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for the provision of public good at national, regional and international levels (UNIDo 2008).
Governance therefore entails effective delivery of public goods and services to the vulnerable
sections of society.

9.16 Despite the importance of the delivery of public goods, governments may suffer from the
“horizon problem” in democracies, where the time horizon over which the benefits of public
goods reach the electorate may be longer than the electoral cycles. The myopia that this creates
may, therefore, lead to under-provisioning of public goods by governments. Research in political
economy, for instance, shows that democratic rulers are often short-sighted due to the constant
political challenge presented through electoral cycles. As a result, many democratically elected
governments can focus only on short-term gains rather than commit to long-term projects (Keefer
2007 and Keefer and Vlaicu 2007). Therefore, the provision of public goods that generate long-
term gains to the economy and the society represents a key aspect of governance in a democratic
polity.

Box 2: The impact of health insurance coverage on
health outcomes in other countries

Healthcare represents one such critical public good. Countries are increasingly adopting the policy
of universal healthcare to reduce inequalities in healthcare provision which is strongly related to
inequality of income (Amado 2020). Hoffman and Paradise (2008) find that in the United States,
there exist strong interconnections between health insurance coverage, poverty and health. Analysing
the impact of Medicaid and SCHIP , they suggests that health insurance coverage provided by the
1
2
government is vital in providing for better health care and health outcomes. Moreover, the extensive
literature citing the ill effects of being uninsured in the US makes the case for the public provision of
health care insurance.
Ayanian et al. (2000) posits that the likelihood of receiving basic preventive services such as breast
cancer screening (64 per cent versus 89 per cent) and hypertension screening (80 per cent versus 94
per cent) was much lower for the uninsured working adults. Similarly, 40 per cent of the uninsured
adults did not undergo a routine checkup in the last two years as compared to 185 of insured adults.
Further studies illustrates that individuals who lack insurance coverage not only suffers on account
of lack of access to care but also bear the burden in terms of worse health outcomes (Hoffman and
Pradise 2008. Szilagyi et al, (2006) postulates that children from the low-income group suffering
from asthma who were newly enrolled in SCHIP, underwent less number of asthma attacks, reduced
rate of hospitalization and less number of visits to the emergency department in the year following
the enrollment as compared to the year before enrollment.
Furthermore, access to government healthcare initiatives such as Medicaid and CHIP has resulted into
3
remarkable benefits for children and their families for example, receiving essential health services,
long term benefits of better health status, greater academic development and higher future earnings .
4

1 Medicaid (1965): a public health insurance programme in the US providing health care coverage to low-income
families or individuals.
2 The State Children's Health Insurance Program (SCHIP) (1997) is a US government scheme providing insurance
coverage for children whose families earn too much to qualify for Medicaid, but cannot afford private coverage.
3 Children’s Health Insurance Program, formerly known as The State Children's Health Insurance Program (SCHIP)
4 Center on Budget and Policy Priorities, “Medicaid Works for Children.”