Here’s why median outpatient spending is zero in India

Out-of-pocket spending on healthcare remains low for a large share of patients in India, with zero median expenditure for outpatient care and low hospitalisation costs at public facilities, according to the latest survey by the National Statistical Office (NSO).

The 80th round of the household health survey, released on Tuesday, shows that the median out-of-pocket expenditure (OOPE) per hospitalisation stood at Rs 11,285 in 2025. In public health facilities, more than half of the hospitalisation cases involved expenditure of Rs 1,100. For non-hospitalisation (outpatient) care, the median OOPE in public facilities was recorded at zero.

“This reflects that a large proportion of citizens are able to access essential healthcare services entirely free of cost,” the government said in a statement.

The survey covered 139,732 households, including 76,296 in rural areas and 63,436 in urban areas, providing data on healthcare access, affordability and utilisation.

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The findings are linked to increased public investment in healthcare, expansion of infrastructure across primary, secondary and tertiary levels, and the scale-up of services focused on preventive, promotive and curative care, the statement said.

The report notes the role of the Free Drugs Service Initiative and Free Diagnostics Initiative, which provide medicines and diagnostic services at public facilities. It also refers to the network of over 184,000 Ayushman Arogya Mandirs delivering primary healthcare services across the country.

Diagnostic services have been strengthened through a hub-and-spoke model with sample transportation, while the Affordable Medicines and Reliable Implants for Treatment (AMRIT) initiative operates more than 220 pharmacies across 29 States and Union Territories, offering over 6,500 drugs at discounts of up to 50% on market prices, the government said.

The survey shows an increase in the use of public healthcare facilities. In rural areas, the share of outpatient care in public facilities rose from 28% in 2014 to 35% in 2025.

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Financial protection has expanded, with coverage under government-funded health insurance schemes increasing from 12.9% to 45.5% in rural areas and from 8.9% to 31.8% in urban areas.

Schemes such as Ayushman Bharat—Pradhan Mantri Jan Arogya Yojana (PM-JAY) are cited in the report as contributing to this expansion. The survey also notes a decline in out-of-pocket expenditure among the bottom two consumption quintiles.

“The percentage of population covered under these Government Health Financed/Insurance Schemes… represents more than a threefold expansion,” the government said.

The data also shows an increase in reported ailments. The proportion of population reporting ailments rose from 6.8% to 12.2% in rural areas and from 9.1% to 14.9% in urban areas between the 75th and 80th survey rounds.

The survey records a decline in infectious diseases and a rise in non-communicable diseases such as diabetes and cardiovascular conditions.

Maternal health indicators have also improved. Institutional deliveries increased from 90.5% in 2017-18 to 95.6% in rural areas and from 96.1% to 97.8% in urban areas. Nearly two-thirds (66.8%) of rural deliveries and 47% of urban deliveries took place in government health facilities, the government said.

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