Question 10 from UPSC CSE 2023 - Social Issues

Question

Consider the following statements:
1. Statement-I: India's public sector health care system largely focuses on curative care with limited preventive, promotive, and rehabilitative care.
2. Statement-II: Under India's decentralized approach to health care delivery, the States are primarily responsible for organizing health services.
Which one of the following is correct in respect of the above statements?

IASCODEX · Accepted Answer

Correct Option: B. Both Statement-I and Statement-II are correct and Statement-II is not the correct explanation for Statement-I

Strategy: - **Evaluate Statement-I:** Confirm that India's public health system is dominated by curative care, supported by recent health spending data showing a higher allocation to curative services over preventive/promotive ones.
- **Evaluate Statement-II:** Verify that India's health administration is decentralized, with 'Public Health' primarily a State List subject, making states responsible for health services.
- **Assess Relationship:** Conclude that both statements are individually accurate, but Statement-II (decentralization) does not correctly explain the emphasis on curative care in Statement-I. This curative focus stems from systemic priorities and historical trends rather than the decentralized structure.

Key Info: India's health care system is organized into three tiers: primary, secondary, and tertiary.

**Health Administration & Funding:**
- 'Public Health' is included in the State List (Entry 6 of List II, Seventh Schedule) of the Indian Constitution, designating states as primarily responsible for organizing health services. The Union government plays an enabling and regulatory role.
- The public sector system is frequently criticized for its heavy emphasis on curative (medical treatment-oriented) care, rather than preventive, promotive, or rehabilitative services.
- According to National Health Accounts Estimates 2019-20, over 70% of expenditures are directed towards inpatient and outpatient curative care, medicines, diagnostics, and related services. In contrast, only about 10% is allocated to preventive care, such as immunizations, sanitation, or general health promotion.

**Challenges and Trends:**
- While decentralization ensures that program delivery can adapt to state-specific needs, historic investment patterns, workforce deployment, and the existing disease burden continue to reinforce curative over preventive strategies.
- Various health programs--like the National Health Mission--have recently aimed to rebalance this trend by increasing focus on preventive and promotive care, but significant challenges persist.
- Rehabilitative services, including support for individuals with disabilities or chronic illnesses, and promotive services, such as behavior change communications, receive minimal attention in budgeting and service delivery.
- The division of responsibilities is firmly anchored in constitutional provisions, and centrally sponsored schemes are designed to supplement, not replace, state administration in health.

IASCODEX · Answer

Option A: Both Statement-I and Statement-II are correct and Statement-II is the correct explanation for Statement-I

IASCODEX · Answer

Option C: Statement-I is correct but Statement-II is incorrect

IASCODEX · Answer

Option D: Statement-I is incorrect but Statement-II is correct