Content
- The rise and risks of health insurance in India
- 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
- Regulatory Failure
- Rules (2000) robust, but symbolic in enforcement.
- No updated decibel standards for modern urban realities.
- Institutional Silos
- Poor coordination between SPCBs, municipal bodies, traffic police.
- NANMN = data-rich but action-poor.
- Invisibility & Civic Fatigue
- Unlike smog/garbage, noise leaves no visual trace.
- Public apathy → lack of outrage → no political prioritisation.
- Infrastructure & Growth Pressures
- Late-night drilling, traffic, logistics-driven expansion continue despite restrictions.
- 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.
