After Reading This Article You Can Solve This UPSC Mains PYQ( 2024)
In a crucial domain like the public healthcare system, the Indian State should play a vital role to contain the adverse impact of marketisation of the system. Suggest some measures through which the State can enhance the reach of public healthcare at the grassroots level.15 marks (GS 2 Health)
Context
The government health expenditure stands at 1.43% of GDP (2022–2023), significantly below the 2.5% target set by the National Health Policy 2017. While visible inputs like medical colleges, the AIIMS network, and the Ayushman Bharat programme have expanded, a recent Parliamentary Standing Committee report highlights a system still struggling with basic capacity, affordability, and regulatory oversight.
Introduction
India’s healthcare expansion has largely been measured through countable inputs—such as institutional seats and insurance cards—rather than actual health outcomes. The core unresolved tension is that the public system is expected to deliver universal care on inadequate financing, forcing a reliance on an under-regulated private sector. This dynamic leaves families financially exposed, underscoring that genuine reform must begin with robust public financing.
Structure of the Public Healthcare System
- Constitutional Mandate: Public health and hospitals are a State subject under the Seventh Schedule, with the Centre functioning primarily through centrally sponsored schemes.
- Tiered Delivery Network: Rural healthcare operates across three tiers: sub-centres, primary health centres (PHCs), and community health centres (CHCs), backed by district and medical college hospitals.
- Shifting Disease Burden: Non-communicable diseases (NCDs) now account for approximately 66% of total deaths, predominantly driven by cardiovascular and chronic respiratory diseases.
- Primary Care Scale: Over 1,85,000 Ayushman Arogya Mandirs (formerly health and wellness centres) are currently operational across the country.
Significance of Recent Healthcare Expansions
1. Infrastructural Growth
The number of medical colleges has increased to 818, raising undergraduate medical seats to 1,28,875 to address the overall doctor-to-population ratio.
2. Financial Protection for the Vulnerable
Ayushman Bharat has functioned as one of the world’s largest publicly funded health insurance programs, helping millions afford essential hospital care.
3. Digital and Remote Access
The Ayushman Bharat Digital Mission ensures portable health records, while the eSanjeevani telemedicine service connects remote primary facilities to urban specialists.
4. Affordable Medicines
The Pradhan Mantri Bhartiya Janaushadhi Pariyojana provides low-cost generic drugs, directly targeting the high medicine-related out-of-pocket expenses for households.
Challenges in the Healthcare Sector
1. Stagnant Public Financing
Health spending is stuck at 1.43% of GDP. Furthermore, only about 40% of public health funds reach primary care, missing the two-thirds target set by the National Health Policy 2017.
2. The “Missing Middle” and High OOP
Over 40 crore Indians fall into the “missing middle”—too wealthy for government schemes but too poor for private insurance. Consequently, Out-of-Pocket (OOP) spending remains high at 43.4% of total health expenditure.
3. Skewed Infrastructure and Staffing
Public capacity is highly urbanized, with 73% of public hospital beds in urban areas. Conversely, rural CHCs face massive specialist shortages of 70 to 80%, and 17,788 sub-centres lack their own buildings.
4. Commercialization and Weak Regulation
With over 60% of hospitalizations managed by the private sector, the lack of national cost-capping mechanisms allows prices to soar. Insurance pays these bills but fails to control the underlying inflation of healthcare costs.
5. Misallocation of Health Cesses
Revenue generated specifically for health often fails to reach its intended destination. The CAG reported a Rs 43,000 crore gap in the transfer of health cess funds to the Pradhan Mantri Swasthya Suraksha Nidhi.
Way Forward
1. Ring-Fence Primary Care Financing
The government must legally ring-fence a rising share of the health budget strictly for primary and preventive care, ensuring compliance with the two-thirds allocation target through annual reporting.
2. Outcome-Linked Central Transfers
Instead of rewarding mere expenditure, central health transfers should be tied to state-level outcome indicators, encouraging actual capacity building (e.g., adapting models like Kerala’s decentralized system).
3. Address Rural Specialist Deficits
Make rural service a mandatory condition for subsidized medical education, linking postings directly to districts that lack specific medical specialties.
4. Automate Health Cess Transfers
Ensure the automatic and transparent transfer of collected health cesses to dedicated funds, mandating the disclosure of closing balances in annual budget documents.
5. Enforce Strict Private Sector Regulation
States must strictly enforce the Clinical Establishments (Registration and Regulation) Act, 2010 to implement published standard treatment guidelines and establish rational rate ranges for high-cost private procedures.
Conclusion
True healthcare reform relies on robust public financing rather than merely counting institutional inputs. Achieving universal healthcare requires shifting focus from passive insurance coverage to an adequately funded, strictly regulated, and equitably distributed public health infrastructure.
| Important Current to Concept (CTC) from this Article for UPSC : Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) |