The Cost of Health: A Broken System

GS-2 Mains : Health 

Revision Notes 


Question : Discuss the societal impact of soaring healthcare costs and the resulting hostility towards healthcare workers in India, highlighting the recent intervention by the Supreme Court to address this issue.

Soaring Costs and Societal Tragedy

  • Out-of-pocket medical expenses and impoverishment due to illness are major societal issues.
  • Growing resentment towards these costs fuels hostility (including violence) against healthcare workers.

Supreme Court Steps

  • The Supreme Court addressed excessive out-of-pocket spending in a Public Interest Litigation (PIL) filed by an NGO.
  • The Court threatened to enforce Central Government Health Scheme (CGHS) rates on all hospitals as a temporary measure.
  • States were given six weeks to develop a solution.

Universal Healthcare: The Ideal Solution

  • A nation prioritizing its citizens’ well-being should eliminate financial barriers to healthcare access.
  • Publicly funded healthcare systems provide timely, free, and effective care regardless of social status.
  • Countries with universal healthcare (funded by taxes) ensure everyone receives care without point-of-service payments. Wealthier individuals subsidize the healthcare of the less fortunate, and everyone utilizes the same facilities.
  • In emergencies, life or death wouldn’t be determined by wealth or social standing.

The Rise of Private Hospitals (Post-Independence)

  • India initially aimed for universal healthcare after independence.
  • However, public healthcare facilities were underfunded (deliberately or through neglect), creating an opening for private alternatives.
  • The elite sought healthcare tailored to their needs, leading to the construction of large hospitals.
  • Initially established as charities, many eventually recognized healthcare’s profit potential.
  • These private institutions unintentionally relieved the government’s burden by providing high-end curative services neglected in the focus on primary care.
  • Liberalization further fueled the growth of private healthcare with the entry of for-profit hospital chains backed by investors and international capital.
  • Offering efficient, sanitized, and technologically advanced care compared to public facilities, private hospitals attracted the middle class and eventually, even the poor.
  • Today, India boasts the world’s largest private healthcare sector.

Why Private Hospitals Thrive in India’s Healthcare System

Market Failures in Healthcare

  • Healthcare doesn’t follow market principles due to inherent unpredictability, distress, and reliance on empathy.
  • Even dominant market economies regulate healthcare for this reason.
  • Minimal regulations in India allow anyone to establish hospitals and promote unproven treatments without consequences.

Conflicts of Interest and Unnecessary Procedures

  • A deep conflict of interest exists – doctors often own hospitals and their income is linked to profits.
  • This incentivizes unnecessary hospitalization, prescriptions, tests, and procedures.

The Public Healthcare Dilemma

  • Revitalizing the public sector seems slow and doesn’t offer quick electoral gains.
  • AB-PMJAY(government health insurance scheme for the poor) relies on a regulated private sector with rationalized costs.
  • The growing private health insurance sector also needs regulation.

The Clinical Establishment Act (2010): A Flawed Attempt at Regulation?

  • Aimed at registering health establishments, setting minimum standards, and controlling costs.
  • Faced resistance from many state governments who haven’t implemented it effectively.

The Government’s Role in Subsidizing Private Healthcare

  • While forcing price controls on private hospitals seems unfair, the government already subsidizes them in several ways:
    • Training healthcare workers in public institutions.
    • Providing infrastructural concessions.

Challenges of Cost Control

  • Previous attempts to control private sector costs have been largely unsuccessful.
  • The Supreme Court’s recent intervention is potentially impactful but faces resistance:
    • From the private healthcare industry.
    • From influential doctors who are often hospital entrepreneurs.

The Limitations of Cost Capping

  • Capping costs might be a small step towards affordability, but substantial improvement requires:
    • Adequate state investment in healthcare.
    • India’s state health funding remains one of the world’s lowest.

Conclusion: A Political Willpower Problem

  • Affordable and universal healthcare has never been a political priority.
  • Fixing out-of-pocket expenses needs political will, not just court orders.
  • Lack of political action led activists to seek judicial intervention.
  • The effectiveness of court-mandated solutions remains to be seen.



Indian Express Editorial  Topic-2 : Politics of the day

GS-2 Mains 

Revision Notes 

Question : Evaluate the anti-India stance adopted by President Muizzu as a pillar of his political strategy, examining its implications for bilateral relations between the Maldives and India, and the broader geopolitical dynamics in the Indian Ocean region.


  • Parliamentary Elections Outcome:
  • Significance for President Muizzu: Test of popularity post defeating Mohamed Solih; faced dissent within ruling alliance; PNC lacked majority in Majles.
  • Super Majority for PNC: PNC won 70 of 93 seats, gaining political capital.

The anti-India Stance:

  • Pillar of Muizzu’s Politics:
  • Campaigned on “India Out” theme; sought withdrawal of Indian troops; scrapped 2019 agreement for hydrographic surveys.
  • Closer Ties with Beijing:
  • Strengthening ties with China; Beijing’s involvement in infrastructure projects.
  • Domestic Focus of Elections:
  • Fought on corruption, economy, housing, employment, and political alliances.
  • Yameen’s acquittal strengthened ruling coalition.

India’s Response:

  • Cautious Approach:
  • Avoided overreaction; dealt with provocative statements calmly.
  • Recognized neighbor’s domestic politics; importance of stability in Maldives.
  • Setting Red Lines:
  • Must ensure actions don’t undermine India’s security and core interests.
  • Geographical proximity makes Maldives integral to India’s Neighbourhood First policy and SAGAR initiative.
  • Continuous Engagement:
  • Regardless of government in Male, engagement must persist.
  • Long-term strategy to safeguard bilateral ties despite political differences.


  • Prudent Diplomacy:
  • India should handle Maldives’ political changes calmly.
  • Clear communication of red lines while maintaining engagement is crucial.
  • Sustained engagement key to ensuring stability and safeguarding interests in the region.



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