Question map
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?
Explanation
The correct answer is Option 2.
Statement-I is correct: Historically, India's public health system has been skewed toward curative care provided through hospitals. Despite the National Health Policy's emphasis on primary care, there remains a significant gap in delivering comprehensive preventive (vaccination, screening), promotive (nutrition, hygiene), and rehabilitative services at the grassroots level.
Statement-II is correct: Under the Seventh Schedule of the Indian Constitution, "Public health and sanitation; hospitals and dispensaries" fall under the State List. Thus, India follows a decentralized model where State governments are primarily responsible for the planning, financing, and delivery of health services.
Relationship: While both statements are factually accurate, Statement-II does not explain Statement-I. The curative bias (Statement-I) is a result of historical funding patterns, infrastructure priorities, and policy implementation gaps, rather than a direct consequence of the constitutional division of powers (Statement-II). Decentralization itself does not mandate a focus on curative care; in fact, it is intended to improve local preventive outreach.
PROVENANCE & STUDY PATTERN
Full viewThis question bridges static Polity (7th Schedule) with the analytical 'Social Sector' chapter of the Economic Survey. It tests if you understand the structural flaws of India's health architecture (curative bias) rather than just memorizing scheme names. It rewards candidates who read the 'Challenges' section of NITI Aayog reports or NCERT Indian Economic Development.
This question can be broken into the following sub-statements. Tap a statement sentence to jump into its detailed analysis.
- Statement 1: Is India's public sector health care system primarily focused on curative care rather than preventive, promotive, and rehabilitative care?
- Statement 2: Does India's public sector health care system provide only limited preventive, promotive, and rehabilitative services?
- Statement 3: Under India's decentralized health care delivery system, are the States primarily responsible for organizing and delivering health services?
Explicit reference to India as a destination for curative medical tourism (cardiology, orthopaedics, transplants) highlights prominence of high-end curative services.
A student could contrast the visibility and investment in tertiary/curative hospitals (often private) with evidence on public primary/preventive service footprints to judge sectoral emphasis.
Notes policy shift (2015 NHP) emphasizing private healthcare and insurance (Ayushman Bharat) while merging some national programmes — suggesting a move toward financing curative services rather than expanded public preventive infrastructure.
Combine this with data on public health spending composition (e.g., insurance payouts vs. PHC budgets) to infer whether public sector focus shifted to curative care.
National Population Policy goals include prevention and control of preventable diseases and integration of Indian systems in reproductive and child health — showing stated policy emphasis on preventive/promotive actions.
Compare these stated preventive aims with implementation indicators (coverage of immunisation, family planning, community health workers) to assess if public sector action matches rhetoric.
Kerala's low infant mortality is linked to 'adequate provision of basic health and educational facilities', implying public provision of basic/preventive services yields better outcomes.
A student could map state-level public primary care provisioning to health outcomes to see if stronger public preventive services correspond to better indicators, suggesting where public focus lies.
Points out a rising burden of chronic diseases and that air quality policies are disconnected from health sector realities, indicating gaps in preventive environmental-health integration.
Use this to probe whether public health policy/practice prioritises upstream prevention (environmental, behavioural) or mainly treats downstream clinical disease.
- Directly states preventive healthcare delivered through primary health centres (PHCs) was found to be lacking.
- Implies that preventive components of the public system are limited in practice despite the intended comprehensive design.
- Notes that implementation challenges remain significant in many regions, which would limit delivery of services.
- Specifically cites infrastructure deficiencies in the public sector that constrain service provision.
Describes Ayushman Bharat as a government insurance scheme providing coverage for secondary and tertiary hospital treatment (curative) in public and private facilities.
A student could note the policy focus on curative, then check whether comparable public funding/existence of programmes explicitly target preventive/promotive/rehabilitative care (e.g., primary health centres, community programmes).
States that the 2015 National Health Policy did not increase government spending and emphasised the role of private healthcare organisations; also mentions merging several national programmes into the National Health Mission and sanitation (Swachh Bharat).
One could infer that constrained public spending plus privatization emphasis may limit public-sector capacity for non-revenue preventive/promotive/rehabilitative services and then compare budgets and service coverage between public and private sectors.
Highlights India's reputation in curative specialties and medical tourism, and credible private-sector strength in wellness and prevention/alternative medicine.
A student might use this to hypothesize that much preventive/promotive service provision (wellness, AYUSH) is concentrated in private or market-oriented providers and then survey availability of such services in public facilities.
The National Population Policy objectives include prevention and control of preventable diseases and integrating Indian Systems of Medicine for reproductive and child health—an explicit preventive/promotive policy aim.
Use this as a benchmark: compare stated public-policy preventive/promotive aims with on-the-ground public-sector service provision (staffing, programmes at primary level) to see if policy translates into broad public provision or is limited.
Argues that creating the wherewithal for providing public services (including health) has not been seriously initiated, implying gaps in supply of public health services.
A student could combine this with data on public health infrastructure (PHCs, community health workers) to assess whether the public sector is under-providing preventive/promotive/rehabilitative services.
- Explicitly states public health is a state subject and that creation of separate Ayush departments is under State/UT governments' purview.
- Describes state-level project management units (SPMU/DPMU) and directorates as mechanisms for implementing health programmes.
- Identifies decentralised planning and programme implementation as a core strategy for achieving national socio-demographic goals.
- Implies delivery of services is organized at subnational/local levels as part of decentralisation.
- Links Kerala's low infant mortality to adequate provision of basic health and educational facilities, attributing outcomes to state-level provisioning.
- Illustrates how differing performance across regions reflects the role of subnational governments in health service delivery.
- [THE VERDICT]: Manageable / Analytical. Statement II is standard Polity (Laxmikanth/NCERT). Statement I is a 'Mains-style' critique found in Economic Survey (Social Infrastructure chapter).
- [THE CONCEPTUAL TRIGGER]: Health Sector Architecture. Specifically, the imbalance between Primary (Preventive) vs Tertiary (Curative) care infrastructure.
- [THE HORIZONTAL EXPANSION]: 1. Constitutional Split: Public Health (State List, Entry 6) vs Population Control (Concurrent, Entry 20A). 2. NHP 2017 Goal: Increase health spending to 2.5% of GDP. 3. Ayushman Bharat Components: PM-JAY (Curative/Insurance) vs Health & Wellness Centres (Preventive). 4. OOPE Data: Out-of-Pocket Expenditure is ~48% due to private curative reliance.
- [THE STRATEGIC METACOGNITION]: When preparing social sectors (Health/Education), always memorize the 'Fundamental Critique'. For Indian Health, the standard critique is: 'Hospital-centric, Curative-biased, and Under-funded.' This single concept validates Statement I immediately.
Health systems can prioritise high-end curative services or population-level preventive, promotive and rehabilitative interventions, which changes health outcomes and service orientation.
High-yield for UPSC because questions probe the balance between curative and preventive care in policy and outcomes. Links to public health, health policy, and social sector questions; enables evaluation-type answers (cause, consequence, reforms) and policy recommendations.
- Indian Economy, Nitin Singhania .(ed 2nd 2021-22) > Chapter 14: Service Sector > Medical Tourism > p. 429
- Science ,Class VIII . NCERT(Revised ed 2025) > Chapter 3: Health: The Ultimate Treasure > Activity 3.7: Let us infer > p. 42
- Environment, Shankar IAS Acedemy .(ed 10th) > Chapter 5: Environmental Pollution > Fourth > p. 101
Shifts in government spending and emphasis on private healthcare alter the public sector’s capacity and focus across curative and preventive services.
Important for mains and interview where candidates must assess policy direction and implications of financing choices. Connects to topics on health policy, Ayushman Bharat, and governance; useful for questions on state capacity, equity, and access.
- Rajiv Ahir. A Brief History of Modern India (2019 ed.). SPECTRUM. > Chapter 39: After Nehru... > Health Policy > p. 781
- Indian Economy, Nitin Singhania .(ed 2nd 2021-22) > Chapter 14: Service Sector > Medical Tourism > p. 429
National population and health policies set explicit preventive and promotive objectives (e.g., disease prevention, reproductive and child health integration).
Crucial for factual and analytical answers on health policy implementation and outcomes. Links to welfare programmes, state performance comparisons (e.g., Kerala), and helps frame critiques or assessments of delivery gaps.
- Geography of India ,Majid Husain, (McGrawHill 9th ed.) > Chapter 13: Cultural Setting > The National Population Policy, 2000 > p. 116
- Understanding Economic Development. Class X . NCERT(Revised ed 2025) > Chapter 1: DEVELOPMENT > DEVELOPMENT 11 > p. 11
- Rajiv Ahir. A Brief History of Modern India (2019 ed.). SPECTRUM. > Chapter 39: After Nehru... > Health Policy > p. 781
Recent central programmes prioritise health insurance and secondary/tertiary curative care rather than expanding preventive or rehabilitative provisioning.
High-yield for UPSC: explains policy shifts towards insurance-based curative models and private provision, links to debates on public vs private roles in health, fiscal priorities, and program evaluation questions. Useful for answering policy critique, scheme comparison, and governance questions.
- Indian Economy, Nitin Singhania .(ed 2nd 2021-22) > Chapter 14: Service Sector > Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana > p. 427
- Rajiv Ahir. A Brief History of Modern India (2019 ed.). SPECTRUM. > Chapter 39: After Nehru... > Health Policy > p. 781
Policy measures have promoted inclusion of Ayurveda, Yoga and other traditional systems into reproductive, child health and wellness initiatives.
Important for UPSC: connects health policy design, pluralistic medical systems, and preventive/promotive health strategies; enables answers on culturally embedded policy responses and health system integration. Helps in questions on traditional medicine's role in public health and medical tourism linkages.
- Geography of India ,Majid Husain, (McGrawHill 9th ed.) > Chapter 13: Cultural Setting > The National Population Policy, 2000 > p. 116
- Indian Economy, Nitin Singhania .(ed 2nd 2021-22) > Chapter 14: Service Sector > Medical Tourism > p. 429
Analyses point to insufficient public-service infrastructure, low public spending and general public-sector performance problems that affect delivery of health services.
High-yield for UPSC: frames questions on public expenditure, service delivery deficits, and poverty-health linkages; useful for policy reform recommendations and critiques of implementation capacity. Connects to budgeting, governance, and social-sector outcomes.
- Indian Economy, Vivek Singh (7th ed. 2023-24) > Chapter 8: Inclusive growth and issues > 8.14 Poverty Eradication: Public services or Income support > p. 278
- Geography of India ,Majid Husain, (McGrawHill 9th ed.) > Chapter 11: Industries > Problems of Public Sector > p. 89
- Rajiv Ahir. A Brief History of Modern India (2019 ed.). SPECTRUM. > Chapter 39: After Nehru... > Health Policy > p. 781
Primary responsibility for organizing and delivering public health falls to subnational governments, making them central actors in health service delivery.
High-yield for questions on federal division of responsibilities, health governance and implementation of national programmes; connects constitutional federalism with practical service delivery and helps answer questions on centre–state roles in policy execution.
- Exploring Society:India and Beyond ,Social Science, Class VIII . NCERT(Revised ed 2025) > Chapter 6: The Parliamentary System: Legislature and Executive > Action Taken: > p. 150
- Introduction to the Constitution of India, D. D. Basu (26th ed.). > Chapter 5: NATURE OF THE FEDERAL SYSTEM > NATURE OF THE FEDERAL SYSTEM > p. 64
While 'Public Health' is a State subject (Entry 6, List II), 'Prevention of the extension from one State to another of infectious or contagious diseases' is actually in the Concurrent List (Entry 29, List III). This is a potential trap for future questions on pandemic management.
Use the 'Structural Flaw' Heuristic. In UPSC, statements that highlight a well-known, long-standing structural deficiency of the Indian system (e.g., 'focuses on curative over preventive', 'focuses on road over rail', 'focuses on cereals over pulses') are almost always CORRECT. The system is rarely praised for being 'perfectly balanced' in these analytical options.
Connect this to GS2 Federalism: The 'Vertical Fiscal Imbalance'. States have the responsibility (Statement II) but lack the independent revenue to fund expensive preventive infrastructure, forcing a reliance on Central schemes (CSS) which often dictate the focus. This explains the gap in Statement I.