Answer

India’s healthcare system faces rising marketisation, increasing inequities in access and affordability. While private sector growth has improved capacity, it has also deepened disparities, making a strong State role essential to ensure equitable and universal healthcare delivery in line with Article 47 of the Indian Constitution.

Adverse Impacts of Healthcare Marketisation

• High Costs: Profit-driven care increases treatment expenses, limiting access for the poor.
  Eg: High out-of-pocket expenditure (~48%, National Health Accounts).
• Urban Bias: Private sector concentration in cities neglects rural healthcare needs.
  Eg: More than 80% of doctors, 75% of dispensaries, and 60% of hospitals are in urban India (BHI 2023).
• Over-treatment: Incentive for unnecessary procedures increases healthcare burden in private hospitals (NITI Aayog observations).
• Inequitable Access: Ability to pay determines quality and speed of treatment.
  Eg: COVID-19 saw disparities in ICU and oxygen access.
• Neglect of Preventive Care: Market focus remains on curative rather than preventive health.
  Eg: Low private investment in vaccination and primary healthcare.

State Role in Mitigating Marketisation

• Regulatory Oversight: Ensure price caps and quality standards to prevent exploitation in private healthcare.
  Eg: Clinical Establishments Act regulates rates and standards across hospitals.
• Public Provisioning: Strengthen government hospitals to provide affordable alternatives to private care.
  Eg: AIIMS expansion and PMSSY improve tertiary public healthcare access.
• Financial Protection: Expand insurance coverage to reduce out-of-pocket expenditure.
  Eg: Ayushman Bharat–PMJAY provides ₹5 lakh coverage to vulnerable families.
• Essential Services: Guarantee free or subsidised essential drugs and diagnostics.
  Eg: Jan Aushadhi stores help reduce out-of-pocket healthcare expenses.
• Enhanced Public Health Financing: Increase government spending to 2.5% of GDP for affordable and robust healthcare.

Measures for Strengthening Grassroots Healthcare Access

• Primary Strengthening: Expand and upgrade Health and Wellness Centres for comprehensive care.
  Eg: Ayushman Bharat targets 1.5 lakh HWCs delivering primary services.
• Human Resources: Increase trained healthcare workers in rural areas.
  Eg: ASHA workers under NHM provide last-mile health services.
• Digital Health: Use telemedicine and digital platforms to bridge access gaps.
  Eg: eSanjeevani teleconsultation platform used widely in rural India.
• Decentralised Planning: Empower local bodies in health planning and monitoring.
  Eg: Kerala’s decentralised health model improved primary care outcomes.
• Infrastructure Push: Invest in sub-centres, PHCs, and district hospitals.
  Eg: PM Ayushman Bharat Health Infrastructure Mission strengthens rural facilities.

Conclusion

A balanced approach combining regulation, public investment, and community-based delivery is essential to achieve SDG 3, while advancing SDG 10 on equity and SDG 9 through resilient, accessible healthcare infrastructure for all.

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