Editorials/Opinions Analysis For UPSC 02 September 2025

Content

1. The rise and risks of health insurance in India
2. Noise pollution is rising but policy is falling silent

The rise and risks of health insurance in India

Basics of UHC

• Definition (Bhore Committee, 1946): Quality health care must be accessible to all, irrespective of ability to pay.
• WHO Framework (2010): UHC = access to promotive, preventive, curative, rehabilitative, and palliative care without financial hardship.
• Core Idea:
  • Equity → everyone gets care.
  • Quality → services must be effective.
  • Financial Protection → no catastrophic out-of-pocket (OOP) spending.

Relevance : GS 2 (Governance – Health, Welfare Schemes, Social Justice), GS 3 (Economy – Health Infrastructure, Inclusive Growth, Regulation)

Practice Question : “India’s reliance on insurance expansion reflects policy shortcutting amid decades of underinvestment in public health.” Critically analyse.(250 Words)

India’s Current Approach

• Public Expenditure on Health (2022, World Bank): 1.3% of GDP vs world average 6.1%.
• Dual Track:
  • Public Facilities: Underfunded, overcrowded, unevenly distributed.
  • Insurance Schemes: PMJAY (2018) + State Health Insurance Programmes (SHIPs).
• Coverage:
  • PMJAY (2023–24): 58.8 crore individuals, budget ~₹12,000 crore.
  • SHIPs: Similar coverage, budget ~₹16,000 crore.
  • Total: ~80% population “covered” on paper, combined outlay ₹28,000 crore.

Merits of Health Insurance Schemes (PMJAY + SHIPs)

• Relief for poor patients when public facilities are inaccessible.
• Financial risk protection for select in-patient treatments.
• Wider hospital choices: ~50% empanelled hospitals private.
• Expanding footprint: budgets rising 8–25% annually (2018–24) in States like Gujarat, Kerala, Maharashtra.
• Politically attractive → visible welfare delivery.

Faultlines in Insurance-Based UHC Model

1. Profit-Driven Health Care

• Two-thirds of PMJAY spending goes to private hospitals.
• Private sector dominance, poorly regulated → overcharging, unnecessary procedures, denial of services.
• Public health system remains neglected.

2. Skewed Priorities

• Focus on hospitalisation → neglect of primary & preventive care.
• Risk: Ageing population + PMJAY coverage for elderly = rising expensive tertiary care burden.
• Example: Strong primary care could reduce avoidable hospitalisation, but gets underfunded.

3. Low Utilisation Despite High Coverage

• Only 35% of insured hospital patients used insurance in 2022–23 (HCE Survey).
• Reasons: Lack of awareness, procedural hurdles, discouragement by private hospitals.
• No significant reduction in Out-of-Pocket Expenditure (OOPE).

4. Discrimination in Access

• Private hospitals prefer uninsured patients (higher fees than insurance reimbursement).
• Public hospitals prefer insured patients (extra revenue).
• Creates inequity → uninsured/poor face neglect or pressure to enrol.

5. Financial Stress & Provider Discontent

• Pending dues under PMJAY: ₹12,161 crore (2023), exceeding annual budget.
• 609 hospitals opted out due to delays & low reimbursements.
• Patients left stranded; trust deficit growing.

6. Corruption & Fraud

• 3,200 hospitals flagged for fraudulent claims (NHA, 2024).
• Reports of ghost patients, unnecessary procedures, patients being charged despite insurance.
• Weak monitoring & lack of transparent audits on scheme portals.

Why Insurance Cannot Deliver UHC

• No country has achieved UHC solely via insurance expansion.
• Canada, Thailand → social health insurance models but:
  • Universal coverage, not targeted.
  • Non-profit or heavily regulated providers.
• India’s insurance → targeted, profit-driven, poorly regulated.
• Without robust public provisioning, insurance remains a stop-gap “painkiller”.

The Real Bottleneck – Underinvestment in Public Health

• India spends 1.3% of GDP on health vs 6.1% global avg.
• Developed + some developing nations (Thailand, Sri Lanka, Costa Rica) achieved UHC with 3–5% of GDP investments.
• India → among world’s lowest in public health investment.
• Consequence: Dependence on private providers, catastrophic OOPE (still >50% of total health expenditure).

Way Forward – Towards Genuine UHC

1. Strengthen Public Health System

• Expand primary health care infrastructure.
• Recruit & train doctors, nurses, community health workers.
• Ensure rural-urban equity in facilities.

2. Increase Public Expenditure

• Target: At least 2.5% of GDP by 2025 (National Health Policy 2017 goal).
• Current reality: 1.3%.

3. Redesign PMJAY/SHIPs

• Broaden to include out-patient & primary care.
• Tight regulation of private hospitals → pricing, quality, accountability.
• Transparent audits, community monitoring.

4. Integrate Preventive & Social Determinants

• Nutrition, sanitation, vaccination, lifestyle disease prevention.
• Reduce hospital demand through preventive interventions.

5. Move Towards Universal, Not Targeted, Coverage

• Avoid fragmentation between insured/uninsured.
• Ensure universality → everyone gets the same quality of care.

Conclusion

• Insurance ≠ UHC. It is only a partial financial risk cover, often inefficient and inequitable.
• India’s reliance on PMJAY/SHIPs reflects policy shortcutting amid decades of under-investment in public health.
• UHC requires strong public health system + adequate financing + regulated private sector.
• Unless India moves from insurance expansion to public health transformation, UHC will remain an illusion.

Noise pollution is rising but policy is falling silent

Basics

• Definition: Noise pollution = unwanted or harmful sound that disrupts normal life, health, or ecology.
• WHO safe limits (Silent Zones):
  • Day: 50 dB(A)
  • Night: 40 dB(A)
• Indian Legal Framework:
  • Noise Pollution (Regulation and Control) Rules, 2000 → silent zones (schools, hospitals, courts).
  • Constitutional Backing:
    • Article 21 → Right to life with dignity includes right to peace & health.
    • Article 48A → Duty of State to protect environment.
  • Judicial Precedent: In Re: Noise Pollution (V), 2005 and reaffirmed by SC in 2024 → Excessive noise violates Art. 21.

Relevance : GS 2 ( Rights-based governance, state capacity, environmental justice) , GS 3 (Pollution, urban planning, biodiversity ), GS 4 (Ethics of civic empathy, invisible pollutants)

Practice Question : “Noise pollution in India is less a technical failure and more a governance failure.” Critically discuss.(250 Words)

Magnitude of the Crisis in India

• Decibel Levels:
  • Delhi & Bengaluru (near schools, hospitals): often 65–70 dB(A), far above WHO norms.
• CPCB’s National Ambient Noise Monitoring Network (2011):
  • Vision: Real-time nationwide monitoring.
  • Reality: Passive, fragmented, poor sensor placement (25–30 feet high, against CPCB’s 2015 guidelines).
• Institutional Failures:
  • State Pollution Control Boards (SPCBs) work in silos.
  • RTI queries unanswered, data not public (e.g., UP, 2025 Q1).
• International Contrast:
  • EU: €100 billion annual economic loss due to noise → used in policymaking, redesign of speed/zoning frameworks.
  • India: Regulatory silence, fragmented governance.

Public Health Dimensions

• WHO: Noise linked to cardiovascular disease, hypertension, sleep disorders, learning impairments.
• India: Normalisation of honking, drilling, loudspeakers → civic fatigue & invisibility of problem.
• Vulnerable Groups: Children, elderly, chronically ill disproportionately affected.
• Mental Health: Chronic exposure → anxiety, stress, disturbed sleep cycles.

Constitutional & Ethical Dimensions

• Article 21: Noise pollution = violation of right to health, sleep, and dignity.
• Judicial Recognition:
  • SC (2005, reaffirmed 2024): Noise = environmental disruption infringing fundamental rights.
• Ethics: “Sonic aggression” undermines civic respect & collective dignity.

Ecological Dimensions

• 2025 Auckland Study: Urban noise & artificial light disrupted common mynas’ sleep & song after one night.
• Impact: Reduced vocal complexity, impaired communication, social signaling → biodiversity erosion.
• Signals ecological dissonance → noise breaks ecosystems’ natural rhythms.

Key Faultlines

1. Regulatory Failure
   1. Rules (2000) robust, but symbolic in enforcement.
   1. No updated decibel standards for modern urban realities.
2. Institutional Silos
   1. Poor coordination between SPCBs, municipal bodies, traffic police.
   1. NANMN = data-rich but action-poor.
3. Invisibility & Civic Fatigue
   1. Unlike smog/garbage, noise leaves no visual trace.
   1. Public apathy → lack of outrage → no political prioritisation.
4. Infrastructure & Growth Pressures
   1. Late-night drilling, traffic, logistics-driven expansion continue despite restrictions.
   1. Urban planning prioritises speed, not sonic civility.

Way Forward – Multi-Dimensional Reform

1. Governance & Policy

• Frame National Acoustic Policy (like air quality standards).
• Regular noise audits → transparent dashboards.
• Inter-agency coordination (traffic police, SPCBs, municipalities).

2. Decentralised Action

• Give real-time NANMN data to local bodies.
• Empower municipal authorities with penalty powers for zoning violations.

3. Urban Planning & Design

• Embed acoustic resilience → noise barriers, green buffers, silent road surfaces.
• Zoning reform → residential, educational, healthcare institutions insulated from highways/construction hubs.

4. Cultural & Behavioural Change

• “Sonic empathy” campaigns: Schools, driver training, community education.
• Move from one-off “No Honking Days” to sustained civic campaigns.
• Use nudges (silent horns, digital reminders).

5. Judicial & Rights-Based Lens

• Enforce Article 21 obligations → sound as part of dignity & mental well-being.
• Fast-track citizen complaints through local grievance redressal cells.

Conclusion

• Noise is invisible but not harmless — it corrodes health, dignity, and ecology.
• India’s current response = symbolic regulation + passive monitoring.
• Need: Rights-based, science-backed, culturally embedded approach.
• Reform must combine policy (acoustic standards), governance (data + enforcement), planning (urban design), and civic ethics (sonic empathy).
• Without this shift, India’s smart cities risk being unliveable not by sight, but by sound.