Overview of Medicalisation in India

Medicalisation refers to the process by which non-medical problems become defined and treated as medical issues, often through biomedical interventions. In India, this phenomenon has accelerated over the last two decades, driven by expanding healthcare markets, increased diagnostic capabilities, and commercialization of health services. The healthcare market in India was valued at approximately USD 372 billion in 2022 and is projected to reach USD 650 billion by 2025 (IBEF 2023). This growth, however, has been accompanied by a disproportionate focus on curative biomedical services rather than preventive or community-based care, raising concerns about equity, cost, and health outcomes.

Constitutional and Legal Framework Governing Healthcare

Article 21 of the Indian Constitution, interpreted by the Supreme Court in Paschim Banga Khet Mazdoor Samity v. State of West Bengal (1996), affirms the right to health as intrinsic to the right to life. The Clinical Establishments (Registration and Regulation) Act, 2010 mandates registration and minimum standards for healthcare providers (Sections 3-6). The Drugs and Cosmetics Act, 1940 regulates drug approval and quality control (Sections 18-26), while the National Medical Commission (NMC) Act, 2019 replaced the Medical Council of India to oversee medical education and ethics, aiming to improve standards and curb malpractices that contribute to over-medicalisation.

• Article 21 ensures access to health as a fundamental right under the right to life.
• Clinical Establishments Act enforces minimum standards to regulate clinical practice and infrastructure.
• Drugs and Cosmetics Act controls pharmaceutical quality, preventing irrational drug use.
• NMC Act reforms medical education to address ethical concerns and promote rational treatment.

Economic Dimensions of Medicalisation

India’s healthcare expenditure is heavily skewed toward curative services, constituting over 70% of total spending (National Health Profile 2023). Out-of-pocket expenditure remains high at 62.6% (National Health Accounts 2019-20), pushing approximately 7% of the population below the poverty line annually (World Bank 2022). The rapid growth of the medical device market at 15.8% CAGR (IBEF 2023) and increased antibiotic consumption by 22% from 2010 to 2020 (Lancet Infectious Diseases, 2022) reflect a growing dependence on costly, technology-driven interventions rather than preventive care. Government health budget allocation remains low at 2.5% of GDP (Union Budget 2023-24), far below the WHO recommended 5%, limiting public investment in primary and preventive health.

• High out-of-pocket expenses exacerbate health inequities and financial distress.
• Medical device imports constitute 70% of demand, indicating dependence on foreign technology.
• Rising costs of diagnostics and pharmaceuticals drive up household health expenditure.
• Limited public spending restricts expansion of preventive and community health services.

Institutional Landscape and Its Role in Medicalisation

Key institutions shaping India's healthcare include the National Medical Commission (NMC), which regulates medical education and ethics; the Ministry of Health and Family Welfare (MoHFW), responsible for policy formulation; the Indian Council of Medical Research (ICMR), which conducts biomedical research; the National Health Authority (NHA), implementing the Ayushman Bharat insurance scheme; and the Central Drugs Standard Control Organization (CDSCO), which regulates pharmaceuticals and medical devices. Despite these institutions, the system prioritizes hospital-based curative care over primary and preventive services, as evidenced by Ayushman Bharat’s focus on hospitalisation rather than comprehensive primary care coverage.

• NMC’s reforms have not sufficiently curbed unethical practices promoting unnecessary interventions.
• MoHFW policies often emphasize tertiary care infrastructure over community health.
• ICMR’s biomedical focus sidelines integration of traditional and preventive systems.
• NHA’s health insurance coverage excludes preventive and outpatient services, reinforcing medicalisation.
• CDSCO’s regulatory capacity is challenged by the rapid expansion of medical devices and pharmaceuticals.

Data Trends Illustrating Medicalisation

The National Family Health Survey-5 (2019-21) reports a 17% increase in non-communicable disease diagnoses, largely attributed to increased medical screening rather than actual disease prevalence rise. India’s doctor-population ratio stands at 0.9 per 1000 (MoHFW 2023), below the WHO norm of 1:1000, leading to over-reliance on medical interventions rather than community health workers. Antibiotic consumption surged by 22% between 2010 and 2020, raising concerns about antimicrobial resistance linked to over-medicalisation. The Ayushman Bharat scheme enrolled over 50 crore beneficiaries but primarily covers inpatient hospitalisation, neglecting outpatient, preventive, and traditional care.

• Increased diagnosis rates reflect medical screening expansion, not necessarily better health outcomes.
• Doctor shortage drives dependence on biomedical interventions over community-based care.
• Rising antibiotic use signals irrational prescription and potential public health risks.
• Insurance coverage gaps limit preventive and primary care access.

Comparative Analysis: India vs Cuba on Healthcare Approach

Cuba’s emphasis on primary care and community health workers yields better health outcomes with higher life expectancy and lower per capita expenditure compared to India, highlighting the drawbacks of India’s medicalised, hospital-centric model.

Critical Gaps in India’s Healthcare Model

The dominant biomedical model marginalizes traditional and preventive healthcare systems such as AYUSH, administered by the Ministry of AYUSH. This fragmentation leads to overdependence on expensive medical interventions without addressing social determinants of health. The lack of integration reduces cost-effectiveness and limits community participation in health maintenance. Furthermore, the skewed focus on curative care neglects preventive strategies essential for controlling non-communicable diseases and infectious diseases alike.

• Fragmented healthcare delivery reduces efficiency and increases costs.
• Underutilization of AYUSH systems limits culturally appropriate, affordable care options.
• Social determinants of health remain unaddressed, perpetuating health inequities.
• Over-medicalisation inflates healthcare costs and burdens households financially.

Way Forward: Addressing Medicalisation in India

• Increase public health expenditure to at least WHO-recommended 5% of GDP, prioritizing primary and preventive care.
• Integrate AYUSH and biomedical systems to provide holistic, cost-effective care addressing social determinants.
• Strengthen regulatory frameworks under NMC and CDSCO to curb irrational medical practices and overuse of diagnostics and antibiotics.
• Expand community health workforce and incentivize preventive healthcare delivery to reduce hospital dependence.
• Revise Ayushman Bharat to include outpatient and preventive services, enhancing insurance coverage breadth.

Jharkhand & JPSC Relevance

• JPSC Paper: Paper 2 - Health and Social Welfare, Public Health Challenges
• Jharkhand Angle: High out-of-pocket expenditure and limited primary healthcare infrastructure in Jharkhand exacerbate the impact of medicalisation on vulnerable populations.
• Mains Pointer: Highlight Jharkhand’s healthcare access gaps, the role of community health workers, and integration of AYUSH to reduce overdependence on costly biomedical interventions.