1. Why is access to affordable curative care still a challenge in India despite multiple health sector reforms? Suggest measures to address the issue. (250 words)
| Syllabus: Social Justice General Studies – : II Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources. |
IN NEWS: Reconnect public health with people’s needs
India’s healthcare journey has seen transformative reforms, shifting from basic infrastructure expansion under the National Health Mission to the world’s largest publicly funded health insurance cover, Ayushman Bharat. Yet, affordable curative care remains a distant reality for millions. While policy focus has successfully expanded hospital access for acute illnesses, deep-rooted structural gaps, high out-of-pocket expenses, and systemic fragmentation continue to make quality curative care a severe financial burden for the average citizen.
Key Challenges
- Exclusion of Outpatient Care (OPD): Flagship insurance schemes like AB-PMJAY cover secondary and tertiary hospitalization, but completely exclude OPD services. According to the National Health Accounts (NHA) estimates, outpatient care, diagnostic tests, and medicines continue to comprise nearly 60-66% of a household’s total health expenses.
- The “Missing Middle” Phenomenon: While the bottom 40% of the population receives coverage through PM-JAY and the affluent buy private insurance, nearly 30% of the population (informal workers, self-employed farmers) remains entirely uninsured, leaving them financially vulnerable to health shocks.
- Sub-optimal Public Financing: Even though public health spending rose slightly, it hovers below 1.5% of the GDP—far short of the 2.5% target envisioned by the National Health Policy (NHP) 2017. This underfunding fuels severe infrastructure shortages and high vacancies in public clinics, forcing over 70% of citizens to seek private, high-cost curative care.
- High Out-of-Pocket Expenditure (OOPE): Driven by unregulated private sector pricing and the cost of non-subsidized drugs, India’s OOPE stands at a heavy 43.4% of Total Health Expenditure (NHA 2022-23 metrics), periodically pushing millions into medical-induced poverty.
Suggested Measures
- Expand Insurance to OPD Cover: Restructure public insurance to integrate outpatient care, diagnostic tests, and consultations to shield households from daily medical costs.
- Increase Public Health Allocation: Commit strictly to raising the government health budget to 2.5% of GDP, prioritizing the expansion of critical care blocks and primary health infrastructure under the PM-Ayushman Bharat Health Infrastructure Mission (PM-ABHIM).
- Cap and Regulate Medical Costs: Scale up the Pradhan Mantri Bhartiya Janaushadhi Pariyojana to ensure universal availability of generic medicines, and empower the National Pharmaceutical Pricing Authority (NPPA) to cap diagnostic and curative procedure rates in empanelled private hospitals.
- Enact a Legal Right to Health: Legislate a universal right to essential healthcare, mirroring Rajasthan’s Right to Health Act, to legally guarantee emergency and affordable curative services for all citizens.
Achieving truly affordable curative care in India requires moving beyond a “hospitalization-first” mindset toward an integrated, universal healthcare paradigm. By bridging the financing gap, regulating private sector pricing, and legally cementing the Right to Health, India can transition from merely managing sickness to guaranteeing holistic, equitable financial health protection for all its citizens.
| PYQ REFERENCE UPSC 2023 Q. “Explain the significance of the National Digital Health Mission (NDHM) in ensuring universal health coverage, and discuss the challenges it faces.” |
2. To what extent can industrial growth be decoupled from greenhouse gas emissions in a developing economy like India? Discuss. (250 words)
| Syllabus: Environment General Studies – : III Conservation, environmental pollution and degradation, environmental impact assessment. |
IN NEWS: India’s patchy industrial climate strategy
Decoupling industrial growth from greenhouse gas (GHG) emissions refers to a structural shift where economic output expands while environmental degradation slows down (relative decoupling) or declines (absolute decoupling). For a developing economy like India, absolute decoupling remains a medium-term challenge, but relative decoupling is actively occurring.
1. Significant Relative Decoupling Achieved
India has proven that economic growth does not require a linear rise in emissions. Between 2005 and 2019, India’s GDP grew at a Compound Annual Growth Rate (CAGR) of approximately 7%, whereas emissions grew at a slower CAGR of 4%. Furthermore, India reduced its GDP emissions intensity by 36% from 2005 levels by 2020, and overall CO2 emissions grew by just 0.7% in 2025—marking the slowest growth rate in over two decades despite robust economic growth.
2. Sectoral Asymmetry (The Core Challenge)
The extent of decoupling varies drastically across sectors:
- The Power Sector: Experiencing rapid decoupling. Power sector emissions fell by 3.8% due to non-fossil fuel power capacity crossing 52% of total installed capacity, exceeding early climate targets.
- Hard-to-Abate Heavy Industries: Deeply coupled with fossil fuels. Steel and cement production surged by 8% and 10% respectively, driving the majority of residual industrial emissions due to an absolute reliance on coal for high-heat manufacturing processes.
Key Enabling Policies
- Updated NDC Targets (2026 Framework): India’s Nationally Determined Contributions target a 47% reduction in emissions intensity of GDP and a 60% non-fossil cumulative electricity capacity by 2035.
- Carbon Credit Trading Scheme (CCTS): Legally binding Greenhouse Gas Emission Intensity (GEI) targets have been formalized for nine heavy industrial sectors (including steel, cement, aluminum, and fertilizers).
Center on Global Energy Policy – Columbia University - National Green Hydrogen Mission: Targeting 5 million metric tonnes of green hydrogen production to substitute fossil inputs in refining, ammonia, and steel.
Suggested Measures for Deeper Decoupling
- Decarbonize Heavy Industry Processing: Mandate scrap-based steel production (Electric Arc Furnaces) and push for the commercialization of Carbon Capture, Utilization, and Storage (CCUS) technologies in cement manufacturing.
- Circular Economy Integration: Incentivize industrial symbiosis where the waste of one industry (e.g., fly ash from power plants or slag from steel) is used as a low-carbon raw material for another (blended cement).
- Access to Low-Cost Climate Finance: Establish blended finance mechanisms and green bonds to lower the high capital cost of clean technology transitions for Micro, Small, and Medium Enterprises (MSMEs).
While absolute decoupling is constrained by India’s inescapable need for infrastructure creation and poverty alleviation, its aggressive renewable energy expansion and market-based carbon regulations show that substantial green growth is achievable. Moving forward, transitioning heavy industries via green hydrogen and green finance will determine the speed at which India achieves its ultimate target of Net-Zero by 2070.
| PYQ REFERENCE UPSC 2022 Q. “Do you think India will meet 50 percent of its energy needs from renewable energy by 2030? Justify your answer. How will the shift of subsidies from fossil fuels to renewables help achieve the above objective? Explain.” |