Ailing system

India’s healthcare system may be expanding on paper, but for millions of ordinary citizens, treatment still comes with crushing hidden costs. The latest National Statistical Office health survey shows that insurance coverage under schemes like Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PMJAY) has increased significantly since 2018. Yet, the reality inside hospitals tells a more troubling story.

Possessing a health insurance card does not guarantee affordable treatment. Patients continue to pay heavily for diagnostics, laboratory tests, medicines, scans and other “ancillary” services that are often excluded from insurance coverage. Private hospitals, unhappy with low reimbursement rates under government schemes, increasingly shift costs onto patients through separate billing. As a result, poor and middle-class families still find themselves trapped in debt despite being “insured”.

The rising burden of non-communicable diseases such as diabetes, heart disease and cancer has made the situation even worse. Chronic illnesses require repeated tests, lifelong medicines and long-term treatment. Life-saving drugs remain painfully expensive, pushing vulnerable families toward financial ruin. A single surgery or prolonged hospital stay can wipe out years of savings.

While public healthcare and insurance schemes have reduced some out-of-pocket expenses, the system still fails to protect citizens from catastrophic medical costs. Healthcare in India remains deeply unequal — affordable for the wealthy, exhausting for the middle class and devastating for the poor.

The next phase of healthcare reform must go beyond insurance cards and slogans. India urgently needs stronger public hospitals, price regulation of diagnostics and medicines, affordable tertiary care and stricter monitoring of private hospitals. Healthcare cannot become a marketplace where illness turns into profit. Access to treatment, medicines and dignified care must remain a basic human right, not a privilege determined by one’s income.