Q. 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.

Model Answer:

Article 47 mandates the State to improve public health. Unregulated healthcare marketisation necessitates robust State intervention to ensure equitable, affordable access for vulnerable populations.

Adverse Impacts of Healthcare Marketisation

1. High OOPE: Out-of-pocket expenditure remains at ~47% (NHA 2019-20), pushing millions into healthcare-induced poverty.
2. Urban Bias: Private healthcare infrastructure heavily concentrates in lucrative urban hubs, widening rural disparities.
3. Profit over Patient: Over-medicalisation leads to unnecessary diagnostics and exploitative surgeries (e.g., unjustified C-sections).
4. Neglect of Preventive Care: Markets prioritize profitable curative treatments over foundational preventive and promotive medicine.
5. Exclusionary Pricing: Exorbitant costs deny essential tertiary and specialized care to marginalized socio-economic groups.

Measures to Enhance Grassroots Public Healthcare Reach

1. Funding Escalation: Urgently increase public health spending to 2.5% of GDP (National Health Policy 2017 target).
2. Infrastructure Upgradation: Expand and fully equip Ayushman Arogya Mandirs (HWCs) with comprehensive medicines and diagnostics.
3. Decentralized Delivery: Scale successful community-level primary care models nationwide (Delhi’s Mohalla Clinics, Kerala’s Aardram Mission).
4. Digital Penetration: Expand eSanjeevani telemedicine to bridge the rural specialist deficit (Ayushman Bharat Digital Mission).
5. Human Resource Incentives: Mandate and financially incentivize rural postings for doctors; continuously upskill ASHA/ANM workers.
6. Regulated PPPs: Deploy public-private partnerships strictly for backend diagnostics, maintaining free patient access at PHCs.
7. Pricing Regulation: Strictly enforce the Clinical Establishments Act to cap essential treatment and diagnostic costs.
8. Empowering PRIs: Vest Panchayati Raj Institutions with funds and authority to audit and monitor local Primary Health Centres.

Strengthening grassroots public healthcare ensures a structural shift from “sick-care” to comprehensive “wellness,” securing Universal Health Coverage and sustaining India’s demographic dividend.