The ubiquity of underuse and overuse of healthcare resources and gravity of resulting harms in India necessitate an investigation of drivers to inform potential solutions. This article describes the network of influences that contribute to poor care and suggests that it is driven by factors that fall into three domains: money and finance; knowledge, bias, and uncertainty; and power and human relationships.
The provision of care is initiated by decision making within the doctor–patient relationship but is substantially influenced by the resources available for health care within the society, its social and political contract, the state of scientific knowledge, the configuration and capacity of the delivery system, and financing mechanisms. The biological, psychological, and social needs of patients and informed preferences must define desirable outcomes and appropriateness of care.…
