Introduction: Defining Medicalisation and Its Rise in India

Medicalisation refers to the process by which non-medical problems become defined and treated as medical issues, often through biomedical interventions. Since the early 2000s, India has witnessed a sharp increase in medicalisation, driven by expanding private healthcare markets, aggressive pharmaceutical marketing, and policy emphasis on tertiary care. This trend reflects systemic gaps in public health policy, where biomedical solutions overshadow preventive and social determinants of health. The phenomenon is evident in rising diagnostic tests, pharmaceutical consumption, and hospital-based care without commensurate improvements in population health outcomes.

Constitutional and Legal Framework Governing Health and Medicalisation

Article 21 of the Indian Constitution implicitly guarantees the right to health as part of the right to life, as affirmed in the Supreme Court judgment Paschim Banga Khet Mazdoor Samity v. State of West Bengal (1996). The Clinical Establishments (Registration and Regulation) Act, 2010 mandates registration and minimum standards for healthcare providers (Sections 3-7), aiming to regulate quality but has limited enforcement. The Drugs and Cosmetics Act, 1940 (Sections 18, 27) regulates drug approvals and sales but faces challenges in curbing irrational drug use. Medical education and practice standards transitioned from the Medical Council of India to the National Medical Commission Act, 2019 (Sections 10-15), focusing on uniformity but struggling to address commercialization in medical training. These frameworks provide a regulatory skeleton but lack robust mechanisms to control overmedicalisation.

Economic Dimensions: Market Growth and Expenditure Patterns

India's healthcare market was valued at approximately USD 372 billion in 2022, growing at a 16.5% CAGR (IBEF 2023). The pharmaceutical sector alone is USD 42 billion with 9-12% annual growth (Pharma India 2023). Despite this expansion, government health spending remains at 2.5% of GDP (Union Budget 2023-24), with only 1.3% allocated to public health infrastructure (Economic Survey 2023). Out-of-pocket expenditure constitutes 62.6% of total health expenditure (National Health Profile 2023), reflecting inadequate public provisioning. Rising medicalisation inflates costs through increased diagnostics (70% rise since 2015) and pharmaceutical consumption (10% CAGR 2018-2023), without proportional health gains, burdening households financially.

• Healthcare market growth driven by private sector expansion and rising demand for tertiary care
• High out-of-pocket spending exacerbates inequity and impoverishment risks
• Pharmaceutical sales growth fueled by overprescription and aggressive marketing
• Government budget allocation insufficient to strengthen primary and preventive care

Institutional Roles in Health System and Medicalisation

The Ministry of Health and Family Welfare (MoHFW) implements public health programs but prioritizes curative services. The National Medical Commission (NMC) regulates medical education and practice standards, yet commercialization persists. NITI Aayog formulates health policy and promotes reforms but has limited regulatory authority. The Indian Council of Medical Research (ICMR) provides biomedical research and guidelines but is less engaged in social determinants. The Central Drugs Standard Control Organization (CDSCO) oversees drug approvals but struggles to check irrational drug use and over-the-counter sales. The National Health Authority (NHA) implements Ayushman Bharat, which covers 50 crore beneficiaries but focuses heavily on tertiary hospitalisation, reinforcing medicalisation.

Data Trends Illustrating Medicalisation in India

Comparative Analysis: India vs United Kingdom on Medicalisation

The UK's National Health Service (NHS) prioritizes primary care and preventive health, with only 20% of health expenditure on hospital-based care (NHS England Annual Report 2023). This model achieves better health outcomes and cost efficiency by reducing unnecessary medical interventions. In contrast, India allocates a disproportionate share to tertiary care and biomedical interventions, resulting in inflated costs and limited population health improvements.

Critical Gaps Driving Medicalisation in India

• Policy bias towards curative and tertiary care over preventive and social determinants
• Weak regulation of private healthcare providers and pharmaceutical marketing
• Inadequate public health infrastructure and budget allocation
• Overdiagnosis and overtreatment due to profit incentives and lack of standard treatment guidelines enforcement
• Limited community-based and primary healthcare focus in schemes like Ayushman Bharat

Way Forward: Rebalancing Health Policy and Regulation

• Increase public health spending to at least 5% of GDP, prioritizing primary and preventive care
• Strengthen enforcement of Clinical Establishments Act and CDSCO regulations to curb overmedicalisation
• Expand community health worker programs and social determinants interventions
• Reorient Ayushman Bharat towards comprehensive primary care and outpatient services
• Promote rational drug use through stricter pharmaceutical marketing controls and physician education

Jharkhand & JPSC Relevance

• JPSC Paper: Paper 2 (Health and Social Welfare), Paper 4 (Economic Development)
• Jharkhand Angle: Jharkhand’s rural health infrastructure is underdeveloped, with high out-of-pocket expenditure and limited preventive care programs, mirroring national trends in medicalisation.
• Mains Pointer: Analyse Jharkhand’s health budget allocation, private sector growth, and diagnostic usage trends to illustrate medicalisation’s local impact and suggest state-specific regulatory reforms.