In a crucial domain like the public healthcare system the Indian State should play a vital role to contain…

Question

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.

Ghissu Editorial · Accepted Answer

The State must act as provider, payer and regulator to protect citizens from the high costs and distorted priorities of marketised healthcare, chiefly by strengthening a free, community-owned primary tier. Out-of-pocket spending was still 39.4% of total health expenditure in 2021-22.

**Introduction**

The Supreme Court in Paschim Banga Khet Mazdoor Samity (1996) read timely medical care into Article 21, yet public health spending was only about 1.84% of GDP in 2021-22, against the NHP 2017 target of 2.5%. An active State must contain marketisation.

**Adverse Impact of Marketisation and the State's Role**

1. **Catastrophic costs**: Out-of-pocket spending was still 39.4% of total health expenditure in 2021-22 (National Health Accounts), pushing families into debt.
2. **Supplier-induced demand**: Unnecessary hysterectomies under RSBY in Bihar and Chhattisgarh showed profit overriding clinical need.
3. **Price regulation works**: The NPPA's 2017 stent price ceiling and Rajasthan's Right to Health Act 2023 show the State can discipline markets.

**Measures to Deepen Grassroots Public Healthcare**

SKETCH: pyramid | Strengthening Care from the Base
- Medical colleges
- District hospitals
- CHCs and PHCs
- Ayushman Arogya Mandirs
- ASHAs and households

1. **Ayushman Arogya Mandirs**: Over 1.75 lakh centres, each with a Community Health Officer, should screen for diabetes, hypertension and cancers near home.
2. **Empower ASHAs**: Fixed honoraria, social security and a career path would keep these frontline workers motivated.
3. **Free medicines**: Pooled procurement on the Tamil Nadu Medical Services Corporation model cuts the largest out-of-pocket cost.
4. **Doorstep and digital care**: Makkalai Thedi Maruthuvam and e-Sanjeevani's 43 crore teleconsultations reach remote homes.

**Way Forward**

1. **Fund primary care**: Spend 2.5% of GDP, about 70% on primary care, as the Srinath Reddy HLEG (2011) advised, routed through panchayats.
2. **Regulate private care**: Make every State notify the Clinical Establishments Act 2010 with displayed rates.

**Conclusion**

The State must set the floor of access, price and quality. A community-owned primary tier is the surest route to universal health coverage and SDG 3.

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.

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