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Subject: Governance

Important aspects of Society

  • [pib] What is Nai Talim?

    The Vice President of India has said that the New Education Policy follows the ‘Nai Talim’ of Mahatma Gandhi by giving importance to the mother tongue as the medium of instruction at the school level.

    What is Nai Talim?

    • The phrase Nai Talim is a combination of two words- Nai Means ‘New’ and Talim – a Urdu word-means ‘Education’.
    • In 1937, Gandhiji introduced the concept of Nai Talim in India. It aimed to achieve Gram Swaraj (liberation of villages).
    • In short, Gandhiji dreamed to make all villages independent; and self-reliant.
    • It is an approach to the total personality development of body, mind and spirit and was based on four principles namely:
    1. Education or learning in mother tongue along with handicraft work,
    2. Work should be linked with most useful vocational needs of the locality,
    3. Learning should be linked with vocational work, and
    4. Work should be socially useful and productive needed for living.

    Gandhiji and Education

    • Gandhi’s first experiments in education began at the Tolstoy Farm ashram in South Africa.
    • It was much later, while living at Sevagram (Wardha) and in the heat of the Independence struggle, that Gandhi wrote his influential article in Harijan about education.
    • In it, he mapped out the basic pedagogy (or teaching) with focus on:
    1. Lifelong character of education,
    2. Social character and
    3. A holistic process
    • Thus, for Gandhi, education is ‘the moral development of the person’, a process that is by definition ‘lifelong’.
    • He believed the importance of role of teacher in the learning process.

     

    Try this PYQ from CSP 2020:

     

    Q. One common agreement between Gandhism and Marxism is

    (a) The final goal of a stateless society

    (b) Class struggle

    (c) Abolition of private property

    (d) Economic determinism

     

     

    [wpdiscuz-feedback id=”3i9ahv7hw9″ question=”Please leave a feedback on this” opened=”1″]Post your answers here:[/wpdiscuz-feedback]

     

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  • Aiding in governance

    Context

    The collaborative effort of markets and the Government are key to the development of a country.

    How CSR law aids citizenry-private partnerships

    • Section 135 of the Companies Act mandates corporates who are beyond a certain level of profits and turnover to pay at least 2% of their net profits before tax to the development space.
    • Scope for collaboration with Non-state actors: This law gives corporates the necessary impetus to collaborate with non-state actors like Non-Governmental Organisations (NGOs) and Civil Society Organisations (CSOs). 
    • Using the depth of engagement of non-state actors: Non-state actors, because of their depth of engagement with communities, bring patient capital to corporate board rooms and help the state, too, by engaging in welfare activities.
    • Role of NGOs: A key pillar of democratic governance is citizens’ power to question the state.
    • NGOs and voluntary groups/organisations have played a significant role in building capacities of citizens to hold governments accountable.
    • Hence, Corporate Social Responsibility (CSR) grants, have assumed importance to provide the much-needed sustenance to NGOs and CSOs as key players in non-state governance.

    How Non-state actors differ from Governments

    • Risk-averse nature of bureaucracy: The Indian bureaucratic elite have little appetite for risk-taking and innovation because of the constant changing goalposts of their politician-bosses or because the quantum of work is more than what they can efficiently handle.
    • Bureaucrats, therefore, often take recourse to the status quo even if it is to at least get some work done and not stall everything by campaigning for change, especially in the realm of governance.
    • Fear of failure: There is also the fear of failure, with its deep-rooted consequence of non-risk-takers smoothly sailing to the top posts.
    • In such contexts, it is the non-state actor who innovates and creates breakthrough models of community engagement.
    • They also become the vehicle to carry the demands of people to formal institutions.
    • We saw this in the case of the Right to Information (RTI) campaign, which became a law after decades-long efforts by NGOs.
    • It is common knowledge that the District Collector calls on vetted NGOs/CSOs to implement various schemes during the normal course of the day or to step in at short notice when calamities strike.
    • When non-state actors take a large load off the state’s shoulder, the state can focus more on governance.
    • Research shows that it is the synergy of NGOs, Government and corporates which is the key to the development.

    Conclusion

    The CSR law has made the corporate world not only clean its own mess but has also created a legal framework for corporates to work with NGOs and CSOs. NGOs and CSOs in India, will play a major role in mobilising citizen action to right various wrongs.

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  • HC allows woman to terminate 28-week pregnancy

    The Delhi High Court has permitted a 28-week pregnant woman to undergo medical termination of pregnancy on account of substantial foetal abnormality.

    What did the HC rule?

    Ans. Termination of Pregnancy is a matter of Right

    • The High Court said the woman cannot be deprived of the freedom to take a decision to continue or not to continue with the pregnancy, due to foetal abnormalities.
    • HC ruled that reproductive choice is a dimension of personal liberty that is enshrined in Article 21 of the Constitution.
    • It stated that allowing the pregnancy to continue would have a deleterious impact on the petitioner’s mental health.
    • The petitioner cannot be deprived of the freedom to take a decision to continue or not to continue with the pregnancy in view the medical board’s opinion.

    What is the Medical Termination of Pregnancy (MTP) Act?

    • Abortion in India has been legal under various circumstances for the last 50 years with the introduction of MTP Act in 1971.
    • The Act was amended in 2003 to enable women’s accessibility to safe and legal abortion services.

    Termination of pregnancy is permitted for a broad range of conditions up to 20 weeks of gestation as detailed below:

    1. Threat to mother: When the continuation of pregnancy is a risk to the life of a pregnant woman or could cause grave injury to her physical or mental health;
    2. Child abnormalities: When there is substantial risk that the child, if born or dead would be seriously handicapped due to physical or mental abnormalities;
    3. Rape survivors: When pregnancy is caused due to rape (presumed to cause grave injury to the mental health of the woman);
    4. Failure of contraception: When pregnancy is caused due to failure of contraceptives used by a married woman or her husband (presumed to constitute grave injury to mental health of the woman).

    Conditions for abortion

    • The MTP Act specifies – (i) who can terminate a pregnancy; (ii) till when a pregnancy can be terminated; and (iii) where can a pregnancy be terminated.
    • There must be an opinion formed of a doctor, that the pregnancy would cause a risk to the life of the pregnant woman or grave injury to her physical or mental health.
    • When a pregnancy exceeds 20 weeks but not 24 weeks, termination is permissible on the opinion formed of two registered medical practitioners.

    What was the recent case?

    • In the present case, the woman has completed 28 weeks of pregnancy.
    • As the MTP Act does not permit pregnancy termination beyond 24 weeks, she approached the court.
    • Various anomalies were found in the heart of the foetus in the foetal ECG.

    Key issues

    There are differing opinions with regard to allowing abortions.

    • One opinion is that terminating a pregnancy is the choice of the pregnant woman and a part of her reproductive rights.
    • The other is that the state has an obligation to protect life, and hence should provide for the protection of the foetus.
    • Across the world, countries set varying conditions and time limits for allowing abortions, based on foetal health, and risk to the pregnant woman.

    Conclusion

    • Access to abortion facilities is limited not just by legislative barriers but also the fear of judgment from medical practitioners.
    • It is imperative that healthcare providers be sensitized towards being scientific, objective and compassionate in their approach to abortions.

    Also read

     

    Termination of Pregnancy (MTP) Amendment Bill, 2020

     

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  • Centre notifies new rules for Consumer Panels

    The Ministry of Consumer Affairs, Food, and Public Distribution has notified monetary jurisdiction for various Consumer Disputes Redressal Commission (CDRC) under the Consumer Protection Act, 2019.

    What are the new changes?

    • The Centre has notified new rules to revise pecuniary jurisdiction for entertaining consumer complaints at district, state and national level commissions, a move aimed at fast disposal of cases.
    • The NCDRC will now have jurisdiction to entertain consumers’ complaints where the value of the goods or services exceeds Rs 2 crore as against the earlier limit of over Rs 10 crore.
    • The state commissions will have jurisdiction to similar complaints with value of goods or services between Rs 50 lakh and Rs 2 crore, and the National Commission over Rs 2 crore.
    • District commissions have jurisdiction to entertain complaints where value of goods or services paid as consideration does not exceed Rs 1 crore.

    Legal basis of these changes

    • The Act provides a “three-tier quasi-judicial mechanism” for redress of consumer disputes: district commissions, state commissions, and the national commission.
    • The law also provides pecuniary jurisdiction of each tier of consumer commission.

    Benefits of the move

    • Fast-track disposal of cases: Reduction of limit of pecuniary jurisdiction of district and state commissions will reduce workload at these two tiers of dispute resolution system, and thereby reduce pendency at these two levels.
    • Easy litigation: Besides, with E-Dakhil in place, consumers can take their complaints to a state or national commission without visiting the commission physically.

    Back2Basics: Features of the Consumer Protection Act, 2019

    [1] Definition of consumer

    • A consumer is defined as a person who buys any good or avails a service for a consideration.
    • It does not include a person who obtains a good for resale or a good or service for commercial purpose.
    • It covers transactions through all modes including offline, and online through electronic means, teleshopping, multi-level marketing or direct selling.

    [2] Rights of consumers

    Six consumer rights have been defined in the Bill, including the right to:

    • be protected against marketing of goods and services which are hazardous to life and property
    • be informed of the quality, quantity, potency, purity, standard and price of goods or services
    • be assured of access to a variety of goods or services at competitive prices and
    • seek redressal against unfair or restrictive trade practices

    [3] Central Consumer Protection Authority

    • The central government will set up a Central Consumer Protection Authority (CCPA) to promote, protect and enforce the rights of consumers.
    • It will regulate matters related to violation of consumer rights, unfair trade practices, and misleading advertisements.
    • The CCPA will have an investigation wing, headed by a Director-General, which may conduct inquiry or investigation into such violations.

    [4] Penalties for misleading advertisement

    • The CCPA may impose a penalty on a manufacturer or an endorser of up to Rs 10 lakh and imprisonment for up to two years for a false or misleading advertisement.
    • In case of a subsequent offence, the fine may extend to Rs 50 lakh and imprisonment of up to five years.
    • CCPA can also prohibit the endorser of a misleading advertisement from endorsing that particular product or service for a period of up to one year.

     [5] Consumer Disputes Redressal Commission

    • CDRCs will be set up at the district, state, and national levels.
    • A consumer can file a complaint with CDRCs in relation to: (i) unfair or restrictive trade practices; (ii) defective goods or services; (iii) overcharging or deceptive charging; and (iv) the offering of goods or services for sale which may be hazardous to life and safety.
    • Complaints against an unfair contract can be filed with only the State and National Appeals from a District CDRC will be heard by the State CDRC.
    • Appeals from the State CDRC will be heard by the National CDRC.
    • Final appeal will lie before the Supreme Court.

    [6] Jurisdiction of CDRCs

    • The District CDRC will entertain complaints where value of goods and services does not exceed Rs one crore.
    • The State CDRC will entertain complaints when the value is more than Rs one crore but does not exceed Rs 10 crore.
    • Complaints with value of goods and services over Rs 10 crore will be entertained by the National CDRC.

    [7] Product liability

    • Product liability means the liability of a product manufacturer, service provider or seller to compensate a consumer for any harm or injury caused by a defective good or deficient service.
    • To claim compensation, a consumer has to prove any one of the conditions for defect or deficiency, as given in the Bill.

     

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  • [pib] Electoral Bonds Scheme

    The 19th phase of sale of Electoral Bonds will commence ahead of elections is some states.

    What are Electoral Bonds?

    • Electoral bonds are banking instruments that can be purchased by any citizen or company to make donations to political parties, without the donor’s identity being disclosed.
    • It is like a promissory note that can be bought by any Indian citizen or company incorporated in India from select branches of State Bank of India.
    • The citizen or corporate can then donate the same to any eligible political party of his/her choice.
    • An individual or party will be allowed to purchase these bonds digitally or through cheque.

    About the scheme

    • A citizen of India or a body incorporated in India will be eligible to purchase the bond
    • Such bonds can be purchased for any value in multiples of â‚č1,000, â‚č10,000, â‚č10 lakh, and â‚č1 crore from any of the specified branches of the State Bank of India
    • The purchaser will be allowed to buy electoral bonds only on due fulfillment of all the extant KYC norms and by making payment from a bank account
    • The bonds will have a life of 15 days (15 days time has been prescribed for the bonds to ensure that they do not become a parallel currency)

    Objective of the scheme

    • Transparency in political funding: To ensure that the funds being collected by the political parties is accounted money or clean money.

    Who can redeem such bonds?

    • The Electoral Bonds shall be encashed by an eligible Political Party only through a Bank account with the Authorized Bank.
    • Only the Political Parties registered under Section 29A of the Representation of the People Act, 1951 (43 of 1951) and which secured not less than one per cent of the votes polled in the last General Election to the Lok Sabha or the State Legislative Assembly, shall be eligible to receive the Electoral Bonds.

    Restrictions that are done away

    • Earlier, no foreign company could donate to any political party under the Companies Act
    • A firm could donate a maximum of 7.5 per cent of its average three year net profit as political donations according to Section 182 of the Companies Act.
    • As per the same section of the Act, companies had to disclose details of their political donations in their annual statement of accounts.
    • The government moved an amendment in the Finance Bill to ensure that this proviso would not be applicable to companies in case of electoral bonds.
    • Thus, Indian, foreign and even shell companies can now donate to political parties without having to inform anyone of the contribution.

    Issues with the Scheme

    • Opaque funding: While the identity of the donor is captured, it is not revealed to the party or public. So transparency is not enhanced for the voter.
    • No IT break: Also income tax breaks may not be available for donations through electoral bonds. This pushes the donor to choose between remaining anonymous and saving on taxes.
    • No anonymity for donors: The privacy of the donor is compromised as the bank will know their identity.
    • Differential benefits: These bonds will help any party that is in power because the government can know who donated what money and to whom.

     

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  • Atal Ranking of Institutions on Innovation Achievements (ARIIA), 2021

    Atal Ranking of Institutions on Innovation Achievements (ARIIA) 2021 has been recently released.

    About ARIIA

    • ARIIA is an initiative of erstwhile Ministry of HRD, implemented by AICTE and Ministry’s Innovation Cell.
    • It systematically ranks all major higher educational institutions and universities in India on indicators related to “Innovation and Entrepreneurship Development” amongst students and faculties.
    • ARIIA 2020 will have six categories which also includes special category for women only higher educational institutions to encourage women and bringing gender parity in the areas of innovation and entrepreneurship.
    • The other five categories are 1) Centrally Funded Institutions 2) State-funded universities 3) State-funded autonomous institutions 4) Private/Deemed Universities and 5) Private Institutions.

    Major Indicators for consideration

    • Budget & Funding Support.
    • Infrastructure & Facilities.
    • Awareness, Promotions & support for Idea Generation & Innovation.
    • Promotion & Support for Entrepreneurship Development.
    • Innovative Learning Methods & Courses.
    • Intellectual Property Generation, Technology Transfer & Commercialization.
    • Innovation in Governance of the Institution.

    Key highlights of 2021 report

    • Seven IITs and the IISc, Bengaluru, are among the top 10 central institutions in promotion and support of innovation and entrepreneurship development.
    • The top rank has been bagged by the IIT, Madras followed by the IITs in Bombay, Delhi, Kanpur and Roorkee.
    • The IISc has bagged the sixth position in the ranking followed by the IITs in Hyderabad and Kharagpur, the NIT, Calicut.

     

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  • Put out the data, boost the dose of transparency

    Context

    The Government must make COVID-19 data including that for vaccine regulatory approvals and policy available.

    Kay decisions

    • On December 25, the Prime Minister of India announced two key decisions.
    • Vaccination of children: All children in the 15-17 age bracket will be eligible to receive COVID-19 vaccines from January 3, 2022.
    • Third shot: All health-care workers, frontline workers and the people aged 60 years and above (with co-morbidities and on the advice of a medical doctor) can get a third shot, or ‘precaution dose’.
    •  The eligibility for the precaution dose will be on the completion of nine months or 39 weeks after the second dose.
    • Teenage children whose birth year is 2007 or before will be eligible for COVID-19 vaccines.
    • Children will receive Covaxin, the reason being (according to the note) it is the only emergency use listed (EUL) World Health Organization vaccine available for use in this age group in India.

    Issues with the decision

    • Lack of scientific evidence: The decision is said to be based on ‘advice of the scientific community’.
    • A few members of the National Technical Advisory Group on Immunisation (NTAGI) in India,  have written or spoken publicly about not having enough scientific evidence to administer booster doses and vaccinate children in India.
    • Successive national and State-level sero-surveys have reported that a majority of children in India had got natural infection, while staying at home and thus developed antibodies.
    • The studies have shown that children rarely develop moderate to severe COVID-19 disease.
    • Targeted vaccination approach not adopted: Most public health and vaccine experts favour a ‘targeted vaccination approach’ by prioritising high-risk children for COVID-19 vaccination.
    • However, such an approach is likely to face an operational challenge in the identification of the eligible children.
    • Consultation cost:  A majority of the elderly have one or other comorbidities. Of the 14 crore elderly population in India, an estimated 7 to 10 crore people could have co-morbidities.
    •  If they have to seek advice from a physician, in order to get vaccinated, this essentially means that there would be up to 10 crore of medical consultations, which would come at a cost —  all of which is avoidable.

    Suggestions

    • Do away with prescription: The conditionality of comorbidities and the need for advice/prescription by a doctor for ‘the precaution shot’ in the elderly should be done away with.
    • Third dose to all immunocompromised adults: There is scientific evidence and consensus on administering the third dose for immunocompromised adults.
    • The Indian government should urgently consider administering a third dose for all immunocompromised adults, irrespective of age.
    • Third dose on a different vaccine platform: Studies have found that a heterologous prime-boost approach — third shot on a different vaccine platform — is a better approach.
    • Identify policy questions: Various pending policy questions on COVID-19 vaccine need to be identified urgently.
    • The technical expert should be given complete access to COVID-19 data for analysis and to find answers to those scientific and policy questions.
    • Vaccine supply and stock management: Vaccination for teenage children, exclusively with Covaxin (which means 15 crore doses for this sub-group) has other implications.
    • Covaxin will also be needed for people coming for their first shot, returning for their second shot, and then for their ‘precaution dose’ if a third shot of the same vaccine is allowed.
    • Focus on primary vaccination: The precaution dose and vaccination for children should not divert attention from the task of primary vaccination, which continues to be an unfinished task in India; 46 crore doses are still needed for the first and second shots.
    • Make data public: It is time the Union and State governments in India make COVID-19 data — this includes clinical outcomes, testing, genomic sequencing as well as vaccination — available in the public domain.
    • This would help in formulating and updating COVID-19 policy and strategies and also assess the impact of ‘precaution dose’ as well as vaccination of children.

    Conclusion

    The Indian government urgently needs to make COVID-19 data available, including the one used for regulatory approvals of vaccines and for vaccine policy decisions. This will bring transparency in decision making and increase the trust of the citizen in the process.

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  • NITI Aayog releases fourth edition of State Health Index

    NITI Aayog has released the fourth edition of the State Health Index for 2019–20.

    State Health Index

    • The State Health Index is an annual tool to assess the performance of states and UTs. It is being compiled and published since 2017.
    • The index is part of a report commissioned by the NITI Aayog, the World Bank, and the Union Health and Family Welfare Ministry.
    • The reports aim to nudge states/UTs towards building robust health systems and improving service delivery.

    Components of the index

    • It is a weighted composite index based on 24 indicators grouped under the domains of ‘Health Outcomes’, ‘Governance and Information’, and ‘Key Inputs/Processes’.
    1. Health outcomes: It includes parameters such as neonatal mortality rate, under-5 mortality rate, and sex ratio at birth.
    2. Governance: This includes institutional deliveries, average occupancy of senior officers in key posts earmarked for health.
    3. Key inputs: It consists of the proportion of shortfall in healthcare providers to what is recommended, functional medical facilities, birth, and death registration, and tuberculosis treatment success rate.

    Performance of the states

    • For the fourth year in a row, Kerala has topped a ranking of States on health indicators. Uttar Pradesh has come in at the bottom.
    • Kerala is followed by Tamil Nadu and Telangana, which improved its ranking.

     

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  • Issues with Health Surveys in India

    This article discusses the feasibility of conducting a single comprehensive survey for collecting health-related data in India.

    Context

    • In a country perennially thirsty for reliable health data, the National Family Health Survey (NFHS) is like an oasis.
    • It has a large volume of data that is openly accessible.
    • The report of the fifth round of the NFHS was recently released. Since then, we had many articles covering different aspects (malnutrition, fertility, and domestic violence to name a few).

    What is NFHS?

    • The NFHS is a large-scale, multi-round survey conducted in a representative sample of households throughout India.
    • Three rounds of the survey have been conducted since the first survey in 1992-93.
    • Currently, the survey provides district-level information on fertility, child mortality, contraceptive practices, reproductive and child health (RCH), nutrition, and utilization and quality of selected health services.
    • The Ministry of Health has designated the International Institute for Population Sciences (IIPS) Mumbai, as the nodal agency, responsible for providing coordination and technical guidance for the survey.

    Issues with health surveys in India

    • Multiple surveys: The NFHS is not the only survey. In the last five years, there has been the National NCD Monitoring Survey (NNMS), the National Mental Health Survey (NMHS) etc.
    • Huge cost: Each survey funding for different rounds of NFHS costs upto â‚č250 crore.
    • Huge chunk of data: The size of the survey has obvious implications for data quality.
    • Different estimates: Multiple surveys also raise the problem of differing estimates, as is likely, due to sampling differences in the surveys.
    • Limited respondents: The respondents are largely women in the reproductive age group (15-49 years) with husbands included.
    • Global obligations: Some of these surveys are done to meet the global commitments on targets (NCDs, tobacco, etc.).
    • Undefined purpose The health surveys have confusing research with programme monitoring and surveillance needs. Ex. Questions on domestic violence in NFHS.

    Need of the hour

    • Alignment of purpose: There have been previous attempts to align these surveys but they have failed as different advocates have different “demands” and push for inclusion of their set of questions.
    • Regularity of surveys: NFHS is the only major survey that India has a record of doing regularly. One does not know if and when the other surveys will be repeated.

    One-stop solution

    • National health data architecture: With diverse aspects of health, there is a need to plan the public health data infrastructure for the country.
    • Budgetary outlay: We also need to ensure that these data are collected in an orderly and regular manner with appropriate budgetary allocation.
    • Purpose definition: This requires clarity of purpose and a hard-nosed approach to the issue that randomized activities.
    • National-level indicators: We have to identify a set of national-level indicators and surveys that will be done using national government funds at regular intervals.

    How should surveys be done?

    • There should be three national surveys done every three to five years in a staggered manner:
    1. NFHS focuses on Reproductive and Child Health (RCH) issues
    2. Behavioral Surveillance Survey (focusing on HIV, NCD, water sanitation and hygiene (WASH)-related and other behaviors) and
    3. Nutrition-Biological Survey (entails collection of data on blood pressure, anthropometry, blood sugar, serology, etc.)

    We need to look at alternate models and choose what suits us best.

    Way forward

    • Important public health questions can be answered by specific studies conducted by academic institutions on a research mode based on availability of funding.
    • States have to become active partners including providing financial contributions to these surveys.
    • It is also very important to ensure that the data arising from these surveys are in the public domain.

    Conclusion

    • We are ready to establish public health data architecture for our complexity of needs.
    • We have the technical capacity to do so.
    • All it requires now is the political will.

     

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  • Extending outpatient health care coverage

    Context

    Over the past two decades, initiatives announced to extend health care coverage to the indigent sections have come under criticism due to their near-exclusive focus on hospitalisation (inpatient, IP) care.

    Significance of outpatient health care

    • What is outpatient health care: Outpatient (OP) health care, mainly comprising doctor consultations, drugs, and tests, can be called ‘the elephant in the room’ of Indian public health care policy.
    • OP expenses have the majority share in total out-of-pocket (OOP) expenditure on health.

    Why do we need to extend OP care coverage?

    • How IP care differs from OP care? IP care comprises high-impact and unavoidable episodes that are less prone to misuse than OP care, for which demand is considerably more sensitive to price and is thus more prone to overuse under health insurance.
    • IP insurance prioritised: This logic, among other reasons, has led to IP insurance schemes being prioritised.
    • [1] OP care and preventive care is neglected: While a price-sensitive demand for OP care entails that it could be misused under insurance, it also means that OP care is the first to come under the knife when there is no insurance.
    • In India, where there are many public IP insurance schemes but no OP coverage, this incentive is further amplified.
    • The mantra of ‘prevention is better than cure’ thus goes for a toss.
    • [2] Against economic sense: It defies economic sense to prioritise IP care over OP care for public funds.
    • Preventive and primary care services which often come with externalities, elicit little felt need and demand, and must therefore be the primary recipients of public investment.
    • Not conducive to epidemiological profile: Greater investments in IP care today translate to even greater IP care investments in future, further reduction in primary care spending, and ultimately lesser ‘health’ for the money invested.
    • None of these are conducive to the epidemiological profile that characterises this country.

    Issues with using private commercial insurance to extend OP care coverage nationwide

    • Some recent policy pronouncements by the Centre have conveyed an inclination to expand healthcare coverage with little fiscal implications for the government.
    • Challenges:
    • [1] The OP practices are under-regulated and there is a lack of standards.
    • [2] The difficulty to monitor OP clinical and prescribing behaviours and the concomitant higher likelihood of malpractices.
    • [3] Low public awareness of insurance products and a low ability to discern entitlements and exclusions.
    • [4] Add to it the inexperience that a still under-developed private OP insurance sector brings.
    • All these entail tremendous and largely wasteful costs and administrative complexity, and it would be of little help even if the government was to step in with considerable subsidies.

    Suggestion

    • Need for fiscal and time commitment: Significant improvements in healthcare are implausible without significant fiscal and time commitments.
    • No perfect model: There is no ‘perfect’ model of expanding healthcare — the emphasis must be on finding the best fit.
    • Implementing even such a best fit could involve adopting certain modalities with known drawbacks.
    • Expand public spending: The focus must be on expanding public OP care facilities and services financed mainly by tax revenues.
    • For India, wisdom immediately points to successful countries that are (or were, at one point) much closer to its socioeconomic fabric, such as Thailand, than countries like the U.S. which we currently look to emulate.
    • Now, the sparse number and distribution of public facilities offers various modes of rationing care, and their expansion is likely to result in a considerable spike in demand.
    • Contracting with private players: Contracting with private players based on objective and transparent criteria would also be called for, with just enough centralised supervision to deter corruption while preserving local autonomy.
    • To deter supply-side malpractices, low-powered modes of provider payment, such as capitation, may be considered for private providers wherever possible.

    Conclusion

    There are several compelling reasons for extending outpatient health care coverage even though there are several challenges to overcome to achieve this.

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