India's public health landscape is burdened with numerous challenges. One significant issue is the inadequate investment in primary health care, which is essential for preventive and community-based health services. Furthermore, the high out-of-pocket expenditure (OOPE) for health services places a financial strain on individuals, with over 50% of health expenses borne by the populace, pushing many into poverty.
Rural areas, in particular, face health infrastructure gaps, struggling with a shortage of hospitals, medical professionals, and diagnostic resources. Additionally, the rise in non-communicable diseases (NCDs) like diabetes and cardiovascular conditions adds to the health burden, alongside persistent issues with infectious diseases such as tuberculosis and malaria. Malnutrition and maternal health also remain critical concerns, with high child malnutrition rates and maternal mortality.
The Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) plays a role in providing financial protection but primarily benefits hospital-based care. This model often neglects preventive health care, directing funds away from primary health centers (PHCs) and encouraging privatization of health services. Consequently, patients are often steered towards private hospitals, diminishing the role of government facilities, and resulting in higher long-term health care costs.
A robust primary health care system can significantly reduce disease burden and prevent unnecessary hospitalizations. Investing in such a system is cost-effective, as early detection and prevention lower long-term health costs. It also strengthens public health infrastructure, ensuring accessible care for rural and marginalized populations while reducing OOPE for low-income families.
In the 2025 health budget, ₹90,469 crore was allocated for AB-PMJAY, with ₹95,957.87 crore for the Department of Health and Family Welfare, and ₹3,900.69 crore for the Department of Health Research. However, the National Health Mission (NHM), crucial for supporting primary health care, sees declining funding, indicating a reduced government focus on grassroots health initiatives.
Privatization trends have led to increased foreign direct investment (FDI) in insurance, with proposals to raise it to 100%. This shift encourages the consolidation of private entities, prioritizing capital accumulation over affordable care. Additionally, informal workers, constituting over 90% of India’s workforce, remain largely uninsured, lacking formal health coverage.
Informal workers, along with migrants and daily wage laborers, face significant health security challenges due to illiteracy and lack of awareness, which often results in limited access to insurance benefits. Women and children are particularly vulnerable, with high maternal mortality rates and prevalent malnutrition due to inadequate health facilities.
Countries like Thailand and Costa Rica offer valuable insights with their successful tax-funded universal health care models. These systems emphasize public investment over private insurance, ensuring universal access and reducing OOPE. Strong primary health care systems in these countries reduce the need for hospitalization, while robust social protection mechanisms enhance overall health outcomes.
To improve health care, India must reinforce primary health care by strengthening PHCs and focusing on preventive and community health. Regulating private insurance models to prevent excessive profit-making is crucial. Expanding NHM funding will ensure grassroots-level health services receive adequate support. Lastly, achieving universal health coverage for informal workers through integrated health security schemes is essential for equitable health care.
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