Answer

Recognizing healthcare as an essential fundamental right for every citizen is must for welfare of the society. The Indian Constitution, through Directive Principles (Article 47), underscores the State’s responsibility in ensuring the health of its population. Recently, the Supreme Court reaffirmed this, emphasising universal healthcare access in light of the ongoing COVID-19 pandemic, highlighting the need for stronger public health systems.

Adverse Impact of Marketisation of the Public Healthcare System

• High Costs (Out of Pocket Expenditure): A market-driven healthcare system raises treatment costs, making healthcare unaffordable and inaccessible to economically weaker sections, undermining the principle of equitable healthcare.
• Inequality in Access: Market-driven healthcare often results in advanced medical facilities being concentrated in urban areas, leaving rural regions underdeveloped and lacking essential healthcare services.
  For example: More than 80 percent of doctors, 75 percent of dispensaries, 60 percent of hospitals are concentrated in urban India as per Bharat Health Index (BHI) 2023.
• Resource Allocation: Marketisation leads to the uneven distribution of healthcare resources, concentrating advanced facilities in profitable urban sectors, while rural regions face a shortage of basic medical infrastructure.
• Regulatory Challenges: Weak regulations in private healthcare can lead to overcharging and breaches in care quality, putting patients at risk of exploitation by providers focused on profit.

Role Played by State in Enhancing Public Healthcare

• Primary Healthcare Reinforcement: Strengthening infrastructure and resources in Primary Healthcare Centers (PHCs) is essential to ensuring accessible and equitable healthcare, especially in rural areas, following the Bhore Committee’s
• Leveraging Public-Private Partnerships: Collaborating with private entities helps improve healthcare efficiency and access, particularly for specialised treatments in underprivileged areas, enhancing the reach of public health services.
  For example: The Rajiv Aarogyasri Scheme in Andhra Pradesh expanded access to specialised healthcare for economically weaker sections.
• Integrating Telemedicine Services: Telemedicine bridges the healthcare gap between urban and rural areas by facilitating remote consultations and enhancing access to medical expertise.
  For example: The National Telemedicine Taskforce has played a key role in expanding telemedicine services across rural India.
• Ongoing Training for Healthcare Workers: Regularly updating healthcare workers’ skills ensures quality healthcare delivery that meets evolving medical standards.
  For example: The National Rural Health Mission regularly organises training programs for rural health workers.
• Empowering Community Health Workers: Strengthening community health workers like ASHAs is pivotal for primary healthcare delivery and health education at the grassroots level.
  For example: ASHAs were instrumental in raising COVID-19 awareness and conducting screenings in rural communities.
• Enhanced Public Health Financing: Increasing government healthcare spending to 5% of GDP as per the National Health Policy 2017 ensures affordable, robust healthcare services, preparing the system for future public health challenges.

Measures to Contain the Adverse Impact of Marketisation

• Implementing Treatment Cost Caps: Setting maximum price limits for essential healthcare services ensures that treatment remains affordable and prevents exploitation by private providers.
  For example: India can implement cost caps on treatments like cardiovascular surgeries to prevent overcharging by private hospitals.
• Availability of Subsidised Medications: Ensuring the availability of affordable medicines through government initiatives like Jan Aushadhi stores can make essential drugs accessible to lower-income groups.
  For example: Ensuring widespread availability of affordable medications in Jan Aushadhi stores helps reduce out-of-pocket expenditure on healthcare.
• Quality Assurance in Private Healthcare: Enforcing stringent quality standards and conducting regular audits in private healthcare facilities would ensure that treatments meet ethical and national standards.
  For example: Periodic audits of private hospitals in metro cities would ensure adherence to ethical practices and prevent over-commercialization.
• Conducting Extensive Health Literacy Campaigns: Raising public awareness about government-supported healthcare programs and services can help reduce dependency on expensive private care.
  For example: Health literacy campaigns focusing on the benefits of Ayushman Bharat could reduce reliance on private healthcare services.
• Generic Drug Supply: Increasing the availability of generic drug for various disease may lessen the impact of marketization in public health sector, as it will cater to majority of population within a limited price range.

Going ahead, the State must ensure that its interventions in the healthcare sector align with Sustainable Development Goal (SDG) 3—ensuring healthy lives and promoting well-being for all at all ages. This includes universal health coverage, reducing inequalities (SDG 10), and building resilient healthcare infrastructure (SDG 9).

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