What does “Healthcare” in India include?

Healthcare in India is a hybrid ecosystem, a mix of public and private providers and includes services such as:

• Primary healthcare: Basic outpatient services, vaccinations, and preventive care
• Secondary care: Inpatient hospital care, surgeries, and maternity services
• Tertiary care: Specialized services such as oncology, cardiology, and organ transplants
• Alternative medicine: Ayurveda, Yoga, Unani, Siddha, and Homeopathy (AYUSH)

India has over 1.6 million registered workers in the healthcare field, yet access and quality remain uneven, especially between urban and rural populations.

Public sector healthcare

India’s public healthcare system is largely underfunded, with government expenditure at just about 2.1% of GDP (2023). Key elements include:

• Primary Health Centres (PHCs) and Community Health Centres (CHCs)
• District hospitals and state-run specialty hospitals
• Central schemes like the Employees’ State Insurance Scheme (ESIS) and Central Government Health Scheme (CGHS)

Despite being free or low-cost, public facilities are often overburdened and lack resources.

Private sector healthcare

The private sector delivers nearly 70% of outpatient care and 60% of inpatient care in India. It ranges from single-doctor clinics to multi-specialty hospitals and corporate healthcare chains.

Employer-provided healthcare also falls under this.

Private healthcare is often:

• Faster and better equipped
• More expensive and sometimes unaffordable

Health insurance, both public and private, helps bridge the cost gap for those who can afford premiums or are eligible under government schemes.

Ayushman Bharat & other government initiatives

The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PMJAY) is India’s flagship health insurance scheme. It targets low-income families and aims to make quality healthcare more accessible. Some of its key features are:

• 500 million beneficiaries, primarily from low-income groups
• Sum Insured of ₹5 lakh per family per year for treatment
• Coverage for hospitalization and surgeries, not just diagnostics
• Over 26,000 empanelled public and private hospitals

Middle and high income groups have to rely on private insurance or out-of-pocket expenses.

Other public health initiatives include:

• National Health Mission (NHM): Strengthening infrastructure and maternal-child healthcare
• Jan Aushadhi Yojana: Affordable generic medicines
• Mission Indradhanush: Immunisation drives for children and pregnant women

What is it about American healthcare…

The United States has a predominantly profit-driven private insurance system. Key features:

• Employer-based insurance is the norm
• Government schemes include Medicare (for the elderly) and Medicaid (for low-income households)
• Healthcare spending at 17.8% of GDP (2022), the highest globally
• No universal health coverage

Recent developments have added complexity to the system. A recently passed bill (the “big beautiful bill”) supported by President Trump could lead to significant cuts in Medicaid, threatening coverage for around 12 million low-income Americans. There are concerns that it could roll back decades of healthcare progress, increasing uninsured rates and reducing preventive care access.

Despite cutting-edge technology and high specialisation, the U.S. system has problems:

• High out-of-pocket expenses
• Complex paperwork and bureaucracy
• Disparities in access to care based on income & insurance status

Though India’s healthcare system has much to be desired, how does it fare against the US’? There might be a few things which suggest we might be doing things better, or atleast are on the right track.

How is India ahead in some areas?

While India still faces enormous challenges, there are specific areas where its healthcare model shows promise over the American system:

1. Universal access: India takes a “welfare” approach towards healthcare, pushing for (Universal HealthCare (UHC) via Ayushman Bharat. The U.S. still lacks a clear federal roadmap toward universal healthcare.
2. Cost Efficiency: Treatments in India cost a fraction of what they do in the U.S. This is mainly due to generic drug availability, lower labor costs, and lean hospital operations.
3. Health reach: India’s use of Accredited Social Health Activists (ASHAs) and community workers has extended healthcare access deep into rural areas, though a lot more needs to be done in this area.
4. Traditional Medicine: Through AYUSH, India integrates traditional medicine within its healthcare framework, something absent in U.S..
5. Inclusivity: India’s initiatives try to ensure access to all, especially the most vulnerable. U.S. coverage often depends on employment or state-level Medicaid, now under threat.

Challenges India faces

India’s path to a robust healthcare system is long and difficult. Some issues which need to be addressed are:

• Low government health spending (2.1% of GDP vs. 8–10% in developed countries)
• Urban/rural divide in infrastructure and specialist availability
• Out-of-pocket expenses still account for 48.2% of total health expenditure (2023)
• Shortage of healthcare professionals, especially in Tier 2 and rural areas
• Regulation for private sector pricing and standardization

India’s model, a combination of public schemes and private participation, is one that focuses on affordability, digital innovation, and universal inclusion, and could pioneer a unique healthcare model that others may learn from.

insurancepe believes that insurance is a tool for social equity and in expanding health insurance access through affordable health insurance.

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