Under Article 47 of the Constitution (Directive Principles of State Policy), the State is obligated to regard the improvement of public health as among its primary duties. The Supreme Court has repeatedly affirmed that access to healthcare is an integral component of the Right to Life under Article 21. As commercial healthcare expands, public investment is necessary to contain out-of-pocket expenses and ensure equitable access.

Adverse Impacts of the Marketisation of Healthcare

• High Out-of-Pocket Expenditure (OOPE): Commercial healthcare costs remain a leading cause of debt in India, with out-of-pocket expenses pushing millions of households into economic vulnerability each year.
• Urban-Rural Infrastructure Asymmetry: Private healthcare facilities concentrate in profitable metropolitan areas; the Bharat Health Index indicates that roughly 80% of doctors, 75% of dispensaries, and 60% of private hospital beds are concentrated in urban areas, leaving rural populations reliant on under-resourced local clinics.
• Overtreatment and Profit Pressures: Market pressures can incentivize unnecessary diagnostic investigations, prolonged ICU stays, and caesarean deliveries in commercial settings.
• Drain of Medical Talent from Public Services: Higher compensation in private tertiary hospitals contributes to staffing shortages of specialist doctors, surgeons, and nurses in rural Community Health Centres (CHCs).

Measures to Enhance Grassroots Public Healthcare Reach

• 1. Strengthening Comprehensive Primary Healthcare:
  • Expand the network of Ayushman Arogya Mandirs (formerly Health and Wellness Centres) to deliver decentralized diagnostic screenings, chronic illness management, and free essential medicines close to rural residences.
• 2. Increasing Public Health Spending:
  • Gradually raise government public health expenditure from roughly 1.3% of GDP toward the 2.5% of GDP target recommended in the National Health Policy 2017.
• 3. Expanding Affordable Medicines (Jan Aushadhi Scheme):
  • Scale up Pradhan Mantri Bhartiya Janaushadhi Kendras (PMBJK) to provide quality generic medicines at prices 50% to 90% below commercial retail brands, reducing out-of-pocket costs.
• 4. Regulatory Price Caps on Essential Procedures:
  • Empower the National Pharmaceutical Pricing Authority (NPPA) to cap prices for essential medicines, coronary stents, and orthopedic implants, and enforce the Clinical Establishments Act to ensure standard treatment charges.
• 5. Leveraging Tele-Medicine Linkages:
  • Deploy the e-Sanjeevani tele-consultation platform to connect patients visiting primary health sub-centres directly with specialist doctors at urban medical colleges.
• 6. Empowering Frontline Health Workers:
  • Provide regular training, upgraded digital diagnostic tools, and improved remuneration for ASHA and ANM workers, who handle immunizations, maternal health tracking, and local health communication.
• 7. Establishing Unified Public Health Cadres:
  • Create dedicated State and National Public Health Cadres to separate disease surveillance and preventive care management from clinical curative duties.

Public healthcare is a fundamental social good that cannot be left entirely to market forces. Combining price regulation with robust public spending on primary healthcare infrastructure is essential to achieve universal health coverage aligned with SDG 3.