In a crucial domain like the public healthcare system the Indian State should play a vital role to contain the adverse impact of marketisation of the system. Suggest some measures through which the State can enhance the reach of public healthcare at the grassroots level.

Healthcare is a classic case of market failure: information asymmetry, high out-of-pocket costs (still nearly half of total health spending) and supplier-induced demand push the poor into distress. Unchecked marketisation concentrates services in cities and profitable specialities, weakening equity and universal access. Hence the State must remain the guarantor of health as a public good.

Why market alone fails

• Private care clusters in urban, tertiary segments, bypassing villages and preventive care.
• Catastrophic out-of-pocket spending pushes families below the poverty line each year.

Measures to enhance grassroots reach

• Universalise comprehensive primary care through Ayushman Arogya Mandirs (Health and Wellness Centres) covering NCDs, maternal and mental health.
• Fix the human-resource gap: mid-level providers, incentivised rural postings, and strong ASHA and ANM cadres.
• Ensure free essential drugs and diagnostics, expanding Jan Aushadhi Kendras.
• Raise public health spending toward the 2.5% of GDP target of the National Health Policy 2017.
• Regulate the private sector via the Clinical Establishments Act, standard treatment guidelines and price caps.
• Leverage the Ayushman Bharat Digital Mission for teleconsultation and portable records; strengthen local governance and social audit.

The Tamil Nadu and Kerala models show that a well-financed, regulated public system delivers equity. An enabling, accountable State-led architecture is the surest route to universal health coverage at the grassroots.