Achieving Universal Health Coverage in India requires addressing the structural imbalance between primary care neglect and tertiary care expansion. Examine this statement in the li

GS2 Healthcare
Achieving Universal Health Coverage in India requires addressing the structural imbalance between primary care neglect and tertiary care expansion. Examine this statement in the light of India's National Health Policy 2017 and Ayushman Bharat scheme.
  • 15 marks
  • 8 min
  • 250 words
  • Hard

The Hindu

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Introduction Achieving Universal Health Coverage (UHC) in India requires a balanced system. However, India faces a structural imbalance where tertiary care expansion outpaces primary care strengthening, undermining accessibility and cost-effectiveness.

Structural Imbalance in Healthcare

  • Skewed focus on specialised hospitals and curative care over preventive and primary services
  • High out-of-pocket expenditure due to inadequate primary care gatekeeping
  • Overburdened tertiary facilities handling avoidable conditions

National Health Policy (NHP) 2017 Perspective

  • Emphasises comprehensive primary healthcare as the foundation of UHC
  • Targets two-thirds of public health spending on primary care
  • Advocates preventive, promotive, and community-based care
  • However, implementation remains uneven with continued underinvestment in primary infrastructure

Ayushman Bharat Scheme

  • Health and Wellness Centres (HWCs)

    • Aim to strengthen primary healthcare with expanded services (NCDs, maternal health, etc.)
    • Progress significant but constrained by human resource and infrastructure gaps

  • Pradhan Mantri Jan Arogya Yojana (PM-JAY)

    • Provides insurance coverage for secondary and tertiary care hospitalisation
    • Risks reinforcing hospital-centric care model
    • Private sector dominance may divert focus from public primary care

Critical Assessment

  • PM-JAY addresses financial protection but not preventive health needs
  • Weak referral systems lead to direct access to costly tertiary care
  • Insufficient integration between HWCs and PM-JAY
  • Regional disparities persist in healthcare access

Way Forward

  • Prioritise primary healthcare investment in line with NHP targets
  • Strengthen referral linkages between HWCs and higher facilities
  • Increase public health workforce and infrastructure
  • Align PM-JAY with preventive and primary care outcomes
  • Enhance state capacity and decentralised planning

Conclusion Without correcting the imbalance between primary and tertiary care, UHC will remain incomplete. A primary care-led, integrated health system is essential for equitable and sustainable healthcare delivery in India.