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.

Healthcare is a fundamental right crucial for individual dignity and welfare.Article 47of the Indian Constitution highlights the State’s responsibility to ensure public health, affirming the commitment to provide equitable access to healthcare for all citizens.

## Adverse impact of marketisation of healthcare system

• Inequity in access: creates a dual healthcare system where wealthy individuals can access, afford and avail healthcare, while the poor rely on underfunded public healthcare.


• Rural-urban divideas only30% healthcare infrastructure serves 70% rural population, leaving rural areas underserved.


• Rising cost and affordability:Eg. 47.1% of total healthcare spending in India is out-of-pocket expenditure (National Health Accounts 2019-2020).


• Commodification of Healthcare:Eg. doctors prescribing unnecessary tests and medicines just to increase profit.


• Limited Focus on Preventive Care: Market-driven systems prioritize curative care over preventive measures, leading to under-investment in public health.

## Role of state in containing marketisation of healthcare

• Regulation of Healthcare Costs: The state can cap treatment prices, regulate drug prices (e.g., India’sNational Pharmaceutical Pricing Authority), and ensure that essential medicines remain affordable.


• Strengthening Public Healthcare: The government can expand and improve public health infrastructure to provide low-cost or free services, reducing dependency on private healthcare providers.


• Universal Healthcare Schemes: Programs likeAyushman Bharatin India help reduce out-of-pocket expenses for poor citizens by providing free access to essential health services.


• Health Insurance Regulation: The state can ensure that private health insurance schemes are affordable, transparent, and provide adequate coverage without discrimination or exploitation.


• Public Health Campaigns: The state plays a key role in promoting preventive healthcare, vaccination drives, and awareness programs to reduce the burden of disease and reliance on expensive treatments.


• Subsidizing Essential Health ServicesThe government should providesubsidies for essential drugs and healthcare servicesto make them more affordable for the general public.Eg. Jan Aushadhi StoresProvidefree preventive healthcare servicessuch as immunizations, maternal and child care, and routine health checkups to reduce out-of-pocket expenditure.


• The government should providesubsidies for essential drugs and healthcare servicesto make them more affordable for the general public.Eg. Jan Aushadhi Stores


• Providefree preventive healthcare servicessuch as immunizations, maternal and child care, and routine health checkups to reduce out-of-pocket expenditure.

## Measures to Enhance Public Healthcare at the Grassroots Level

• Decentralization of Healthcare Governance: Empower local governing bodies likePanchayati Raj Institutions (PRIs) and urban local bodiesto take charge of healthcare delivery at the local level. This would ensure more responsive and need-based healthcare.


• Public-Private Partnerships (PPP):NITI Aayog in its report ‘Reimagining Healthcare In India Through Blended Finance’ Encouraged  partnerships between the government and private healthcare providers for the supply of healthcare equipment, medicines, and mobile health units in rural areas.


• Health Education and Community Participation: Launch health literacy programs and engage local communities in healthcare planning by forming village health committees to monitor programs.Eg. ASHA and Anganwadi workers can be leveraged.


• Increased Budget Allocation for Public Healthto improve infrastructure, recruit more healthcare workers, and ensure the continuous supply of medicines. Allocate funds specifically for underserved areas, ensuring equitable distribution of healthcare resources across the country.


• Focus on Preventive Healthcare:  Prioritize preventive healthcare measures, such as improving sanitation, clean drinking water access, and widespread vaccination campaigns.


• Implement nutrition programs targeting maternal health and child developmentto reduce the incidence of malnutrition and related diseases.


• Technological Integration: Use telemedicine, mobile health apps, and electronic health records to enhance remote care access and continuity. Eg:Practo,eSanjeevani.

TheKerala Model of health careKey initiatives include empowered health workers, decentralized governance, and public health education.

As the saying goes, “Health is wealth, not wealth in health,”emphasizing the importance of accessible health care. By focusing on public investment and community health initiatives, the state can ensure health remains a fundamental right, not a commodity.

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