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Indian Health Care Sector- Vision And Failure


  • GS Mains Paper-2, Health

What is the issue?

  • Indian policymakers have done nothing to provide equitable medical care to all citizens cutting across classes.
  • India boasts of having an ultra modern healthcare infrastructure but the masses in India actually aren’t even able to afford even basic medical facilities.

What is NITI Aayog’s vision in the health sector?

  • The NITI Aayog’s 3 year vision document has recommended the government to prioritize preventive care rather than provide curative care.
  • The document has advised the government to focus on the public health as a whole and not merely restrict itself to “health care” and hospitals sector.
  • Further, it asks the government to better public health infrastructure to cater to the needy who can’t afford private care.
  • Notably, out-of-pocket expenses for medical care are about 70% of all medical expenditure in India currently.
  • While the vision statement spelt out seems ambitious, India’s previous track record in health care has resulted in serious skepticism.

How is Indian healthcare sector entrenched in class-based exclusiveness? 

  • It is a hard reality that not all medical interventions are available to every citizen who may need it due shortage of infrastructure and funds.
  • The major technological leaps in medicine starting from 1980s have only widened the gap between the private sector and the government hospitals.
  • Every government since Independence has stated egalitarianism as its goal in health care, but the reality has been rather different.
  • Many interventions, especially those which are very expensive, continue to be accessible only to those who can pay for them.
  • Notably, costly interventions are provided in a few government hospitals, but these are merely tokenism, and an attempt by governments to appear fair.

What happened recently?

  • Even the new “Ayushman Bharat Health Scheme” which covers a whopping 40% of India’s population seems patchy on this count.
  • Notably, the scheme seeks to provide secondary and tertiary care to the economically deprived class, but has a cap of Rs. 5 lakh per family per year.
  • While the beneficiaries can access both private and public hospitals for treatment within that limit, it is unlikely help them access costly treatments.
  • Notably, there are indications that an explicit “negative list” for procedures which will not be covered under the scheme, will be pronounced.

What are other drawbacks of India’s health policy?  

  • In order to promote investments in health, governments have been giving subsidies to private players in health sector.
  • Notably, it is these subsidies that have aided these private hospitals to cater to foreign clients at rates far cheaper than the western world.
  • As subsidies in a way are taxpayer’s money, it is a clear case of taking from the poor to give to the rich private corporate hospitals.
  • Private hospital chains in India have entered every segment of medical care including complex tertiary care, and diagnostics.
  • Most have large investors from abroad and some are effectively controlled by foreign investors, all of whom benefit from the government subsidies.
  • Successive governments have been increasingly dependent on the private sector to deliver health care to the masses.
  • The new “Ayushman Bharat Scheme” would only further this dependence and hospital chains are sure to see a significant spike in their profits.

What is the condition of our public health institutions in India?

  • As health care is indeed costly and out of reach for most citizens, public hospitals continue to be the only resort for the masses.
  • Successive government policies over the year have been favoring private health players over the public sector due to various constrains.
  • Public health sector has been largely under-funded, under-equipped and under-staffed, and its quality and credibility eroded over time.
  • Consequently, even the morale of the doctors and staff in public hospitals has taken a severe beating in comparison to their private sector peers.
  • If public hospitals are to be bettered, coordinated and sustained action is needed on the part of the government, which currently seems lacking.


National e-Commerce Policy- What & Why



  • GS Mains Paper-2, Government Policies and Intervention

Why in news?

  • The “task force” of the Commerce Ministry has submitted its recommendations on a draft national e-commerce policy.
  • The suggestions are comprehensive and if accepted, it can significantly impact the development of e-commerce in India.

How is India’s e-commerce sector doing?

  • India’s e-commerce sector, currently estimated to be worth around $25 billion, is expected to grow to $200 billion over the next 10 years.
  • Much of the projected growth in the sector is due to greater consumer access created by cheaper smart-phones, data tariffs, and enhanced connectivity.
  • Notably, the expansion of 3G and 4G networks have put consumers online even in a considerable number of smaller cities and towns.
  • Further, having covered the metros and large cities, the bigger e-commerce firms expect their future growth to come from tier-II and tier-III towns.
  • These factors are hence resulting in job creation, productivity improvement, and increased consumer presence on online platforms.

How the new e-commerce policy is born?

  • For India to fully benefit from the opportunities that are opening up in cyber-space, it was felt that policymakers have to evolve suitable support structures.
  • To further cyber-businesses, it is imperative to have clearly laid down rules for e-commerce in the country that are consolidated as one set.
  • In this context, the national e-commerce policy was envisioned to create regulations under which online retail will be comprehensively governed.
  • In this context, a “think tank” headed by Commerce Minister “Suresh Prabhu” was set up with secretaries from other and ministries industry representatives.
  • Subsequently, a task force was set up under the commerce secretary to synthesise the ideas of the think-tank and draft an e-commerce policy.
  • The task force has now submitted its report and “draft e-commerce policy”.

What does the task force say about the inventory model for e-commerce?

  • The government does not currently allow foreign direct investment (FDI) in e-commerce companies that hold their own inventories.
  • Hence, online retailers with foreign investments can only operate as marketplaces that let sellers list their products on their platform.
  • But foreign investors have circumvented this clause by establishing subsidiaries that directly list products on their platform.
  • Separately, in 2016, the government mandated that no platform company should have more than 25% of its sales coming from a single seller.
  • Due to the restrictions on the inventory-based model, e-commerce companies have not been able to offer their in-house brands extensively.
  • The task force has recommended allowing FDI in inventory-based e-commerce firms up to 49% in order to facilitate sale of its own brands.
  • But it also seeks to establish the condition that the e-tailer should sell 100% Made-in- India products through its inventory.
  • Further, the task force has sought to regulate subsidiary firms (or group companies) of “Online Marketplace Companies” from listing on their platform.
  • This is to prevent them from directly or indirectly influencing prices of goods and services on their platforms.
  • Further, in this way, the marketplace firms will also not be able to offer deep discounts through their in-house companies listed as sellers.

What about various consumer grievances?

  • There have been several incidents across the country of customers expressing dissatisfaction with products they purchased online and its delivery.
  • This is an inherent flaw of the marketplace model, where platforms do not have full control over the supply chain.
  • Consumer Affairs Ministry’s “National Consumer Helpline” is presently the only redressal mechanism available for such grievances.
  • Currently, “National Consumer Helpline” is receiving more than a lakh complaints related to the e-commerce sector per annum.
  • To effectively address consumer grievances, the task force has suggested the setting up of a Central Consumer Protection Authority (CCPA).
  • CCPA has also been envisioned as the nodal agency for intra-government coordination, and for recording fraudulent e-commerce practices.

What about the recommendations regarding Payment Options?

  • The task force seeks to make it mandatory for e-commerce platforms to provide the government’s RuPay payment option.
  • In order to bring foreign e-commerce sites on par with their Indian counterparts, it has been suggested to make two-factor authentication a rule for all payment systems.
  • With the aim to make online payments safer, the task force has also suggested creating a “”fraud intelligence mechanism”.
  • Notably, a large chunk of payments for online purchases is made through the cash-on-delivery option as there is a lack of trust for online payment.


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