UPSC Mains 2015 GS Paper 2 Q12: model answer

Most Indians, even poor ones, first go to a private clinic when they fall ill. Out-of-pocket spending once made up more than 60% of health spending and pushed millions into poverty each year.

Limits of the public system

• Government health spending has stayed under 2% of GDP for decades.
• Shortages of doctors and specialists in rural areas; vacant posts in community health centres.
• Overcrowded district hospitals, weak diagnostics, absenteeism.

Can the private sector help?

• Capacity: most hospitals and beds are private.
• PM-JAY (2018) covers over 50 crore people for hospital care, mostly through private empanelled hospitals; from 2024 it covers everyone above 70.
• PPP models: dialysis under the Pradhan Mantri National Dialysis Programme, diagnostics in public hospitals.
• Innovation: telemedicine, low-cost surgery (Narayana Health, Aravind).

Risks

• Private care concentrates in cities and profitable specialities.
• Over-treatment and inflated bills; frauds in insurance claims.
• Weak regulation; the Clinical Establishments Act, 2010 is not adopted by all States.

Other viable alternatives

• Strengthen primary care: Ayushman Arogya Mandirs (health and wellness centres).
• Raise public spending to 2.5% of GDP (National Health Policy, 2017).
• Community health workers: ASHAs, as in Chhattisgarh's Mitanin model.
• Free medicines and diagnostics, as in Tamil Nadu and Rajasthan.
• Generic drugs through Jan Aushadhi Kendras.
• Insurance for outpatient care, which causes most out-of-pocket spending.

Conclusion

The private sector can fill gaps if it is regulated and paid for outcomes. Universal coverage still rests on a strong, well-funded public system at the base.