MAINS Current Affairs includes Revamping the Functioning of Parliament & The Medical Poverty Trap Is Real

Polity and Governance

1. Revamping the Functioning of Parliament

Context: The Constitution (131st Amendment) Bill and the Delimitation Bill, 2026, introduced jointly, propose increasing the strength of the Lok Sabha from 550 to 850 members.

• The proposal highlights an important institutional concern: increasing the number of elected representatives alone may not improve democratic representation unless Parliament’s functional and operational capacity is strengthened simultaneously.

Why Does Parliament Need Functional Reforms?

• Rising representative burden: According to the Election Commission’s 2024 Atlas, India has an electoral roll of 98 crore voters distributed across 543 Lok Sabha constituencies, averaging approximately 18 lakh voters per constituency.
• Unequal constituency sizes: Electoral representation varies considerably across constituencies. Malkajgiri in Telangana has approximately 8 lakh voters, whereas Lakshadweep has only 57,953 voters, illustrating significant differences in constituency size.
• Representation beyond numerical strength: Increasing the number of Lok Sabha members will not automatically resolve existing functional limitations. If Parliament’s working timetable remains unchanged, a larger membership could reduce the time available to individual MPs to participate in legislative discussions and other parliamentary proceedings.

Issues in Parliamentary Functioning

1. Inadequate Parliamentary Working Time

• India does not have a constitutional provision prescribing a minimum number of annual working days for Parliament.
• Consequently, the time available for legislative business, executive accountability and deliberation depends on the parliamentary calendar and the duration allocated to different activities.

2. Constraints on Question Hour

• Question Hour enables Members of Parliament to seek information from ministers and hold the executive accountable.
• It includes two principal categories:
  • Starred questions: Require oral answers and may be followed by supplementary questions.
  • Unstarred questions: Receive written answers.
• Under Lok Sabha rules, a maximum of 20 starred questions and 230 unstarred questions are listed for a sitting day, limiting the number of questions that can receive oral responses.
• During the 17th Lok Sabha, Question Hour functioned for only 60% of its scheduled time, reducing opportunities for MPs to question the government.

3. Insufficient Protection for Zero Hour

• Zero Hour provides MPs with an opportunity to raise urgent matters of public importance.
• Without a protected time allocation, increasing the membership of the House could make it more difficult for individual MPs to raise constituency-specific issues and draw attention to local grievances.

4. Limited Legislative Scrutiny

• Parliamentary debates allow MPs to examine proposed legislation, including its constitutional validity and wider legal, social and economic implications.
• Parliamentary committees facilitate detailed examination of Bills through cross-party deliberations and consultations.
• However, their effectiveness depends on adequate membership, sufficient time for examination, access to research assistance and opportunities to consult relevant stakeholders.
• Without these institutional resources, complex legislation may not receive the detailed scrutiny it requires.

5. Reduced Scrutiny of Public Expenditure

• During the 17th Lok Sabha, 35% of Bills were passed after less than one hour of debate.
• Approximately 80% of the national Budget was passed through the guillotine procedure.
• Under the guillotine procedure, the remaining Demands for Grants are put to a vote without detailed discussion once the allotted time expires.
• This limits opportunities for MPs to examine government expenditure, assess competing priorities and scrutinise the financial implications of public policies.

6. Constraints on Private Members’ Business

• Private Members’ Business provides MPs who are not ministers with an opportunity to introduce Bills and resolutions.
• It allows legislators to raise emerging social concerns and propose alternative policy approaches.
• Inadequate time for such initiatives restricts legislative participation beyond government-sponsored business and reduces opportunities for wider parliamentary deliberation.

Measures Needed to Strengthen Parliament

1. Establish a Minimum Annual Sitting Requirement

• Article 85(1) of the Constitution stipulates that no more than six months may elapse between the last sitting of one session and the first sitting of the next. However, it does not prescribe a minimum number of annual sitting days.
• The provision should be strengthened by introducing a mandatory minimum number of parliamentary working days each year.
• The National Commission to Review the Working of the Constitution (2002), chaired by Justice M. N. Venkatachaliah, recommended that:
  • Lok Sabha should meet for at least 120 days annually.
  • Rajya Sabha should meet for at least 100 days annually.

2. Protect Essential Parliamentary Business

• Parliament should establish defined minimum time allocations for:
  • Question Hour.
  • Zero Hour.
  • Private Members’ Business.
  • Substantive debates on legislation and other matters of public importance.
• Exceptions should be narrowly defined and governed by clear procedural rules to prevent routine curtailment of these activities.

3. Strengthen Parliamentary Committees

• Parliamentary committees should receive enhanced research and technical assistance.
• Adequate time should be provided to examine Bills, consult stakeholders and scrutinise public expenditure.
• Stronger committee functioning would facilitate evidence-based deliberation and improve the quality of legislation.

4. Improve Legislative Planning

• The government should provide MPs with adequate advance notice of proposed Bills.
• Bills should be accompanied by explanatory documents that clarify their objectives, provisions and implications.
• This would enable legislators to study proposed laws before their consideration in the House and contribute more effectively to debates.

5. Expand Institutional Capacity

• Any increase in the strength of the Lok Sabha should be accompanied by corresponding improvements in parliamentary infrastructure and support systems.
• Essential requirements include:
  • Adequate seating and physical facilities.
  • Sufficient committee rooms and consultation facilities.
  • More research personnel and legislative support services.
  • Improved technological infrastructure for parliamentary proceedings and information access.
• Such measures would help ensure that a larger House can function efficiently without compromising the quality of deliberation.

Way Ahead

• Numerical expansion and functional reform must go together: Increasing the strength of the Lok Sabha may help address the growing burden of electoral representation, but it cannot independently guarantee meaningful democratic participation.
• Ensure meaningful participation: Every MP should have adequate time and opportunity to raise public concerns, question the executive, examine legislation and participate in financial scrutiny.
• Strengthen parliamentary accountability: Regular sittings, protected time for essential business and effective committee oversight are necessary to improve legislative quality and executive accountability.
• Make representation substantive: Parliamentary reforms should ensure that the voices of citizens are heard through their elected representatives rather than merely increasing the number of seats.

Conclusion

A larger Parliament can strengthen representative democracy only when its institutional capacity keeps pace with its expanding membership. Effective representation requires not only more MPs but also sufficient time, meaningful debate, rigorous legislative scrutiny and strong accountability mechanisms. Revamping parliamentary functioning is therefore essential to ensure that numerical expansion translates into better governance and more responsive democracy.

Health

2. The Medical Poverty Trap Is Real

Context: The 80th Round of the National Sample Survey (NSS), covering January–December 2025, has raised concerns regarding the accessibility, affordability and availability of medical services in India.

• Its findings highlight the financial burden of healthcare on households and the risk that medical expenses may push vulnerable families into poverty.

What Is the Medical Poverty Trap?

• The medical poverty trap refers to a situation in which high healthcare expenditure pushes a household into poverty, while declining income and depleted savings further restrict its ability to obtain timely and quality medical treatment.
• It creates a vicious cycle of illness and financial hardship:
  • Illness increases expenditure on consultations, medicines, diagnostics and hospitalisation.
  • Medical expenses deplete savings and may force households to borrow or sell assets.
  • Financial distress delays or prevents further treatment, worsening health outcomes.
• Impact on economic development: Poor health reduces human capital, labour-force participation and workforce productivity, thereby affecting broader economic growth.
  • A 2025 study estimated that illnesses and deaths among adolescents alone resulted in US$38 billion in lost economic output, equivalent to 3% of India’s GDP in 2021.

Key Findings of the NSS 80th Round

• Increase in reported morbidity: The proportion of people reporting an ailment during the preceding 15 days increased between the 75th and 80th rounds:
  • Rural India: from 8% to 12.2%.
  • Urban India: from 1% to 14.9%.
• High dependence on private healthcare: Private healthcare providers treated a substantial proportion of non-hospitalised ailments:
  • Rural India: 4%.
  • Urban India: 8%.
• Significant difference in treatment costs: Average out-of-pocket expenditure (OOPE) for non-hospitalised ailments varied considerably by provider:
  • Rural government facilities: ₹304.
  • Rural private facilities: ₹1,541.
• Substantial hospitalisation expenses: Average OOPE per hospitalisation, excluding childbirth, stood at:
  • Rural India: ₹31,484.
  • Urban India: ₹38,688.

These findings point to the combined challenges of rising reported morbidity, dependence on private providers and the financial burden of obtaining treatment.

Why Does the Medical Poverty Trap Persist?

1. Limited Capacity of Public Healthcare Facilities

• Shortages of doctors, nurses, essential medicines, diagnostic services and hospital beds constrain the ability of public health facilities to meet demand.
• Patients may consequently turn to private hospitals and clinics, where treatment can be considerably more expensive.

2. Unequal Access to Quality Healthcare

• Rural areas and economically weaker states face greater difficulties in accessing reliable and affordable medical services.
• Uneven distribution of healthcare infrastructure and personnel creates geographical disparities in the availability of timely treatment.

3. High Out-of-Pocket Expenditure (OOPE)

• Households often pay directly for medical consultations, medicines, diagnostic tests and hospitalisation.
• These expenses can exhaust savings, increase indebtedness and force families to divert resources away from food, education and other essential needs.

4. Limitations of Health Insurance

• Insurance coverage does not automatically guarantee access to affordable and timely treatment.
• Patients may still face difficulties because of the absence of nearby empanelled hospitals, delays in obtaining treatment or expenses that are not covered by their insurance arrangements.

5. Delayed Treatment and Worsening Illness

• Financially vulnerable households may postpone medical consultations or avoid treatment because of its cost.
• Delayed diagnosis and inadequate treatment can allow manageable conditions to become more serious, requiring more expensive interventions later.

6. Loss of Income and Livelihood

• Illness may prevent patients from working and earning an income.
• Family members who provide care may also have to reduce their working hours or leave employment.
• As a result, household income declines precisely when medical expenditure increases, deepening financial vulnerability.

Initiatives Taken by the Government

1. Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (PM-JAY)

• PM-JAY provides health coverage of ₹5 lakh per family per year for eligible secondary and tertiary care hospitalisation.
• Senior citizens aged 70 years and above: All Indians in this age group are eligible for coverage regardless of income or socio-economic status.
• Ayushman Arogya Mandirs (AAM): As another pillar of Ayushman Bharat, these centres aim to make primary healthcare services more accessible to communities.

2. Affordable Medicines and Diagnostics

• Pradhan Mantri Bhartiya Janaushadhi Pariyojana (PMBJP): Promotes access to affordable generic medicines, helping reduce the cost of treatment.
• AMRIT pharmacies: Provide essential medicines and medical implants at discounted prices, lowering the financial burden on patients.

3. Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA)

• Launched in 2016, PMSMA aims to provide pregnant women with assured, free and quality antenatal care.
• The programme provides these services on the 9th day of every month, supporting maternal health and early identification of pregnancy-related risks.

4. Swasth Bharat Portal

• The Swasth Bharat Portal is designed as an integrated, one-stop digital platform for bringing multiple national health programmes together.
• It aims to facilitate access to information and improve the coordination of health-related services.

5. eSanjeevani

• eSanjeevani enables remote medical consultations through telemedicine.
• It can improve access to healthcare professionals and specialists, particularly for people living in rural and underserved areas.

6. Prevention and Treatment of Non-Communicable Diseases

• Non-communicable diseases (NCDs), including heart disease, diabetes, cancer and stroke, account for approximately 60% of all deaths in India, according to the source.
• The National Programme for Prevention and Control of Non-Communicable Diseases (NP-NCD) strengthens healthcare infrastructure for early detection, diagnosis and treatment.
• Preventive care and early diagnosis can help reduce the risk of costly complications and prolonged treatment.

7. Disease Control and Targeted Programmes

• National TB Elimination Programme: Supports improved disease detection and treatment coverage while working to reduce tuberculosis incidence.
• National Sickle Cell Anaemia Elimination Mission: Focuses on screening and eliminating sickle cell disease by 2047.
• Pradhan Mantri National Dialysis Programme: Provides free dialysis services to eligible patients, helping reduce expenditure associated with long-term treatment.

Way Ahead

1. Address Regional Inequalities

• Healthcare resources should be directed towards rural areas and states where public health services are inadequate or existing facilities face excessive demand.
• More equitable distribution of medical personnel, medicines, diagnostics and hospital beds is essential to improve access to care.

2. Measure Outcomes, Not Merely Infrastructure

• Healthcare performance should be evaluated beyond the number of hospitals, beds or health centres established.
• Important indicators should include:
  • Waiting times for consultations and treatment.
  • Availability of essential medicines and diagnostic services.
  • Quality and effectiveness of treatment.
  • Patient health outcomes.
  • Financial burden imposed on households.

3. Improve the Functioning of Existing Facilities

• Priority should be given to ensuring adequate staffing, essential medicines, diagnostic facilities, functional equipment and dependable operating hours.
• Better utilisation of existing infrastructure can improve service delivery and reduce unnecessary dependence on expensive private healthcare.

4. Reduce the Financial Burden of Treatment

• Public health services and financial protection mechanisms should work together to minimise direct payments by households.
• Greater access to affordable medicines, early diagnosis and preventive care can help prevent medical expenses from escalating into catastrophic financial burdens.

Conclusion

Universal health coverage must extend beyond insurance enrolment to guarantee that every individual can obtain timely, affordable and quality healthcare without suffering financial hardship. Strengthening public health systems, reducing out-of-pocket expenditure and improving the availability of essential medical services are crucial to breaking the medical poverty trap and ensuring that illness does not push households into poverty.

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