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.
It asks 2 things — 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 · Out-of-pocket spending was still 43.4% of total health expenditure in 2022-23 (National Health Accounts), while Article 47 makes improving public health a primary duty of the State.
Cover
- Adverse impacts: catastrophic out-of-pocket costs, urban concentration of hospitals, over-treatment, weak regulation of private providers.
- Data: out-of-pocket spending 43.4% (2022-23; 39.4% in 2021-22, 64.2% in 2013-14); government share 43.7%, up from 28.6%.
- Primary care: over 1.86 lakh Ayushman Arogya Mandirs functional by August 2026; add free medicines, diagnostics and referral (flowchart).
- Local bodies: the 15th Finance Commission's ₹70,051 crore health grants (2021-26) for rural and urban local bodies.
- People and financing: fill PHC/CHC vacancies, support ASHAs; NHP 2017 target of 2.5% of GDP; PM-JAY for hospital care.
- Regulation and technology: Clinical Establishments Act, drug price control, Jan Aushadhi; eSanjeevani and ABDM.
- State model and community voice: Tamil Nadu's Makkalai Thedi Maruthuvam; Rogi Kalyan Samitis, village health committees, social audits.
Close with · Meeting the National Health Policy 2017 goal of 2.5% of GDP, primary care first, would honour Article 47 and keep healthcare a right, not a commodity.
Add value (verified)
- National Health Accounts 2022-23 (NHSRC report, 2026): out-of-pocket spending was 43.4% of total health expenditure in 2022-23, up from 39.4% in 2021-22 but far below 64.2% in 2013-14.National Health Accounts Estimates for India 2022-23 (NHSRC, Ministry of Health and Family Welfare), Table 3 ↗“Out-of-Pocket Expenditures (OOPE) as a percent of THE 64.2 62.6 60.6 58.7 48.8 48.2 47.1 44.4 39.4 43.4”
- Same report: the government's share of total health expenditure rose from 28.6% (2013-14) to 43.7% (2022-23), after a peak of 48.0% in 2021-22; the State is already the anchor of the system.National Health Accounts Estimates for India 2022-23 (NHSRC, Ministry of Health and Family Welfare), Table 3 ↗“Government Health Expenditure (GHE) as a percent of THE 28.6 29 30.6 32.4 40.8 40.6 41.4 42.8 48.0 43.7”
- Article 47: improving public health is among the State's primary duties.Constitution of India (as on 2024) - Legislative Department ↗“The State shall regard the raising of the level of nutrition and the standard of living of its people and the improvement of public health as among its primary duties”
- PIB factsheet: over 1.86 lakh Ayushman Arogya Mandirs were functional by 12 August 2026, offering 12 free services (1,75,338 on 30 November 2024).Affordable and Accessible Healthcare for All (PIB factsheet, August 2026) ↗“Over 1.86 lakh Ayushman Arogya Mandirs (AAMs) are now functional across the country to provide primary healthcare at every neighbourhood (As of 12 August 2026).”
- 15th Finance Commission: health grants of ₹70,051 crore to local governments for 2021-26 (₹43,928 crore rural, ₹26,123 crore urban).Health Sector Grant of Rs.8,453.92 crore released to Local Bodies of 19 States - PIB ↗“The grants recommended by the Commission inter-alia include health grants of Rs.70,051 crore. Out of this amount, Rs.43,928 crore have been recommended for Rural Local Bodies and Rs.26,123 crore for Urban Local Bodies.”
- Tamil Nadu's Makkalai Thedi Maruthuvam neared 2 crore beneficiaries (2024).Dinamalar (newspaper), 2024: Makkal Thedi Maruthavam nears 2 crore beneficiaries ↗“Makkal Thedi Maruthavam nears 2 Crore deneficiaries, says Health Minister at CII Medclave 2024”
Question: UPSC's CS (Main) 2024, GS Paper II — paper ↗. Approach: Minimalist IAS, checked 3 Oct 2026 (how we verify) — UPSC publishes no model answers. ·
Model answer· 354words · Minimalist IAS
Even after a steep fall from 64.2% in 2013-14, out-of-pocket spending was still 43.4% of India's total health expenditure in 2022-23 (National Health Accounts; 39.4% in 2021-22). Yet Article 47 makes the improvement of public health one of the State's primary duties. Markets serve those who can pay; only the State can reach those who cannot.
Why the State must contain marketisation
- Catastrophic costs: out-of-pocket payments push families into debt; the poor delay or skip treatment.
- Skewed supply: hospitals and specialists cluster in cities, leaving rural and tribal areas underserved.
- Perverse incentives: over-treatment and needless tests thrive where private providers are weakly regulated.
- Neglected public goods: prevention, immunisation and surveillance earn no profit, yet decide population health.
- The State already anchors: government's share of health spending rose from 28.6% (2013-14) to 43.7% (2022-23); the task now is to push it to the grassroots.
Measures to enhance grassroots reach
- Primary care first: over 1.86 lakh Ayushman Arogya Mandirs were functional by August 2026 (1,75,338 in November 2024), offering 12 free services; add assured medicines, diagnostics and referral.
- ASHA and Ayushman Arogya Mandir
- PHC
- CHC
- District hospital
- PM-JAY hospital care
- Local-body funds: the 15th Finance Commission gave ₹70,051 crore in health grants (2021-26) to rural and urban local bodies; panchayats and municipalities must spend them on primary care.
- People: fill PHC and CHC vacancies, expand community health officers and pay ASHAs fairly.
- Financing: raise public health spending towards the National Health Policy 2017 target of 2.5% of GDP; use PM-JAY for hospital care.
- Regulation: enforce the Clinical Establishments Act, control prices of essential drugs and devices, and expand Jan Aushadhi generics.
- Technology: eSanjeevani teleconsultation and the Ayushman Bharat Digital Mission for portable records.
- State model: Tamil Nadu's Makkalai Thedi Maruthuvam (healthcare that seeks out people) neared 2 crore beneficiaries in 2024.
- Community voice: village health committees, Rogi Kalyan Samitis and social audits keep facilities answerable.
The State need not replace the market, but it must anchor the system. Reaching the National Health Policy's 2.5% of GDP goal, with primary care first, would honour Article 47 and keep health a right at the grassroots, not a commodity.
Prepared by Minimalist IAS to the answer standard of Shivam Singh (mentor, 7 years) · facts checked against official sources (how we verify) · updated 3 Oct 2026. UPSC publishes no model answers: compare your structure and coverage with this, then write your own.
