Q.17. In a crucial domain like the public healthcare system the Indian State should play a vital role to contain the adverse impact of marketization of the system. Suggest some measures through which the State can enhance the reach of public healthcare at the grassroots level. [UPSC 2024 GS P-2]

The Indian public healthcare system plays a critical role in ensuring equitable access to healthcare services, especially for marginalized and rural populations. However the marketization of the public healthcare system can have several adverse impacts, particularly in a country like India, where equitable access to healthcare is crucial. Here are the key adverse impacts:

  1. Increased Healthcare Costs: Market-driven healthcare systems often prioritize profit, leading to inflated costs for medical treatments, diagnostics, and medicines, making healthcare unaffordable for low-income populations.
  2. Inequality in Access: Marketization can lead to a concentration of healthcare services in urban and affluent areas, while rural and marginalized populations are left with limited or no access to quality healthcare.
  3. Neglect of Public Health Goals: Private healthcare providers may focus on profitable treatments rather than preventive healthcare, public health goals, or diseases that disproportionately affect the poor, like infectious diseases or malnutrition.
  4. Over-commercialization and Exploitation: Patients may be subjected to unnecessary tests, treatments, and procedures, driven by profit motives, leading to over-medicalization and exploitation.
  5. Reduced Accountability and Regulation: Private providers may lack sufficient regulatory oversight, which can result in compromised quality of care, unethical practices, and uneven adherence to standards.
  6. Weakened Public Healthcare Infrastructure: The focus on private healthcare services can undermine investment in and support for public healthcare systems, leading to a deterioration in the quality and availability of government-provided healthcare.
  7. Healthcare Becomes a Commodity: Marketization turns healthcare into a commodity where the ability to pay dictates access to services, leading to a scenario where the poor may be excluded from receiving adequate care.
  8. Neglect of Primary and Preventive Care: Private providers are more likely to invest in specialized and tertiary care, which yields higher profits, leaving primary and preventive care underdeveloped.
  9. Brain Drain of Healthcare Professionals: Skilled healthcare workers may prefer higher-paying private sector jobs, leading to a shortage of trained professionals in the public healthcare system, especially in rural areas.
  10. Fragmentation of Services: The market-driven approach can lead to a lack of coordination and integration between different healthcare providers, resulting in fragmented services that are difficult for patients to navigate.

 

To counter this and ensure healthcare reaches the grassroots, the Indian state can take several proactive measures:

1. Strengthening Primary Healthcare Infrastructure

  • Expand and Upgrade Health and Wellness Centers (HWCs): Building and upgrading more primary healthcare centers (PHCs) and community health centers (CHCs) across rural and underserved areas is essential. This ensures basic healthcare services are easily accessible at the grassroots level.
  • Improve Diagnostic Facilities: Ensure that PHCs are equipped with modern diagnostic tools and trained staff to handle preventive, curative, and emergency healthcare services.

2. Increase Public Health Expenditure

  • Higher Allocation in Health Budgets: India’s public health expenditure is relatively low as a percentage of GDP. Increasing public investment in healthcare infrastructure, human resources, and essential services can help bridge the gap between the public and private sectors.
  • Funding State-specific Health Programs: States should be provided with more financial autonomy and resources to tailor health programs specific to their unique demographic needs.

3. Universal Health Coverage (UHC) and Insurance Schemes

  • Expand Coverage of Schemes like Ayushman Bharat: Government initiatives like Ayushman Bharat—Pradhan Mantri Jan Arogya Yojana (PMJAY) should be expanded to cover a broader population and ensure access to free or subsidized healthcare, particularly for rural and low-income families.
  • Awareness Campaigns: Many beneficiaries are unaware of the benefits available under government schemes. Comprehensive awareness campaigns can educate citizens about the healthcare benefits they can avail themselves of, reducing dependency on private providers.

4. Public-Private Partnerships (PPP)

  • Leverage Private Sector Expertise: The government can collaborate with private healthcare providers to deliver healthcare services in rural areas through public-private partnerships. This can enhance service delivery while ensuring affordability and accessibility.
  • Regulation of Private Sector: Regulating the private healthcare sector to ensure standardization of costs, quality, and ethical practices will prevent exploitation and market-driven inflation of healthcare costs.

5. Capacity Building and Human Resources

  • Recruit More Healthcare Workers: India faces a shortage of healthcare professionals, particularly in rural areas. Increasing recruitment and incentivizing doctors, nurses, and paramedics to serve in rural and underserved regions is vital.
  • Training and Upskilling of Health Workers: Providing regular training to healthcare workers, including Accredited Social Health Activists (ASHAs), Auxiliary Nurse Midwives (ANMs), and Anganwadi workers, can enhance their capacity to deliver grassroots services effectively.

6. Telemedicine and Digital Healthcare

  • Promote Telemedicine Solutions: Leveraging telemedicine can help overcome geographical barriers and provide healthcare consultations to people in remote areas. The government can set up digital platforms for teleconsultations, reducing the need for travel to urban centers.
  • Expand Digital Health Infrastructure: Integrate healthcare services through digital platforms like the National Digital Health Mission (NDHM), allowing for easier access to medical records, e-prescriptions, and teleconsultations.

7. Focus on Preventive Healthcare

  • Promote Public Health Campaigns: The state should intensify awareness campaigns on hygiene, sanitation, nutrition, and disease prevention to reduce the disease burden, especially in rural areas. Immunization drives and maternal and child health programs should be prioritized.
  • Focus on Nutrition and Sanitation: Addressing malnutrition and poor sanitation through health interventions like midday meals and Swachh Bharat Abhiyan can reduce disease outbreaks and improve overall community health.

8. Strengthen Grievance Redressal and Accountability Mechanisms

  • Establish Feedback Mechanisms: Implement systems for receiving and addressing grievances related to healthcare service delivery, ensuring public accountability and transparency.
  • Social Audits: Encourage community participation in the monitoring of healthcare service delivery by organizing regular social audits at the local level.

9. Incentivize Local Participation in Healthcare Programs

  • Empower Local Bodies: Involve Panchayati Raj Institutions (PRIs) and urban local bodies in healthcare planning and implementation to ensure that healthcare solutions are responsive to local needs.
  • Community-based Monitoring: Encourage local community monitoring and participation to ensure that healthcare services are responsive and aligned with the specific needs of the population.

10. Encourage Indigenous Healthcare Systems

  • Integrate AYUSH (Ayurveda, Yoga, Unani, Siddha, and Homeopathy): Promote the integration of traditional and alternative medicine systems like AYUSH at the grassroots level, which can help complement allopathic healthcare and provide affordable and accessible care.

By implementing these measures, the Indian state can enhance the reach of public healthcare, ensuring that market-driven forces do not limit access to quality healthcare for the vulnerable and marginalized sections of society. The aim should be to create a healthcare system that is affordable, equitable, and universally accessible.

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