UPSC Mains 2024 GS2 Q17: model answer

India's private sector now provides most outpatient and much inpatient care. Without a strong public system, health becomes a commodity that the poor cannot afford.

Adverse impact of marketisation

• High out-of-pocket spending: though falling, it was still about 39% of total health spending in 2021-22 (National Health Accounts).
• Medical expenses push millions into poverty each year.
• Urban concentration of hospitals; rural shortage of specialists.
• Over-treatment and unregulated prices.

Measures to expand grassroots public healthcare

• Raise spending: government health spending is under 2% of GDP; National Health Policy 2017 targets 2.5%.
• Primary care: strengthen Ayushman Arogya Mandirs (health and wellness centres) with staff, medicines and diagnostics; tele-consultation through eSanjeevani.
• Human resources: fill vacancies at PHCs and CHCs, rural service incentives, community health officers, empower ASHAs with better pay.
• Free medicines and tests: Jan Aushadhi, Free Drugs and Diagnostics initiatives; Tamil Nadu's medical procurement model.
• Insurance with regulation: PM-JAY covers hospitalisation; extend to outpatient care, and audit claims.
• Regulate private care: enforce the Clinical Establishments Act, cap prices of essential drugs and stents.
• Public health cadre: separate cadre for preventive care, as Tamil Nadu has.
• Community participation: Rogi Kalyan Samitis, village health committees, social audits.
• Digital health: ABHA health IDs for continuity of care.

Kerala and Tamil Nadu show that strong public primary care lowers costs and improves outcomes. Health must remain a public good, with the market as a complement, not a master.