Arvind Panagariya’s recent column in the Economic Times, “The crisis in rural health care,” captures the horrible state of health services facing India’s poor.  His diagnosis is impeccable, and echoes the problems about health services in general made in this blog.  Two of his prescriptions--health vouchers for poor people so they can choose between public and private providers, and training of paramedics to treat routine illnesses--are also spot on, and follow from his analysis.  However, he then goes on to advocate training many more qualified doctors (“to replace unqualified ‘doctors’).  But Arvind himself cites the statistic that these qualified public doctors are absent from rural health clinics 40 percent of the time.  Worse, there is some evidence that, in poor neighborhoods in Delhi, qualified public-sector doctors give worse service than unqualified private sector doctors.  The reason of course is the different incentives facing public and private sector doctors.  Unless there are changes in the incentives for public sector doctors to show up to work, and provide courteous and appropriate service to their patients, especially poor patients, it is not clear that training more doctors will significantly improve the quality of health services for India’s poor.