India’s problem of overtreatment and overmedication
Unnecessary tests, prescriptions and procedures are part of the growing overtreatment problem
360° Perspective Analysis
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Context
An editorial highlights the growing challenge of overmedicalisation and overtreatment in India's healthcare system, driven by factors like excessive diagnostic testing, a fragmented specialist-focused approach, and the commercialisation of healthcare. While advancing medical technology enables early detection, it has also led to unwarranted interventions, false positives, and polypharmacy, particularly among the elderly. The author advocates for systemic reforms, including strengthening primary care, promoting the 'Choosing Wisely' global movement, and shifting payment models to reward clinical reasoning over the volume of services.
UPSC Perspectives
Governance
The issue of overtreatment underscores critical gaps in healthcare governance and the urgent need for structural reforms, particularly within the framework of (UHC). The editorial points to the commercialisation of medicine, where investigations and procedures are treated as products, exacerbated by the fee-for-service model that incentivizes volume over value. To counter this, there is a need to shift towards value-based care models where payment is tied to patient outcomes and adherence to evidence-based practices. The author's recommendation to empower bodies like the (ICMR) to develop lists of low-value tests aligns with the need for strong regulatory guidelines and standard treatment protocols. This connects to UPSC questions on the effectiveness of healthcare regulations (e.g., the ), the role of medical councils in ensuring ethical practice, and how to transition India's health architecture towards sustainable, patient-centric models rather than profit-driven systems.
Social
The social dimension of this issue is characterized by a stark paradox of healthcare in India: the coexistence of overtreatment for those who can afford it and severe undertreatment for the marginalized. This dual burden reflects deep-seated socio-economic inequalities. Overtreatment, driven by unnecessary diagnostics and polypharmacy (the simultaneous use of multiple drugs), disproportionately affects the elderly and the urban middle class, leading to potential harm and financial toxicity. Conversely, rural and poorer populations struggle to access essential primary care. The editorial strongly advocates for reviving the role of the family physician and strengthening the primary care infrastructure, which is a core tenet of the scheme's Health and Wellness Centres. From a UPSC perspective, this highlights the necessity of robust primary healthcare as the gatekeeper of the medical system to prevent unnecessary specialist referrals, thereby ensuring equitable and rational resource allocation across different social strata.
Economic
The economic implications of overmedicalisation are profound, directly contributing to high Out-of-Pocket Expenditure (OOPE), a major cause of medical impoverishment in India. The article highlights how health insurance, while intended for financial protection, can create moral hazard—both ex-ante (reduced incentive for preventive care) and ex-post (encouraging costlier, unnecessary interventions since the insurer pays). This phenomenon inflates the overall cost of healthcare delivery, straining both public health budgets and private household finances. Furthermore, the practice of defensive medicine—ordering excessive tests to avoid potential litigation—adds a hidden tax on the healthcare system. UPSC questions often focus on healthcare financing; thus, understanding how overtreatment distorts market dynamics, exacerbates OOPE, and undermines the financial sustainability of health insurance schemes like (PM-JAY) is crucial for analyzing health sector economics.