Citizen-Centric Healthcare Delivery & Use of Technology 

Contextual Background

• Trigger
  • Lancet Commission (2025–26) report calling for a citizen-centric, publicly financed, and technology-enabled healthcare system in India.
• Context
  • Persistent gaps in:
    • Access
    • Quality
    • Financial protection in India’s healthcare.
  • Post-COVID recognition of:
    • Health as a public good
    • Need for system-wide reform, not scheme-based fixes.

Conceptual & Static Foundation

Core Concept – Citizen-Centric Healthcare

• Citizen-Centric Healthcare
  • A system where:
    • Citizens, not diseases or insurance packages, are at the centre.
    • Emphasis on continuity of care, not episodic treatment.
• Key Principles
  • Universality
  • Equity
  • Public financing
  • Accountability
• Lancet’s Core Assertion
  • Health systems should be publicly financed and publicly provided, with technology as an enabler—not a substitute.

Historical Evolution of Health Policy in India

• Post-Independence
  • Focus on public health infrastructure (PHCs, CHCs).
• 1990s–2000s
  • Gradual shift towards:
    • Privatisation
    • Out-of-pocket expenditure (OOPE).
• Recent Phase
  • Insurance-led approach (e.g., PM-JAY).
• Emerging Shift
  • From insurance-centric → care-centric health systems.

Constitutional & Legal Dimensions

• Constitutional Basis
  • Article 21: Right to life interpreted to include right to health.
  • Article 47 (DPSP): Duty of the State to improve public health.
• Legal Reality
  • Health is a State subject (Entry 6, State List).
• Judicial Interpretation
  • Supreme Court: Access to healthcare integral to dignity.
• Constitutional Gap
  • No enforceable right to healthcare yet.
• Federal Implication
  • Need for strong Centre–State coordination without encroachment.

Governance & Administrative Dimensions

• Lancet Commission’s Diagnosis
  • Fragmented health system:
    • Preventive, promotive, curative care poorly integrated.
• Institutional Recommendations
  • Strengthen:
    • Primary healthcare as the foundation.
    • Referral-based, integrated care pathways.
• Governance Reform
  • Shift from:
    • Disease-specific vertical programmes
    • To people-centred, life-cycle-based care.
• Centre–State Issues
  • Uneven capacity
  • Fiscal asymmetry
• Accountability
  • Citizens should have voice and grievance redressal in health systems.

Economic Dimensions

• Public Health Spending
  • India spends ~2.1% of GDP on health (Economic Survey).
• Out-of-Pocket Expenditure
  • Still ~45–50% of total health expenditure.
• Lancet’s Economic Argument
  • Preventive and primary care reduce:
    • Long-term costs
    • Hospitalisation burden.
• Macroeconomic Link
  • Poor health outcomes reduce:
    • Labour productivity
    • Human capital formation.
• Global Evidence
  • Publicly funded health systems are more cost-effective and equitable.

Social, Ethical & Equity Dimensions

• Equity Concerns
  • Poor, women, elderly disproportionately affected by:
    • OOPE
    • Fragmented care.
• Ethical Lens
  • Healthcare as:
    • Right
    • Public trust
    • Moral obligation of the State.
• Dignity & Consent
  • Citizen-centric care emphasises:
    • Patient dignity
    • Informed consent
    • Continuity of care.
• SDG Link
  • SDG 3: Good Health and Well-being
  • SDG 10: Reduced Inequalities.

Technology Dimensions

• Role of Technology (Lancet View)
  • AI, digital platforms, health data systems should:
    • Support clinicians
    • Improve diagnostics
    • Enable continuity of care.
• Indian Context
  • Digital Health Mission
  • Electronic Health Records (EHRs).
• Risks
  • Tech-first approach may:
    • Exclude digitally marginalised
    • Undermine doctor–patient relationship.
• Principle
  • Technology should augment, not replace, human care.

Data & Evidence

• Nearly 30 experts contributed to the Lancet Commission.
• India’s OOPE ~45–50% of total health expenditure.
• Public health spending ~2.1% of GDP.
• Primary healthcare prevents up to 70% of avoidable hospitalisations (global estimates).
• India faces a dual burden of communicable and non-communicable diseases.

Challenges, Gaps & Criticisms

Structural / Institutional Issues

• Over-reliance on private sector.
• Weak primary healthcare in many States.
• Fragmented service delivery.

Implementation & Design Issues

• Insurance schemes prioritise:
  • Hospital care over prevention.
• Human resource shortages:
  • Doctors, nurses, allied health workers.
• Poor integration of digital health platforms.

Expert / Committee Criticism

• Lancet Commission
  • Warns against:
    • Insurance-only solutions
    • Market-driven healthcare.
• Public Health Experts
  • Emphasise need to rebuild public provisioning capacity.

Way Forward

• Policy Shift
  • Move from insurance-centric to care-centric health policy.
• Financing
  • Increase public health spending to ≥3% of GDP.
• Primary Care
  • Strengthen Health and Wellness Centres as first point of contact.
• Technology
  • Use AI, digital records for:
    • Preventive care
    • Chronic disease management.
• Equity Focus
  • Design systems for:
    • Poor
    • Elderly
    • Rural and tribal populations.
• Governance
  • Institutionalise citizen feedback and accountability mechanisms.