Higher public spending, strong policy interventions key to making health an essential good

India’s healthcare sector is a study in contrasts. On the one hand, the country is a global hub for pharmaceuticals, vaccines and medical innovation. On the other hand, millions struggle with limited access to quality care and high costs. As the debate over affordability and accessibility deepens, stakeholders say healthcare must be treated as a fundamental right, akin to education, or an essential good like food and water. Bridging this gap, they say, will require not only policy shifts but also a rethink of how India delivers care and higher public investment and private sector participation. Healthcare a Right According to the India Brand Equity Foundation under the Ministry of Commerce and Industry, healthcare has become one of India’s largest sectors in terms of revenue and employment. The Indian hospital market was valued at Rs 8.2 lakh crore ($98.98 billion) in FY23 and is projected to grow at an 8% CAGR to Rs 16.1 lakh crore ($193.59 billion) by FY32. But there is a paradox. According to PRS Legislative Research, an independent institute supporting Indian lawmakers on policy and budgets, India’s healthcare system faces major challenges in infrastructure, manpower and financial accessibility, despite ongoing government efforts. Central health spending remains low at around 2% of GDP, well below the 2.5% target set by the National Health Policy, 2017. This means a shortage of infrastructure—India has 0.6 hospital beds per 1,000 people, far below the WHO recommendation of 3.5 per 1,000. Additionally, there is just one government doctor per 10,189 people, against the WHO norm of 1:1,000, and 1.7 nurses per 1,000 people, compared to the recommended three per 1,000. Primary healthcare facilities such as sub-centres (SCs), primary health centres (PHCs) and community health centres (CHCs) are insufficient to meet the needs of India’s vast population. As of March 2023, India had 150,488 SCs, 31,859 PHCs, and 6,064 CHCs, but these often operate with severe staff shortages, says the PRS Legislative Research report. More than 70% CHCs lack essential specialists such as surgeons, paediatricians and physicians. The doctor-patient ratio is particularly poor in rural areas, where a single PHC serves over 35,000 people, exceeding the recommended 30,000 for plains and 20,000 for hilly regions. “A strong public-private partnership (PPP) model, powered by data-driven insights, can help tailor healthcare solutions at the district level, ensuring access to quality diagnostics, skilled healthcare professionals, essential medicines and specialised care where they are needed most,” says Anand K., Managing Director &amp; CEO, Agilus Diagnostics Ltd. Expanding insurance coverage and embedding diagnostic services into initiatives like Ayushman Bharat will enhance accessibility and affordability -Ameera Shah,PROMOTER, METROPOLIS HEALTHCARE In India, nearly 55% hospitalisations occur in private facilities and out-of-pocket expenditure accounts for 48% health spending, far higher than the global average of 18%. Although the Pradhan Mantri Jan Arogya Yojana (PM-JAY) provides Rs 5 lakh coverage per family annually, its funding— Rs 7,300 crore for FY25—raises concerns about sustainability. Moreover, the PM-JAY primarily covers hospitalisations, and outpatient services and diagnostics, a large part of healthcare expenses, are uncovered, pushing many into financial distress. “The government has launched key initiatives to strengthen healthcare, including Ayushman Bharat Health and Wellness Centres and the PM Ayushman Bharat Health Infrastructure Mission. However, there is a significant reliance on the private sector,” says Arup Mitra, Professor of Economics at South Asian University in New Delhi. The shortage of medical professionals is another pressing concern. India requires 2.4 million more doctors and 3.3 million nurses to meet global standards. Despite producing one lakh doctors and 250,000 nurses annually, uneven distribution worsens the crisis, especially in rural states like Bihar and Uttar Pradesh, where the doctor-patient ratio is even worse at one per 28,000 people. The private sector employs 80% doctors, further limiting the accessibility of public healthcare. Low insurance penetration also raises questions about how the country can build a sustainable universal healthcare financing model. The Ayushman Bharat Scheme aims to cover 500 million people but concerns over hospital participation and reimbursements persist. “To make healthcare a fundamental right, we need a major transformation. This requires unprecedented collaboration between the government, healthcare providers and the private sector. We must leverage India’s strengths in pharmaceuticals and technology to drive innovations that ensure widespread, cost-effective care,” says Ashutosh Raghuvanshi, MD &amp; CEO, Fortis Healthcare. With nearly 70% hospitals being privately run, affordability remains a big challenge. Some experts suggest India should consider regulating private healthcare costs similar to drug price controls, while others advocate a stronger PPP model to create a hybrid healthcare system. Digital health interventions such as telemedicine, AI-driven diagnostics and preventive care present opportunities for expanding access. “Enhancing public health expenditure and embracing digital health tools are crucial steps towards building a more resilient healthcare system,” says Raghuvanshi. Pharma’s Dilemma: Profit or Access? India is often referred to as the “pharmacy of the world.” It produces over 50% of the world’s vaccines. It is also the largest supplier of generic medicines, fulfilling approximately 20% of global demand for generics. However, the high costs of research and development mean many new therapies remain unaffordable for a large segment of the population. In recent reforms, the government has reduced the cost of essential drugs and strengthened cancer care infrastructure across the country. But a 2024 study published in the Journal of Pharmacy and Bioallied Sciences that examined the availability and utilisation of essential medicines across states found that availability ranged from 17% to 51%, with stock-out periods lasting between four and 14 weeks. It identified challenges such as inefficient procurement and distribution and pointed out the need for stronger systems to ensure consistent medicine availability. A 2024 study in Scientific Reports that assessed the affordability of essential medicines for non-communicable diseases in India revealed that most medicines cost more than a day’s wage across sectors. The Indian pharmaceutical industry is projected to grow from Rs 5.4 lakh crore ($65 billion) in 2024 to Rs 10.8 lakh crore ($130 billion) in 2030 and Rs 37.4 lakh crore ($450 billion) in 2047. “In a country as diverse and vast as India, we have a long way to go to ensure equitable healthcare access. As the global health paradigm shifts from illness to wellness, the focus must be on recognising healthcare and medicines as essential goods to make them affordable, available and accessible to all,” says Sudarshan Jain, Secretary General, Indian Pharmaceutical Alliance. The policy challenge is multi-faceted. The National Pharmaceutical Pricing Authority has imposed price caps on over 800 essential drugs but there are concerns whether these are sustainable for the industry. Stringent price regulations can sometimes lead to shortages. Another pressing issue is India’s reliance on imports for Active Pharmaceutical Ingredients (APIs); around 70% of these are sourced from China. To reduce this dependency, policymakers are working to strengthen domestic API production through Production Linked Incentive schemes. “By strengthening research, building resilient supply chains and ensuring access to life-saving medicines, we can create a future where no individual is denied the care they deserve,” says Jain. Diagnostics: The Missing Link Diagnostics influence 70% of healthcare decisions but account for less than 5% of healthcare spending. The high cost of diagnostic services, particularly in Tier-II and Tier-III cities, limits accessibility. The rise of at-home testing during the pandemic highlighted growing demand but weak regulation around these services remains a concern. We must leverage India’s strengths in pharmaceuticals and technology to drive innovations that ensure widespread, cost-effective care -Ashutosh Raghuvanshi,MD &amp; CEO, FORTIS HEALTHCARE Ameera Shah, Promoter and Executive Chairperson, Metropolis Healthcare Ltd, says diagnostics are the foundation of preventive healthcare. With the industry projected to reach Rs 2.1 lakh crore ($25 billion) by FY28, she sees an opportunity to expand access, given the increasing burden of preventable diseases, a rapidly ageing population and limited insurance coverage. “To make healthcare truly essential, diagnostics must be integrated into public health frameworks. Expanding insurance coverage and embedding diagnostic services into government initiatives like Ayushman Bharat will enhance accessibility and affordability,” says Shah. At present, there is a significant gap in data-driven preventive care, as India lags in integrating predictive diagnostics into its public health policy, which could aid early detection and cost-effective management. “Strengthening collaboration between policymakers, healthcare providers and the diagnostics industry is crucial to making quality healthcare not just a service but a fundamental right,” says Shah. Similarly, Anand K. believes that early detection through widespread screening programmes can significantly reduce the burden of chronic diseases and lower treatment costs. A recent study in Social Sciences &amp; Humanities Open highlights the dual crisis of non-communicable diseases (NCDs) in India, impacting both public health and household economies. “Controlling the epidemic of NCDs requires a comprehensive approach. A large-scale initiative for screening diabetes, hypertension, heart disease and kidney ailments in Tier-II and Tier-III towns could bridge the long-standing gap in reliable diagnostic services,” says Arvind Lal, Executive Chairman, Dr Lal PathLabs. After all, only a healthy India can become a Viksit India. @neetu_csharma

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Higher public spending, strong policy interventions key to making health an essential good

Why higher public spending and strong policy interventions are the key to making health an essential good.