Writing in The Hindu, public health physician and author Dr. Chandrakant Lahariya observes that while modern medicine boasts unprecedented diagnostic power, the healthcare system is increasingly trapped in a vicious cycle of overtreatment and overmedication. In India, this creates an acute ethical paradox: unnecessary tests and surgeries are aggressively pushed upon those who can pay, while millions of impoverished citizens still lack basic primary care, timely treatment, and essential affordable medicines.
Overtreatment rarely begins with malicious intent; rather, it unfolds as a cascade of care. A routine executive health screening detects an incidental, benign anomaly. This triggers confirmatory imaging, biopsy, anxiety-induced overdiagnosis, and a lifelong cocktail of pharmaceuticals. The proliferation of commercial "preventive health check-up packages"—criticized by the National Medical Journal of India as early as 2016—has outpaced clinical rationale, generating false positives and patient distress.
| Structural Driver | Underlying Clinical / Economic Mechanism | Manifestation in Indian Healthcare | Systemic Hazard |
|---|---|---|---|
| Unnecessary Screening Packages | Unwarranted biochemical & radiological tests in healthy individuals | Aggressively marketed 'whole-body checkups' with 60+ parameters | Incidentalomas, false-positive cascades, severe patient anxiety, unneeded biopsies |
| Care Fragmentation & Lack of Gatekeeping | Bypassing primary care; patients directly approach organ-specific super-specialists | Consulting 4 different specialists for chronic multi-morbidity without coordination | Polypharmacy, drug-drug interactions, redundant diagnostic investigations |
| Healthcare Marketisation & Fee-for-Service | Doctors and hospitals financially incentivized for volume of interventions rather than restraint | Corporate hospital revenue targets linked to pharmacy sales, bed occupancy, and surgeries | Erosion of doctor-patient trust; treating healthy individuals as commercial consumers |
| Insurance Moral Hazards (Ex-Ante & Ex-Post) | Third-party payment removes immediate financial friction for procedures | Patients wanting to 'recover' paid insurance premiums; hospitals inflating intervention costs | Neglect of preventive lifestyle care; physical bodily trauma of unnecessary surgery |
| Defensive Medicine & Patient Expectation | Fear of medical litigation and mob violence prompts battery of defensive tests | Clinicians ordering redundant CT/MRI scans; reassurance perceived as clinical inaction | Soaring out-of-pocket expenditure; therapeutic nihilism replaced by pill-dependence |
1. Deprescribing: The planned and supervised process of dose reduction or stopping of medication that may be causing harm or is no longer providing benefit.
2. Ex-post Moral Hazard: A phenomenon where insured individuals utilize more medical services or opt for costlier procedures simply because the marginal financial cost is covered by insurance.
3. Incidentaloma: An unanticipated finding detected during medical imaging or screening performed for an unrelated clinical purpose.
Which of the statements given above are correct?
Explanation: All three statements are correct. Deprescribing is a critical countermeasure to polypharmacy. Ex-post moral hazard refers to overutilization of healthcare post-insurance coverage. An incidentaloma is an incidental finding on scans that frequently drives overtreatment cascades.
1. It aims to allocate major proportion of resources to primary care.
2. It advocates a 'Test and Treat' policy for non-communicable diseases.
3. It proposes to raise public health expenditure to 2.5% of the GDP in a time-bound manner.
Which of the statements given above are correct?
A) 1 and 2 only
B) 2 and 3 only
C) 1 and 3 only
D) 1, 2 and 3
Explanation: National Health Policy 2017 recommends allocating up to two-thirds or more of resources to primary healthcare (Statement 1 is correct) and increasing public health expenditure to 2.5% of GDP by 2025 (Statement 3 is correct). 'Test and Treat' is a WHO policy primarily applied to HIV/AIDS, not NCDs (Statement 2 is incorrect).
• Structural Drivers: Bypassing general practitioners, excessive super-specialisation, and absent gatekeeping in outpatient care.
• Ethical & Legal Dimensions: Rise of defensive medicine driven by fear of litigation/violence; violation of primum non nocere (first, do no harm) due to avoidable iatrogenic harm.
• Reform Matrix: Institutionalizing the family physician model, adopting ICMR-backed 'Choosing Wisely' guidelines, and mandating periodic deprescribing reviews for polypharmacy patients.