Why in the News?

• The National Statistical Office recently released findings from its 80^th round survey on Household Social Consumption: Health(2025).
• The report reveals a paradox in India’s healthcare trend wherein health insurance coverage has expanded significantly, yet financial distress persists for many households.

What’s in Today’s Article?

• 80^th NSO Health Survey (Overview, Insurance Coverage, Govt Interventions, Existing Gaps, Financial Protection, Way Forward)

Overview of the 80^th Round NSO Health Survey

• The 80^th round survey conducted from January to December 2025 provides a comprehensive picture of healthcare access, utilisation, and financial protection in India.
• Compared to the 75^th round conducted in 2017-18, insurance coverage, healthcare access, and institutional deliveries have improved substantially.
• However, the survey also reveals that higher coverage has not necessarily translated into lower out-of-pocket expenditure (OOPE) or increased hospitalisation in public facilities.

Rising Insurance Coverage in India

• According to the latest data, 47.4% of rural and 44.3% of urban households are now covered under some form of health insurance.
• This is a significant increase, largely driven by an expansion of Government-Financed Health Insurance (GFHI) schemes such as Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana (PMJAY)and various State-level initiatives.
• Government records show a more than two-and-a-half-fold rise in GFHI coverage between 2017-18 and 2025.
• Schemes like the Employees’ State Insurance Scheme (ESIS), Central Government Health Scheme (CGHS), and state employee schemes are also part of this growth.
• The combined effect indicates India’s rapid movement toward universal health assurance.

Expanding Access and Government Interventions

• The Union Health Ministry has hailed the survey results as evidence of improved healthcare access across India.
• Initiatives such as the Free Drugs and Diagnostics Initiatives (FDSI and FDI), launched in 2015, have expanded the availability of essential medicines and tests even in remote areas.
• The creation of 1.84 lakh Ayushman Arogya Mandirs (AAMs)has strengthened India’s network for comprehensive primary healthcare, focusing on preventive, promotive, and curative services.
• Schemes like the Affordable Medicines and Reliable Implants for Treatment (AMRIT), offering up to 50% discounts on 6,500 medicines through 220 pharmacies, have also bolstered affordability.
• These reforms have supported early detection and management of chronic illnesses such as diabetes and cardiovascular conditions, reflecting a clear epidemiological transition toward non-communicable diseases.

Persisting Gaps: Hospitalisation and Expenditure Patterns

• Despite expanded coverage, the hospitalisation rate has not risen notably since 2017-18 and remains below 2014 levels.
• Utilisation of public institutions for hospitalisation and childbirth has declined, while demand for private sector care has surged, especially in urban areas.
• Contrary to government claims of declining expenditure, independent analysis of NSO data shows OOPE on hospitalisation has more than doubled between 2017-18 and 2025.
• Average hospitalisation expenses in private hospitals have increased by 70% in rural areas and 80% in urban areas.
• Even in public hospitals, patients often face costs for medicines, diagnostics, transport, and incidental charges due to systemic shortages.
• Official data indicate a median OOPE of Rs. 11,285 per hospitalisation in 2025, with substantially lower costs in public facilities (median Rs. 1,100).
• However, many high-cost cases, particularly specialised treatments sought in private care, push the average far higher.

Inequities in Utilisation and the Role of GFHI

• Government-financed insurance schemes such as PMJAY are designed to protect vulnerable families from catastrophic health expenditures. However, utilisation trends suggest uneven benefits:

• 57% of insured individuals sought hospital care in private facilities.
• Among urban beneficiaries using insurance-linked hospitalisation, only 13% belonged to the poorest income group.
• The better-off classes disproportionately benefit from the system, while state governments bear heavy fiscal burdens, up to 15% of health budgets in states like Haryana and West Bengal.

• The structure of these insurance models channels substantial public funds to the private healthcare sector, which operates largely on profit-driven principles.
• Despite GFHI reimbursements, many hospitals impose additional charges on patients, undermining the schemes’ promise of “free” treatment.

Financial Protection and Public Health Equity

• From a macro perspective, the survey presents mixed outcomes. While coverage and access indicators have improved, financial risk protection remains inadequate.
• In rural India, the bottom two income quintiles have shown some decline in OOPE, but in urban areas, the financial strain persists due to heavy reliance on private providers.
• The  AAMs, envisioned as the primary care backbone under Ayushman Bharat, demonstrate potential for sustainable UHC.
• Yet, underfunding of AAMs and the National Health Mission (NHM)continues to limit their impact.

Way Forward

• India’s experience illustrates that insurance-led healthcare models alone cannot achieve equitable health outcomes.
• Strengthening the public health infrastructure, ensuring consistent drug and diagnostic availability, and rationalising private sector regulation are crucial for protecting citizens from medical impoverishment.
• The focus must shift towards preventive and primary care, robust data systems for monitoring, and outcome-based financing that prioritises value over volume.
• A well-functioning public health system remains the cornerstone of inclusive development and social justice.