UPSC Darpan

MedicalMarichi · UPSC

Bimaari ka Bill Kaun Bharta Hai: OOPE, PM-JAY aur Primary Care

Ek parivaar ko hospital ka bill toh insurance ne bacha liya — phir agle saal woh gareebi rekha ke neeche kyun chala gaya?

Socho pehle… phir dekho jawab

Kyunki bimaari ka bada kharch hospital ke andar nahi, uske bahar hota hai — dawaiyan, jaanch aur baar-baar ki OPD visit. Isi ko out-of-pocket expenditure (OOPE) kehte hain, aur jab yeh ghar ke kharch ka bada hissa kha jaaye toh use catastrophic health expenditure kehte hain.

Do paribhasha pakki karo. OOPE woh paisa hai jo parivaar ilaaj ke waqt seedha apni jeb se deta hai. Catastrophic health expenditure tab maana jaata hai jab yeh kharch ghar ke kul upbhog ke ek tay hisse (jaise 10%) ko paar kar jaaye; aur jo parivaar isi wajah se gareebi rekha ke neeche chale jaayein, woh impoverishment effect hai. National Health Accounts ke anumaan batate hain ki OOPE ka hissa pichhle dashak mein kaafi ghata hai par abhi bhi oonchi hai — aur uska bada hissa dawaiyon aur outpatient care ka hai.

Ayushman Bharat ke do stambh. Health and Wellness Centres, jinhe ab Ayushman Arogya Mandir kaha jaata hai — sub-centre aur PHC ko upgrade karke comprehensive primary care, NCD screening samet. Aur PM-JAY, jo patra parivaron ko prati parivaar prati varsh ₹5 lakh tak ka secondary aur tertiary hospitalisation cover deta hai, aur jise 70 saal se upar ke sabhi buzurgon tak badhaya gaya. Nuance: PM-JAY mukhya roop se bharti cover karta hai, routine OPD aur bahar se khareedi dawa nahi — isliye insurance badhne par bhi OOPE apne aap nahi girta.

Supply side Bhore Committee (1946) se shuru hota hai, jisne preventive aur curative ko jodne aur PHC aadharit dhaanche ki sifarish ki thi. Doctor-population ratio par WHO ka 1:1000 norm quote hota hai; sarkar allopathic aur AYUSH milakar behtar aankda batati hai, jabki aalochak kehte hain ki 'registered' aur 'rural mein practising' ek baat nahi — nurse-ANM ki kami isse bhi gehri hai. NMC Act, 2019 ne MCI ki jagah NMC banayi. Keemat par: Jan Aushadhi generic dawa sasti deta hai, aur NPPA, DPCO 2013 ke tehat NLEM ki dawaon ka ceiling price tay karta hai.

Prelims trap: Seventh Schedule mein 'public health and sanitation, hospitals and dispensaries' State List mein hain, jabki 'population control and family planning' aur 'medical education' Concurrent List mein. National Health Policy, 2017 ne public health expenditure ko GDP ka 2.5% tak le jaane ka lakshya rakha tha. AMR ko One Health ke chashme se dekho — National Action Plan on AMR aur antibiotic packs par Red Line campaign isi ka hissa hain. Note: yeh lesson policy samajhne ke liye hai; ismein kisi bimaari ki pehchaan ya dawa ki salah nahi hai.

Ghar pe try karo

Apne zile ka naam daal kar PM-JAY ke empanelled hospitals ki list dekho aur gino ki unmein sarkari kitne hain aur private kitne. Phir ek chhoti table banao: 'primary care mein nivesh' vs 'insurance cover' — har ek ke do faayde aur do seemayein. Yeh table Mains mein ready-made structure ban jaayegi.

Wow!

Bhore Committee ne 1946 mein hi likh diya tha ki koi paise ki kami se ilaaj se vanchit na rahe — 80 saal baad bhi hamari sabse badi swasthya chunauti wahi ek vaakya hai.

3 sawaal

  1. 'Catastrophic health expenditure' ka sahi arth kya hai?
    Jawab dekho

    Ghar ka swasthya kharch jo uske kul upbhog ke ek tay hisse (threshold) se zyada ho jaaye. Yeh household-level concept hai; isi se impoverishment effect naapa jaata hai.

  2. PM-JAY ke baare mein kaunsa kathan sahi hai?
    Jawab dekho

    Yeh prati parivaar prati varsh ₹5 lakh tak secondary aur tertiary hospitalisation cover deta hai. Trap: OPD aur bahar se khareedi dawa aam taur par cover nahi — isliye insurance ke baavjood OOPE bacha reh sakta hai. Empanelled private hospitals bhi shaamil hain aur 70+ buzurg bhi.

  3. Trap: Seventh Schedule ke anusaar kaunsa vishay Concurrent List mein hai?
    Jawab dekho

    Population control and family planning. Public health, sanitation, hospitals aur dispensaries State List mein hain; population control, family planning aur medical education Concurrent List mein.

NCERT se jodo: GS2 — Health governance (issues relating to development and management of social sector: health); GS3 — Science & Technology (AMR, pharma); NCERT Class 12 Biology — human health and disease

Baal Darpan app kholo