UPSC Prelims 2023 Q75: India's Public Health Care System — Explained
Consider the following statements:
Statement-I:
India's public sector health care system largely focuses on curative care with limited preventive, promotive and rehabilitative care.
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?
- Both Statement-I and Statement-II are correct and Statement-II is the correct explanation for Statement-I
- Both Statement-I and Statement-II are correct and Statement-II is not the correct explanation for Statement-I
- Statement-I is correct but Statement-II is incorrect
- Statement-I is incorrect but Statement-II is correct
Answer: (b) Both Statement-I and Statement-II are correct and Statement-II is not the correct explanation for Statement-I
Statement-wise explanation
- Statement-I: correct — India's public health system was planned from the 1940s (Bhore Committee) as a three-tier network meant to deliver both preventive and curative care. In practice, money and staff have gone mostly to hospitals and treating illness. Health promotion, screening and rehabilitation have stayed weak. WHO's India Health System Review (March 2022) describes the public sector in exactly these terms, and the push to convert sub-centres and PHCs into Health and Wellness Centres was meant to correct this curative bias.
- Statement-II: correct — 'Public health and sanitation; hospitals and dispensaries' is Entry 6 of the State List (List II, Seventh Schedule). State Departments of Health and Directorates of Health Services organise and deliver care, from primary centres up to district and tertiary hospitals. The Centre supports them with money and technical help, mainly through the National Health Mission. But this does not explain Statement-I: who organises health services (the States) says nothing about why care leans curative. That bias comes from underfunding, hospital-centred spending and patient demand, and it shows up in central institutions too.
How to eliminate
Statement-II can be settled from basic polity: health is a State subject (Entry 6, List II). That rules out the option calling Statement-II incorrect. Statement-I uses a soft word ('largely'), not an absolute one, and repeats a standard criticism of Indian health care. That makes it very likely true, which also rules out the option calling Statement-I incorrect. The real test is the link between them. Use the 'because' test: 'Care is curative because States organise health services.' This does not follow. A federal division of work explains who delivers care, not what kind of care gets delivered. If one statement only describes structure and the other describes an outcome with other causes, Statement-II is usually 'correct but not the explanation'.
Know more
Who does what in Indian health care
The Constitution puts most of health with the States, but the Centre has key concurrent and Union powers.
| List (Seventh Schedule) | Health-related entries |
|---|---|
| State List (II) | Entry 6: Public health and sanitation; hospitals and dispensaries |
| Concurrent List (III) | Entry 19: drugs and poisons; Entry 20A: population control and family planning; Entry 26: medical and other professions; Entry 29: preventing infectious diseases from spreading between States |
| Union List (I) | Entry 81: inter-State quarantine |
So States run hospitals and primary care. The Centre shapes policy and pays through Centrally Sponsored Schemes like the National Health Mission. It also directly runs institutions such as the AIIMS.
The four kinds of care
| Type | Aim | Example |
|---|---|---|
| Promotive | Improve overall health | Yoga, nutrition, health education |
| Preventive | Stop disease before it starts | Immunisation, NCD screening |
| Curative | Treat illness | OPD, surgery, medicines |
| Rehabilitative | Restore function after illness | Physiotherapy, disability care |
Why public care stays curative: low public spending, hospital-centred budgets, and patients who seek care only once they are ill. Private providers handle about 70% of outpatient visits and 58% of inpatient episodes (WHO India Health System Review, 2022). The public system has competed with them mostly on treatment.
Course correction: The National Health Policy 2017 and Ayushman Bharat's Health and Wellness Centres aim for comprehensive primary health care. That means preventive, promotive, curative, rehabilitative and palliative care close to home.
In the news
Both statements closely follow the wording of WHO's India Health System Review (Asia Pacific Observatory, 30 March 2022), published a year before the exam. The Ayushman Bharat Health and Wellness Centres rollout, with its target of 1.5 lakh centres by December 2022, kept the shift from curative to comprehensive primary care in the news.
NCERT Concepts to Revise
- State List: Statement-II rests on where 'public health and hospitals' sits among the constitutional lists.
- Union, State and Concurrent Lists: Health entries are spread across all three lists, so you need to know which level controls what.
- Health expenditure: How health money is spent, on hospitals versus prevention, is central to judging Statement-I.