First Step to Universal Healthcare: Making Diagnostics Accessible and Cheap

General Studies Paper-3

Context

• Universal healthcare — the ideal system where every citizen, regardless of income, receives quality medical care — needs to begin by making diagnostics accessible, affordable, and ubiquitous.

About Universal Health

• It means that all people have access to the full range of quality health services without financial hardship.
• Key components of UHC include:
  • Access to Care:Everyone should be able to obtain necessary health services when they need them.
  • Quality Services:The care provided should be effective, safe, and of good quality.
  • Financial Protection:Individuals should not face financial difficulties due to medical expenses.
• India is committed to Universal Health Coverage (UHC), as outlined in the National Health Policy 2017 and the UN’s SDGs.

Role of Diagnostics in Effective Healthcare

• Accurate diagnosis is the foundation of effective medical treatment. It relies on patient history, clinical examination, and laboratory tests to confirm or adjust the initial assessment, often predicting disease progression.
• Diagnostics guide over 60% of clinical decisions globally, from identifying diseases early to tailoring treatments and monitoring progress.
  • In India, diagnostics receive less than 5% of total health spending.
• Without timely and reliable diagnostic services, patients risk delayed or incorrect treatment, leading to worse outcomes and higher costs.

Current Gaps in Diagnosis & Need for Localised Services

• Limited Access and Affordability: Diagnostics account for 10 – 15% of out-of-pocket health expenditure, especially in outpatient care.
  • Most public health facilities lack basic diagnostic infrastructure — only 12% of PHCs have labs that meet minimum standards.
  • Private labs dominate the market but are often unaffordable for rural and low-income populations.
• Poor Quality and Regulation:India has over 100,000 labs, but fewer than 2% are accredited by NABL.
  • Many labs operate without standardized protocols, proficiency testing, or external audits.
  • Faulty diagnostics lead to misdiagnosis, delayed treatment, and irrational drug use, fueling antimicrobial resistance.
• Evolving Health Needs and Priority Areas: Shifting demographics and lifestyles have brought non-communicable diseases (NCDs)like diabetes and heart disease to the forefront, alongside persistent infectious diseases such as tuberculosis and malaria.
• Fragmented Data and Digital Disconnect:Lack of integration between public and private diagnostic data systems undermines continuity of care.
  • The Ayushman Bharat Digital Missionaims to bridge this gap, but implementation is uneven.
• Neglect of Preventive Diagnostics:Insurance schemes like PM-JAY focus on inpatient care, excluding preventive diagnostics.
  • Non-communicable diseases (NCDs) like diabetes and cardiovascular conditions require early detection, which is often missed due to lack of routine screening.
• Workforce and Training Deficit:Many technicians lack proper training in test administration, quality control, and ethical practices.
  • Rural areas suffer from acute shortages of skilled diagnostic personnel.

Government and Policy Responses

• National List of Essential Diagnostics (NLED): The ICMR’s updated NLEDreflects India’s health and technology transitions. Key inclusions:
  • PHC-level HbA1C testingfor diabetes monitoring;
  • Rapid testsfor sickle cell anaemia, thalassaemia, hepatitis B, syphilis, and dengue at sub-centres;
  • Molecular TB testingstarting from sub-centres, with in-house testing at higher facilities;
  • Expanded blood chemistry tests at PHCs;
  • Dental X-raysat Community Health Centres (CHCs)
• Ayushman Bharat Health and Wellness Centres:These centers are being equipped to offer frontline diagnostic services, including HbA1c tests for diabetes and rapid tests for infectious diseases.
  • The Ayushman Bharat Digital Mission (ABDM)integrates diagnostics with electronic health records, enabling better data sharing and predictive care.
• Vision 2035 by NITI Aayog:Emphasizes lab networks and surveillance systems as critical components of public health infrastructure.
• G20 Health Working Group: Advocates decentralized manufacturing and regional diagnostic strategies to improve access and affordability.

Innovations and Solutions

• Tele-diagnostics:Services like tele-radiology and tele-pathology bridge expertise gaps between rural clinics and urban hospitals.
• Point-of-Care Devices:Portable diagnostic tools are expanding reach in underserved areas.
• AI and Genomics:Advanced technologies are improving diagnostic accuracy and enabling personalized medicine.
• Technological Advances in Diagnostics: District hospitals now offer enhanced imaging, while PHCs are equipped with semi-auto analysers. Modern healthcare benefits from:
  • Molecular diagnosticsfor higher precision;
  • Tele-diagnostics(tele-radiology, tele-pathology, tele-dermatology) to bridge expertise gaps;
  • Point-of-care devicesfor frontline use.
• Cost-Effectiveness and Evidence-Based Practice: Choosing the right tests involves balancing accuracy and cost. ICMRplays a key role in developing diagnostic algorithms to guide healthcare providers on:
  • Sequential vs. simultaneous testing;
  • Cost–benefit trade-offs;
  • Maximum value per diagnostic step;

Lessons for India

• Countries like Rwanda and Thailandhave shown that investing in diagnostics pays off.
  • Rwanda’s community health worker modelincludes basic diagnostic tools, leading to early detection of diseases like malaria and pneumonia.
  • Thailand’s universal coverage schemeincludes free diagnostics, which has drastically reduced out-of-pocket expenses.
• Lessons from TB and COVID-19: The COVID-19 pandemic accelerated the spread of RT-PCR and molecular diagnosticsacross India.
  • These technologies are now critical for faster TB detection and drug-resistance monitoring, replacing older, less sensitive techniques.

Roadmap: Democratizing Diagnostics

• Public-Private Partnerships:Encourage collaborations between government and private labs to set up low-cost diagnostic centers in underserved areas.
• Mobile Labs and Telemedicine: Deploy mobile diagnostic vans and integrate remote consultations to reach remote populations.
• Subsidies and Insurance Coverage:Include diagnostics in government health schemes like Ayushman Bharat, ensuring tests are covered and not just treatments.
• Local Manufacturing:Invest in domestic production of diagnostic equipment and reagents to reduce dependency on imports and lower costs.
• Training and Workforce Development:Scale up training for lab technicians and radiologists, especially in Tier 2 and Tier 3 cities.
• Building Technical Capacity: Beyond equipment supply, healthcare delivery needs:
  • More trained laboratory technicians;
  • Skilled frontline workers for point-of-care testing
  • Clinical training in interpreting diagnostic probabilities
• AI could support providers in interpreting results and reducing errors.

Conclusion

• Achieving UHC in India requires diagnostics that are affordable, available close to home, and supported by trained personnel.
• By strengthening the diagnostic backbone—through policy, technology, and training—India can ensure early detection, reduce treatment delays, and improve health outcomes for all.