other extreme
are direct, market-based, non-contractual interactions between the population and providers.
These include both private providers per se and informal fee charging in public facilities:
80% of total health care spending takes place in this domain. In between are several
forms of contractual arrangement. One type comprises long-term contracts between the
public sector and nongovernmental providers (both non-profit and for-profit). This arrangement
is used predominantly for treating patients suffering from cataract and, by increasing
the number of providers that are financed publicly, has allowed for a large expansion of
surgery to prevent blindness, particularly among the poor. Another contractual arrangement
characterizes private insurance, which may or may not be publicly regulated. The
client has one kind of relation with an insurer, which in turn has a different relation – one
that may or may not be contractual – with providers.