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The constitution of India ensures the "right to health" for every citizen. It is the responsibility of the state governments to provide health care services to citizens. The funding for healthcare in India is 3.3% of GDP and is continuously decreasing since (3.75% in 2013).

The infant mortality rate was reduced from 88/1,000 in 1990 to 32/1,000 in 2020. The maternal mortality rate was reduced from 556/100,000 to 113/100,000 during 2016-18.

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DESCRIPTION OF HEALTHCARE SYSTEM

India has a mixed healthcare delivery mechanism. Approximately 70% of outpatient and 58% of inpatient services are provided in the private sector. Government healthcare centers account for 30% of outpatients and 42% of inpatient services.

HEALTH INSURANCE COVERAGE

In the National Family Health Survey (NFHS), the government clearly stated that it was not satisfied with the coverage in India.

India has expanded health insurance coverage significantly over the past decade, yet a substantial portion of the population remains without financial protection against medical expenses.

According to recent estimates, around 70% of Indians had some form of health insurance coverage in 2023, while approximately 30% remained uninsured.

Publicly funded health insurance schemes accounted for coverage of nearly 50% of the population, while private and social health insurance programs covered another 20%.

Despite these advances, millions of people continue to face the risk of paying healthcare costs directly from their own pockets.

Ayushman Bharat PM-JAY: The World’s Largest Government-Funded Health Insurance Program

The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) serves as India's flagship public health insurance initiative. The program provides health coverage of up to INR 500,000 per family annually for hospitalization expenses related to secondary and tertiary care.

AB PM-JAY primarily targets economically vulnerable households, covering roughly 120 million low-income and marginalized families, representing approximately 550 million beneficiaries nationwide. This makes it the largest government-funded health insurance program in the world.

In 2024, the government announced a major expansion of the scheme by extending eligibility to all citizens aged 70 years and above, regardless of income level. Funding for the program is jointly shared by the central and state governments.

However, it is important to note that outpatient medical services are not covered under PM-JAY, which means patients must still pay for many routine consultations and treatments.

Central Government Health Scheme (CGHS)

The Central Government Health Scheme provides healthcare coverage for serving and retired central government employees along with their dependents. The scheme offers access to a broad range of healthcare services, including conventional treatments as well as certain alternative and homeopathic therapies.

CGHS operates through a subscription-based model where beneficiaries contribute monthly premiums based on their salary level. Contributions generally range from INR 250 to INR 1,000 per month.

The scheme currently serves approximately 4.6 million registered beneficiaries.

Employees’ State Insurance Scheme (ESI)

The Employees’ State Insurance Scheme is designed for workers employed in organizations with at least 10 employees. Managed by the Ministry of Labour and Employment, the program is funded through contributions from both employees and employers.

As of 2024, the scheme provided healthcare and social security benefits to around 144 million beneficiaries across the country.

Nearly One-Third of Indians Still Lack Health Insurance

Although government-backed initiatives have expanded healthcare coverage considerably, around 30% of India's population remains uninsured. This coverage gap continues to be a major challenge for policymakers seeking to achieve universal health coverage and reduce financial hardship caused by medical expenses.

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ROLE OF GOVERNMENT AND PRIVATE SECTOR

The Ministry of Health and Family Welfare at the federal level is responsible for the policy decisions but was not involved in delivering the majority of services. It is responsible for providing national health programs.

In 2014, the government launched the federal Ministry of Ayurveda, Yoga and Naturopathy, Unani, Siddha, and Homeopathy, to promote alternative medicinal practices in India.

The State departments of health and family welfare are involved in the delivery of services. The responsibilities of the state unit are

• managing the workforce

• collecting health information

• supervising the healthcare facilities and services

There is also a significant variation in the delivery of services between the states.

Public sector

Nearly 50% of patients seek care in the public sector whenever the patient becomes sick, and almost 48% of people seek care in private centers. Patients visit government and municipality hospitals. There is a gradual increase in the population using the public sector for health care services (45% in 2015-16 to 50% in 2019-21). All citizens can avail free inpatient and outpatient services in government facilities. However, because of the lack of adequate facilities, patients often opt private sector.

Private sector

Clinics and physicians are most commonly visited in the private sector. A significant portion of patients typically visits high-cost private hospitals for services, which leads to high out-of-pocket costs (65% of health care spending in 2015-16).

DELIVERY OF SERVICES

Primary care: Under the Health and Wellness Centres program, 150,000 subcenters provide primary healthcare services, including free medicines, diagnostics, and healthcare services. Primary healthcare centers (PHCs) and community healthcare centers offer other healthcare services. All the services are provided for free-of-care and require no registration. Community healthcare centers also provide obstetric care and specialist consultations.

All the physicians working in the primary and specialty physicians within the public sector were provided with fixed salaries. It is planned to provide social security and free insurance to these patients.

Outpatient specialty care: Outpatient care is provided at community healthcare centers. District hospitals cover services that are not covered at community healthcare centers.

Hospital care: District hospital is the terminal referral centers. In addition to services provided in the community health center, emergency care, and maternity services, newborn care was provided at district hospitals.

There is an increase in the number of private hospitals in India because of the perceived poor quality of care in public hospitals and increased medical tourism. Public hospitals account for only 10% of total hospitals in India.

Long-term care: The National Programme for Health Care of the Elderly was launched in 2011 to provide long-term care to senior citizens. Free services are provided at the primary and secondary healthcare facilities for the elderly population. The National Health Protection Scheme was launched.

Digital Health Transformation in India

India is rapidly expanding its digital healthcare ecosystem to improve access and streamline service delivery. The Ayushman Bharat Digital Mission (ABDM), launched in 2021, is building a nationwide digital health network through digital health IDs, electronic health records, and the Unified Health Interface. By February 2025, more than 739 million digital health IDs had been created.

Telemedicine has also gained momentum through eSanjeevani, India's national telehealth platform, which connects patients in remote areas with healthcare professionals through over 125,000 Health and Wellness Centres. In addition, digital platforms such as Aarogya Setu and e-Hospital are helping patients access healthcare services and manage medical records more efficiently.

Outlook for India's Healthcare System

India has made significant progress in expanding health insurance coverage and strengthening digital healthcare infrastructure. Programs such as AB PM-JAY, CGHS, ESI, and ABDM have improved healthcare access for millions of people.

Despite these advances, healthcare spending remains relatively low, outpatient services are largely excluded from public insurance coverage, and nearly one-third of the population remains uninsured. Addressing these gaps will be critical as India moves toward broader and more equitable healthcare coverage.