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.
Approach · directive: “suggest”
What it asks · Justify the State's role in countering the ill-effects of market-driven healthcare, then suggest concrete measures to extend public healthcare to the grassroots.
The question has 2 parts — answer each
- Establish the State's role: the adverse impacts of marketised healthcare that justify state intervention
- Suggest measures to enhance the reach of public healthcare at the grassroots level — specific and actionable
Open with · With high out-of-pocket spending and a largely private delivery system, market-driven healthcare in India tends to exclude the poor and neglect prevention.
Cover
- Adverse impacts: catastrophic out-of-pocket costs, urban concentration of hospitals, over-treatment, weak regulation of private providers.
- Data: NHA estimates 2021-22 — out-of-pocket spending 39.4% of total health expenditure (64.2% in 2013-14); government share 48%.
- Principle: health is a public good; the National Health Policy 2017 targeted public health spending of 2.5% of GDP.
- Primary care: strengthen Ayushman Arogya Mandirs with comprehensive primary care, free medicines and diagnostics.
- People: ASHAs, community health officers and mid-level providers; rural service incentives; fill vacancies in PHCs and CHCs.
- Financing and regulation: PM-JAY for hospital care; Clinical Establishments Act; price controls on essential drugs and devices; Jan Aushadhi stores.
- Technology: eSanjeevani telemedicine and the Ayushman Bharat Digital Mission; PM-ABHIM for public health infrastructure.
- Community voice: Rogi Kalyan Samitis, village health and sanitation committees, social audits.
Close with · The State need not replace markets, but it must anchor the system — strong public primary care and firm regulation keep healthcare a right, not a commodity.
Add value (verified)
- Union Health Ministry (NHA estimates 2021-22, released September 2024): out-of-pocket spending fell to 39.4% of total health expenditure from 64.2% in 2013-14. Union Health Ministry releases National Health Accounts Estimates for India 2020-21 and 2021-22 — PIB, 25 September 2024 ↗“the decline in Out-of-Pocket expenditure out of Total Health Expenditure from 64.2% in 2013-14 to 39.4% in 2021-22 reflects a very positive indicator”
- Same release: the government's share of total health expenditure rose from 29% (2014-15) to 48% (2021-22) — the State is already the anchor of the system. Union Health Ministry releases National Health Accounts Estimates for India 2020-21 and 2021-22 — PIB, 25 September 2024 ↗“Share of Government Health Expenditure in Total Health Expenditure increases from 29.0% (2014-15) to 48.0% (2021-22)”
Question: UPSC's CS (Main) 2024, GS Paper II — paper ↗. Approach: Minimalist IAS, checked 30 Sept 2026 (how we verify) — UPSC publishes no model answers. ·
Model answer · 348 words (UPSC limit 250) · Minimalist IAS
Healthcare in India is delivered largely by private providers and paid for largely out of pocket: NHA estimates show that out-of-pocket spending was still 39.4% of total health expenditure in 2021-22, even after a steep fall. Markets deliver care to those who can pay, not to those who need it most.
Why the State must contain marketisation
- Catastrophic costs: out-of-pocket payments push households into debt and poverty, and the poor forgo or delay treatment.
- Skewed supply: hospitals and specialists cluster in cities, leaving rural and tribal areas underserved.
- Perverse incentives: over-treatment, unnecessary diagnostics and induced demand, with weak regulation of quality and pricing.
- Public goods neglected: prevention, sanitation, immunisation and disease surveillance yield no private profit yet decide population health.
- Constitutional duty: Article 47 makes public health a primary duty of the State; the National Health Policy 2017 set a target of 2.5% of GDP for public health spending.
Measures to reach the grassroots
- Primary care first: make Ayushman Arogya Mandirs deliver comprehensive primary care — screening for chronic disease, free essential medicines and diagnostics — with assured referral links.
- People: fill vacancies in PHCs and CHCs, expand community health officers and mid-level providers, incentivise rural service through bonds and career paths, and strengthen ASHAs with fair pay and training.
- Financing: move public health spending towards the 2.5% target with a larger share for primary care; use PM-JAY for hospital care while empanelling and monitoring public hospitals.
- Regulation: implement the Clinical Establishments Act in every state, standard treatment guidelines, price control of essential medicines and devices, and Jan Aushadhi stores for generics.
- Infrastructure and surveillance: PM-ABHIM for block public health units and district laboratories; integrated disease surveillance.
- Technology: eSanjeevani tele-consultation linking sub-centres to specialists; the Ayushman Bharat Digital Mission for portable records.
- Community voice: village health, sanitation and nutrition committees, Rogi Kalyan Samitis and social audits to keep facilities answerable.
The State need not replace the market, but it must anchor the system: strong public primary care, adequate funding and firm regulation keep healthcare a right at the grassroots rather than a commodity for those who can pay.
Written by Minimalist IAS from facts checked at source (how we verify) — a little fuller than exam length, so every part of the question is covered; in the hall, keep the structure and trim the detail. UPSC publishes no model answers: compare your structure and coverage with this, then write your own.