From UPSC perspective, the following things are important :
Mains level: Private Healthcare System in India
Why in the news?
With growing health disparities and inconsistent access to medical services, the need for fair and sustainable healthcare policies has never been more pressing.
Private Healthcare System in India
Private hospitals in India, especially those accredited by the Joint Commission International (JCI) and National Accreditation Board for Hospitals (NABH), are hubs of specialised care and innovation.
These institutions invest heavily in top-tier infrastructure and advanced technologies, significantly enhancing patient outcomes, particularly in complex procedures. Integration of telemedicine and remote care is common, broadening access and building patient trust.
Price Caps, Quality, and Innovation
Affordability vs. Quality: The Supreme Court’s deliberation on standardising medical procedure rates across government and private sectors highlights the tension between affordability and quality. A study indicates a 15% increase in patient dissatisfaction in hospitals under financial pressure from price caps
Impact on Innovation: Price caps could slow the development of new treatments and technologies, particularly in high-investment fields like cancer research and robotic surgery. Value-based pricing, where payments reflect health outcomes rather than service volume, is proposed as a potential solution.
Economic Implications: Properly implemented rate standardisation can alleviate healthcare disparities but must avoid destabilising providers’ economic health. Dynamic pricing models, which adjust based on medical complexity and patient financial status, are recommended. Thailand’s tiered pricing system is cited as a successful example.
Legal and regulatory challenges
No regulation on Rate Fixation: States like Rajasthan and Tamil Nadu have identified significant gaps in the provisions for rate fixation, indicating a need for more robust legal frameworks to ensure fair and standardised pricing across different regions.
Inadequate Laws as per Local Conditions: Current laws may not adequately consider local demographic and economic conditions, necessitating reforms that allow for more customised approaches to healthcare cost management.
Lack in uniform regulation: Moreover,” the Clinical Establishment Act of 2011″, aimed at setting standards for quality, transparency, and accountability, has been adopted by only a few states, and its implementation remains lax. This lack of uniform regulation allows for wide disparities in service costs and quality.
Role of Data in Shaping Policies
Data-Driven Insights: Predictive analytics can foresee the long-term impacts of rate fixation on healthcare innovations, helping policymakers adjust regulations to encourage innovation and accessibility.
Pilot Projects: Implementing pilot projects in select districts can gauge the impact of rate caps on healthcare quality and innovation.
Way Forward
Balanced Pricing Models: Implement value-based pricing where payments are linked to health outcomes rather than the volume of services provided.
Supporting Innovation: Allocate government subsidies and grants for research and development in private hospitals.
Mains PYQ
Q Appropriate local community-level healthcare intervention is a prerequisite to achieve ‘Health for All’ in India. Explain. (UPSC IAS/2018)
From UPSC perspective, the following things are important :
Prelims level: Missing Data and Limitations of Disaster Databases
Why in the news?
The Food and Agriculture Organization (FAO) of the United Nations noted a rise in global disasters from roughly 100 yearly in the 1970s to about 400 in recent years, influenced partly by reporting biases.
Recent Observations
Increase in Disaster Events: The number of disaster events reported worldwide has risen from 100 events per year in the 1970s to around 400 per year in the last 20 years. Patterns in disaster data reveal factors such as increased resilience, climate change, and improved humanitarian response.
Improved Reporting: Reporting of small events, particularly those with fewer than 200 deaths, has increased significantly since the 1980s and 1990s. Historical data mainly included major events due to limited interest and capacity for data collection in earlier periods.
Missing Data and Limitations of Disaster Databases
Biases and Gaps in Historical Records: Earlier records predominantly captured major disasters, with smaller events often missing. Data coverage is particularly poor in low-income regions such as Sub-Saharan Africa and South Asia, where economic losses from disasters are frequently underreported.
Missing Economic Damage and Insured Losses: More than 40% of disasters between 1990 and 2020 lacked estimates of monetary damages. Insured damages were missing in 88% of disaster reports, and 96% needed records of reconstruction costs.
No coverage of Heat Events and Health Impacts: Reporting of heat events is concentrated in a few countries, suggesting underreporting in other regions. Indirect health effects of extreme temperatures, such as increased cardiovascular disease risk, are challenging to quantify and often underestimated.
Need for Data (Way Forward)
Improving Data Coverage: Enhanced data collection in low-income regions and better integration of smaller events into disaster databases are crucial.
Accurate Health Impact Quantification: Improved methods for estimating indirect health effects of extreme temperatures and other disaster-related conditions are needed. Utilising statistical methods to capture the broader health impacts of disasters can aid in better policy formulation.
Policy and Resilience Planning: Reliable and comprehensive disaster data are essential for effective policy-making and resilience planning. Data-driven insights and predictive analytics can help foresee the long-term impacts of disasters and guide regulatory measures to enhance disaster preparedness and response.
Mains PYQ:
Q Discuss the recent measures initiated in disaster management by the Government of India departing from the earlier reactive approach. (UPSC IAS/2020)
From UPSC perspective, the following things are important :
Prelims level: Credit rating agencies
Mains level: How to ensure the benefits of high growth trickle down to the lower income categories?
Why in the news?
The release of India’s GDP data was eagerly anticipated, especially following the recent upgrade in the “sovereign rating outlook” by S&P. It comes just days before the announcement of the union election results.
Back2Basics: Rating Agency
A rating agency is a company that assesses the financial strength of companies and government entities, especially their ability to meet principal and interest payments on their debts.
Fitch Ratings, Moody’s Investors Service and Standard & Poor’s (S&P) are the big three international credit rating agencies controlling approximately 95% of the global rating business.
In India, six credit rating agencies are registered under the Securities and Exchange Board of India (SEBI): CRISIL, ICRA, CARE, SMERA, Fitch India and Brickwork Ratings.
What does the data say?
India’s GDP growth for 2023-24 is 8.2%, exceeding market expectations and surpassing the previous year’s growth of 7%.
Fourth-quarter growth is particularly robust at 7.8%, with upward revisions in previous quarters contributing to overall growth.
Notable divergence of 1 percentage point between GDP and GVA growth in 2023-24, mainly due to increased net taxes.
Sectoral analysis reveals mixed performance, with manufacturing and construction showing strong growth, while agriculture remains subdued.
Expenditure-side breakdown highlights a slower growth rate in private consumption but healthy growth in investment, led mainly by government spending.
Pillars need to be sustained:
Private Consumption: Ensuring sustained consumer spending, particularly by addressing high inflation and low wage growth, to maintain economic momentum.
Investment: Continuously stimulating both government and private sector investment to drive economic expansion and foster innovation and productivity.
Exports: Maintaining competitiveness in global markets and promoting export-oriented growth to leverage external demand and diversify revenue sources.
How to ensure the benefits of high growth trickle down to the lower-income categories?
Improving Private Consumption: Focus on reviving private consumption, especially among lower-income groups. Address concerns of high inflation and low wage growth affecting consumer confidence.
Enhancing Employment Opportunities: Prioritize improving the employment scenario, particularly in sectors generating significant employment like IT and the unorganized sector. Recognize the importance of employment in sustaining consumption growth and overall economic stability.
Investment in Rural Development: Ensure spatial and temporal distribution of rainfall for rural demand recovery. Moderating food inflation and improving employment conditions crucial for rural consumption revival.
Boosting Private Capex Cycle: Create an environment conducive to private investment, focusing on policy certainty and confidence in economic stability. Encourage private sector investment through favourable policies and supportive regulatory frameworks.
Policy Focus on Inclusive Growth: Direct policy attention towards ensuring that the benefits of high growth extend to lower-income categories. Implement targeted social welfare programs and initiatives to support vulnerable groups and reduce income inequality.
Monitoring Global Developments: Stay vigilant of global economic trends and developments that could impact the Indian economy, such as geopolitical tensions and supply shocks. Adapt policies accordingly to mitigate risks and capitalize on opportunities for sustained economic growth.
Conclusion: The Indian government aims to bolster equitable growth through measures such as stimulating private consumption, enhancing employment prospects, and fostering a conducive investment environment, supported by targeted policies and proactive global monitoring.
Mains PYQ:
Q Explain the difference between the computing methodology of India’s Gross Domestic Product (GDP) before the year 2015 and after the year 2015. (UPSC IAS/2021)
From UPSC perspective, the following things are important :
Prelims level: Gold Reserves of RBI
Why in the News?
The RBI has repatriated over 100 tonnes of gold from the UK to its domestic vaults, the largest transfer since at least 1991.
What are Gold Reserves?
A gold reserve is the gold held by a country’s central bank, acting as a backup for financial promises and a store of value.
India, like other nations, stores some of its gold reserves in foreign vaults to spread out risk and facilitate international trading.
India’s Gold Reserves:
As of the end of March 2024, the RBI held 822.10 tonnes of gold, with 408.31 tonnes stored domestically.
The share of gold in the total forex of India is around 7-8% as of 2023.
Where does the RBI store its gold?
India’s gold reserves are primarily stored in the Bank of England, which is known for its stringent security protocols.
The RBI also stores a portion of its gold reserves at the:
Bank for International Settlements (BIS) in Basel, Switzerland, and the
Federal Reserve Bank of New York in the United States.
During India’s foreign exchange crisis in 1990-91, the country pledged some of its gold reserves to the Bank of England to secure a $405 million loan, according to reports.
Even though the loan was paid back by November 1991, India decided to keep the gold in the UK for convenience.
Why does the RBI store its gold in foreign banks?
Convenience: Storing gold overseas makes it easier for India to trade, engage in swaps and earn returns.
Averting Risks: There are risks involved, especially during times of geopolitical tensions and war.
The recent freezing of Russian assets by Western nations has raised worries about the safety of assets kept abroad and the RBI decision to shift a portion of the gold reserve to India could be prompted by these concerns.
Stable Prices: Unlike fiat currencies, which can be subject to inflation or devaluation due to various economic factors, the value of gold tends to be relatively stable over time, which makes it an attractive asset for central banks to hold as a reserve.
Benefits Offered by Gold Reserves
Control domestic gold prices: With its big stash of gold, the RBI can help control local gold prices by using some of it in India. Last financial year, the RBI added about 27.47 tonnes of gold to the total reserve, bringing it to 794.63 tonnes.
Security buffer: The increased gold reserve works as a hedge against any financial crisis and to take measures to control inflation as well as currency devaluation.
Why is the recent move significant?
Efficiency and Confidence: Bringing gold back to India reduces storage fees and signals confidence in the stability of the Indian economy.
Logistical Efficiency: Moving gold to India saves on storage fees paid to foreign custodians, such as the Bank of England.
Diversified Storage: Repatriation ensures diversified storage, enhancing security and reducing dependency on foreign storage.
Has the RBI made similar purchases or transfers of gold in the past?
RBI started buying gold in 2018 and had previously bought 200 tonnes during the global financial crisis in 2009.
In the first quarter of 2024, the RBI bought 19 tonnes of gold, surpassing the 16 tonnes purchased throughout 2023.
PYQ:
[2015] The problem of international liquidity is related to the non-availability of:
From UPSC perspective, the following things are important :
Prelims level: Hunga Tonga Volcano
Why in the News?
Hunga Tonga-Hunga Ha’apai (Hunga Tonga) erupted in Tonga, triggering a tsunami and global seismic waves.
About Hunga Tonga Volcano
The Hunga Tonga-Hunga Ha’apai volcano is situated in the western South Pacific Ocean, west of the main inhabited islands in the Kingdom of Tonga. It lies on the Pacific Ring of Fire.
It forms part of the Tofua Arc, within the larger Tonga-Kermadec volcanic arc, resulting from the subduction of the Pacific Plate beneath the Indo-Australian Plate.
It comprises two small uninhabited islands, Hunga-Ha’apai and Hunga-Tonga.
Hunga Tonga is one of 12 confirmed submarine volcanoes along the Tofua Arc.
Key Findings on Hunga Tonga Eruption
The Hunga Tonga eruption primarily emitted water vapour, which reached the stratosphere, affecting ozone depletion and acting as a potent greenhouse gas. Minimal smoke was produced.
Impact on Weather
Ozone Hole: The study reveals that Hunga Tonga contributed to the exceptionally large ozone hole in the preceding year and the unexpectedly wet summer of 2024.
Global Mean Temperatures: While the eruption had a negligible effect on global temperatures, it induced lasting regional disruptions in atmospheric wave patterns.
Traditionally, massive volcanic eruptions reduce temperatures by emitting sulfur dioxide, which forms sulphate aerosols reflecting sunlight.
Regional Effects: Anticipated changes include colder and wet winters in northern Australia, warmer winters in North America, and colder winters in Scandinavia until approximately 2029.
Do you know?
Previous volcanic eruptions, such as Tamborain 1815 and Samalasin 1257, have significantly impacted global climate, leading to phenomena like the “year without a summer” and the onset of the Little Ice Age.
PYQ:
[2021] Discuss about the vulnerability of India to earthquake-related hazards. Give examples including the salient features of major disasters caused by earthquakes in different parts of India during the last three decades.
From UPSC perspective, the following things are important :
Prelims level: PraVaHa Tool
Why in the News?
The Indian Space Research Organisation (ISRO) has launched the Computational Fluid Dynamics (CFD) software named Parallel RANS Solver for Aerospace Vehicle Aero-thermo-dynamic Analysis (PraVaHa).
About PraVaHa
PraVaHa was developed at ISRO’s Vikram Sarabhai Space Centre (VSSC), showcasing India’s prowess in aerospace technology.
It can simulate both external and internal flows on various aerospace vehicles, including launch vehicles, and winged, and non-winged re-entry vehicles.
It facilitates initial aerodynamic design studies by evaluating numerous configurations, crucial for optimizing vehicle performance and safety.
Role of Computational Fluid Dynamics (CFD)
CFD predicts aerodynamic and aerothermal loads by solving governing equations. It has matured to offer high accuracy and fast simulations, addressing aerospace challenges like high pressure and intense heat flux.
Integration in Gaganyaan Program
Key Applications: PraVaHa plays a pivotal role in the Gaganyaan program, facilitating aerodynamic analysis of human-rated launch vehicles such as HLVM3, Crew Escape System (CES), and Crew Module (CM).
Scalability and Collaboration: Designed to leverage both CPU and GPU architectures, PraVaHa ensures compatibility with existing and future supercomputing facilities, fostering collaboration with academic and government institutions.
PYQ:
[2010] In the context of space technology, what is “Bhuvan”, recently in the news?
(a) A mini satellite launched by ISRO for promoting the distance education in India.
(b) The name given to the next Moon Impact Probe, for Chandrayaan-II.
(c) A geoportal of ISRO with 3D imaging capabilities of India.
From UPSC perspective, the following things are important :
Prelims level: Colombo Process
Why in the News?
India has become chair of the regional grouping “Colombo Process” for the first time since its inception in 2003.
What isthe Colombo Process?
The Colombo Process, established on March 19, 2003, in Colombo, Sri Lanka, is a regional consultative initiative addressing challenges faced by migrant workers from South and Southeast Asia.
Objective:
Primary Goal: The Colombo Process aims to enhance the management of contractual labour migration from Asian countries.
Focus: It seeks to safeguard the rights and welfare of migrant workers while maximizing the benefits of labour migration for both sending and receiving countries.
The Process is non-binding and decision-making is by consensus.
Membership:
Initial Composition: Initially comprising 11 member countries, including Afghanistan, Bangladesh, China, India, Indonesia, Nepal, Pakistan, the Philippines, Sri Lanka, Thailand, and Vietnam.
Expansion: The Process has since expanded to include additional countries like Cambodia and Myanmar.
Five Thematic Area Working Groups (TAWGs) i.e.
Skills and Qualification Recognition (chaired by Sri Lanka);
Fostering Ethical Recruitment (chaired by Bangladesh);
Pre-Departure Orientation and Empowerment (chaired by the Philippines);
Remittances (chaired by Pakistan) and
Labour Market Analysis (chaired by Thailand).
Key Focus Areas:
Policy Development: Addressing various aspects of labour migration, including policy development, capacity building, data collection, and sharing best practices.
Rights Protection: Ensuring the protection of migrant workers’ rights, skills recognition, ethical recruitment, and combating human trafficking and irregular migration.
Activities and Initiatives:
Dialogue Platforms: Regular meetings, conferences, and workshops serve as platforms for dialogue and cooperation among member countries.
Guidelines and Toolkits: Development of guidelines, toolkits, and policy frameworks to assist member countries in effectively managing labour migration.
Collaboration: Collaboration with international organizations such as the International Labour Organization (ILO) and the International Organization for Migration (IOM) to implement joint initiatives and projects.
PYQ:
[2022] ‘India is an age-old friend of Sri Lanka.’ Discuss India’s role in the recent crisis in Sri Lanka in light of the preceding statement.
Q Public health system has limitations in providing universal health coverage. Do you think that the private sector can help in bridging the gap? What other viable alternatives do you suggest? (UPSC IAS/2015)
Q The increase in life expectancy in the country has led to newer health challenges in the community. What are those challenges and what steps need to be taken to meet them? (UPSC IAS/2022)
Mentor Comment: Health insurance, now central to India’s UHC policy, is being enhanced by digital advancements, enabling reforms akin to the U.S. but with cost-effective local adaptations. A South Indian healthcare chain recently integrated insurance and care provision, forming an Indian-style MCO. This prompts reflection on MCOs’ potential to extend universal health care in India significantly.
Let’s learn_ _
Why in the news?
Universal healthcare poses a multifaceted challenge, yet managed care organizations may offer a piece of the solution that Indian healthcare requires.
What is a Managed Care Organization?
A Managed Care Organization (MCO) is a health care company or a health plan that is focused on managed care as a model to limit costs, while keeping quality of care high.
The background of Managed Care Organizations (MCOs) in the United States and India:
Evolution of MCOs in the United States:
MCOs have their origins in rudimentary prepaid healthcare practices in the 20th century.
The mainstreaming of MCOs gained momentum in the 1970s due to concerns over healthcare costs.The economic slowdown post-1970s made high insurance premiums less attractive to purchasers.
A shift occurred towards integrating insurance and healthcare provisioning functions. Focus areas included prevention, early management, and cost control, all under a fixed premium paid by enrollees.
MCOs have evolved through multiple generations and forms, deeply penetrating the health insurance market. While evidence of their effectiveness in improving health outcomes and prioritizing preventive care is mixed, they have been effective in reducing costly hospitalizations and associated costs.
Evolution of MCOs in India:
The first public commercial health insurance emerged in the 1980s.The focus has primarily been on indemnity insurance and covering hospitalization costs.
There is a significant market for outpatient consultations, valued at nearly $26 billion.
Health insurance in India has traditionally lagged behind life and general insurance. The sector faces issues such as lack of innovation and high, often unsustainable, operational costs.
As per Thomas (2011), Health insurance has played a secondary role to other forms of insurance. The industry’s operational inefficiencies and high costs have been persistent issues.
Challenges in India:
Lack of Natural Incentives for Cost Control: The evolutionary trajectory of Indian health insurance has not incentivized consumer-driven cost control.
Target Demographic: Health insurance has mainly targeted a thin, urban, well-off segment, neglecting broader demographics.
Informality in Outpatient Practices: There is widespread informality among outpatient practices, complicating efforts to standardize and regulate care.
Lack of Clinical Protocols: The absence of widely accepted clinical protocols hampers the quality and consistency of care.
Economic Viability: Unprofitable operations and unaffordable premiums pose significant economic challenges, preventing sustainable growth and systemic improvement.
Limited Impact on UHC: Private initiatives, despite their potential, are unlikely to significantly contribute to Universal Health Coverage (UHC) without public support.
Insufficient Control Over Patient Journeys: Health insurers have little control over the patient’s journey before hospitalization, limiting their ability to manage early interventions and reduce costs through comprehensive outpatient care.
Prospective Solutions and Remaining Issues:
Potential for Big Healthcare Brands: Large healthcare brands with loyal urban patient bases and substantial resources may initiate successful managed care projects.
Need for Public Patronage: Exploring managed care with cautious and incremental public patronage could be promising, indicating a need for government involvement to achieve broader impacts.
Underutilization of Outpatient Insurance: Given the low share of insurance in outpatient care spending and the average of three consultations per year per person, there is significant potential to reduce healthcare costs through early interventions and comprehensive outpatient care coverage.
NITI Aayog Report:
Outpatient care insurance scheme: In 2021, NITI Aayog released a report advocating for an outpatient care insurance scheme based on a subscription model to enhance savings through improved care integration.
Yield significant benefits: A well-functioning managed care system can yield significant benefits, including consolidating practices, streamlining management protocols, and emphasizing preventive care in the private sector.
Catering for the beneficiaries of PMJAY: The report highlights the potential of incentives under the Ayushman Bharat Mission to encourage the establishment of hospitals in underserved areas catering to beneficiaries of the Pradhan Mantri Jan Arogya Yojana (PMJAY).
Conclusion: While Managed Care Organizations are not a perfect solution, they can play a role in addressing the complexities of achieving Universal Health Coverage (UHC) in India by being part of a broader strategy.
