The Directive Principles of State Policy (Articles 38, 39, 42, and 47) mandate the State to ensure the health and well-being of all citizens. However, increasing marketisation of healthcare has led to inequality and exclusion, necessitating proactive state intervention.
Adverse Impacts of Marketisation
High OOPE: Nearly 47% of health expenditure in India is borne out-of-pocket (NHA 2023).
Around 75% of private hospitals are located in urban areas, creating rural-urban disparities
Profit Orientation: Commercial motives undermine equity and quality.
Violation of Right to Health under Article 21 (Olga Tellis Case)
Neglect of Preventive and Primary Care – Private sector prioritises curative and high-profit specialities
Erosion of Equity and Ethics: Healthcare becomes a commodity
Weak Regulation and Accountability leads to price inflation, quackery, and malpractice.
Brain Drain from Public Sector due to better pay and infrastructure in private sector
Role of the State
As per Article 38 and 47, the State must promote public health and ensure equitable access.
Ensuring Universal Health Coverage (UHC): State intervention is key to fulfilling SDG-3 (Good Health and Well-being) and ensuring healthcare equity.
Correcting Market Failures: Government must act as a regulator and service provider, ensuring affordability, quality, and inclusivity.
Measures to Enhance Reach of Public Healthcare at the Grassroots Level
Upgrade Sub-Centres, PHCs, and CHCs under the Ayushman Bharat. Ensure diagnostic labs, maternity wards, and telemedicine facilities at PHC level.
Raise public health spending to 2.5% of GDP (National Health Policy 2017). Prioritise spending on rural and preventive healthcare.
Recruit and train ASHA, ANM, and community health officers with proper incentives and infrastructure.
Implement transparent PPPs for tertiary healthcare in district hospitals (NITI Aayog)
Expand Pradhan Mantri Jan Aushadhi Kendras for affordable drugs. Mandate prescription of generic medicines.
Decentralised Health Governance – Empower Panchayati Raj Institutions and urban local bodies for health planning, awareness, and monitoring. (Kerala Model)
Preventive Health – Strengthen immunisation, sanitation, and nutrition programmes (e.g., POSHAN Abhiyaan, Swachh Bharat).
Promote health literacy through ASHA-led campaigns.
Expand telemedicine (eSanjeevani) to connect rural PHCs with urban specialists.
Integrate AYUSH systems with allopathic care at PHC level for holistic wellness.
By strengthening primary care, the State can transform healthcare into a rights-based, inclusive, and sustainable system, achieving the goal of “Swastha Bharat, Samriddh Bharat.”
