Abstract

A comprehensive picture of provider coalitions in health policymaking remains incomplete due to the lack of empirically driven insights from low- and middle-income countries. We examine the politics of provider coalitions in the health sector in Karnataka, India, by investigating policy processes during 2016–2018 to develop amendments to the Karnataka Private Medical Establishments Act. Through this case, we explore how provider associations function, coalesce, and compete, and the implications of their actions on policy outcomes. We conducted in-depth interviews, document analysis, and non-participant observations of two conferences organized by associations. We find that provider associations played a major role in drafting the amendments and negotiated competing interests within and between doctors’ and hospital associations. Despite the fragmentation, the associations came together to reinterpret the intentions of the amendments as being against the interests of the profession, culminating in a statewide protest and strike. Despite this show of strength, provider associations only secured modest modifications. This case demonstrates the complex and unpredictable influence of provider associations in health policy processes in India. Our analysis highlights the importance of further empirical study of the influence of professional and trade associations across a range of health policy cases in low- and middle-income countries.

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