India’s health-care system stands at a defining juncture. The task is dual: expand access for the millions who are underserved, while ensuring affordability amid rising costs. This needs an integrated framework, strengthening insurance, leveraging scale, embedding prevention in primary care, accelerating digital adoption, enabling regulatory clarity, and unlocking sustained investment. Through a systemic, interconnected approach, India can build a health-care model that is inclusive, financially viable, and globally aspirational.
Insurance as the foundation of affordability
Pooling risk remains the most effective way to make costly care accessible. Even modest premiums — ₹5,000 to ₹20,000 for individuals or ₹10,000 to ₹50,000 for families — can unlock coverage worth several lakhs, shielding households from catastrophic financial shocks. Yet, penetration remains low: only 15%-18% of Indians are insured, with the premium-to-GDP ratio at 3.7% compared to the global average of 7%. The gap is significant, but so is the opportunity, as gross written premiums already stand at $15 billion in 2024 and are projected to grow at over 20% CAGR till 2030.
Affordability cannot rest on insurance alone. True impact comes when payers, providers and patients partner, expanding coverage, embracing prevention and making insurance a tool for everyday health security, not just a crisis shield.
India’s health-care system has mastered something that the world is only now beginning to appreciate — delivering quality care at extraordinary scale. Where an MRI in the West may handle seven to eight scans a day, in India the same machine manages many times that volume. This ability to stretch resources without diluting quality is not coincidence. It is the product of decades of ingenuity in doctor-patient ratios, workflow design, and infrastructure use.
The next leap is clear: extend this efficiency to India’s vast heartland. Tier-2 and tier-3 cities remain underserved, yet they represent the true frontier. If India can replicate its urban efficiency in these geographies, it will not just close the access gap. It could set a global benchmark for how scale, innovation and inclusion can reshape health care.
Schemes such as Ayushman Bharat (Pradhan Mantri Jan Arogya Yojana, or PM-JAY) have redefined access. Covering nearly 500 million people, with ₹5 lakh a family for advanced care, PM-JAY has enabled millions of cashless treatments in both public and private hospitals. Its impact is visible: timely cancer treatments for beneficiaries have increased by nearly 90%.
Expanding private hospital participation in government-backed schemes is essential to reach the next 500 million. But this must be anchored in fair reimbursements and transparent processes, ensuring viability for providers and real value for patients.
Prevention as the most powerful cost-saver
A study in Punjab revealed a stark reality — even insured families faced catastrophic expenses on diabetes, hypertension, and other non-communicable disease (NCD) outpatient care. The solution is two-fold: redesign insurance to include outpatient and diagnostics, and launch a nationwide push for prevention. But this is incomplete without public participation.
Alongside payers and providers, people must embrace a preventive mindset — controlling risks, staying alert and raising awareness. Every rupee in healthier lifestyles saves multiples in treatment. If schools, employers, communities and citizens rally behind prevention, India can blunt the looming tsunami of NCDs and secure a healthier future.
India was early to adopt telemedicine and is now pushing boundaries with Artificial Intelligence. Tools that detect early signs of sepsis, triage diagnostic reports, or enable remote consultations are already in practice. These innovations not only improve patient outcomes but also optimise the productivity of doctors and nurses.
Digital health is also democratising access. Remote consultations mean that a cardiologist in a metropolitan city can guide treatment for a patient in a village that is hundreds of kilometres away. Combined with the government’s Ayushman Bharat Digital Mission, such innovations could enable universal health records and continuity of care across the country.
Regulation and trust as the missing link
Health-care innovations are promising, but challenges persist. Insurers in New Delhi are considering a 10%-15% premium hike due to pollution-driven respiratory illnesses which shows how environmental factors raise health-care costs. Without safeguards, such pressures could hit affordability for millions. This is where regulation is crucial. The Finance Ministry has urged the Insurance Regulatory and Development Authority of India (IRDAI) to strengthen claims of settlement and grievance redress, recognising that trust drives insurance penetration. Without confidence in fair and transparent claims, households will not prioritise health insurance. Robust regulation, paired with fair pricing, is essential to deepen coverage and build confidence.
In 2023, India’s health sector drew $5.5 billion in private equity and venture capital, fuelling digital health, pharmacy networks, and hospitals. But capital remains skewed toward metros. The true test is directing this to tier-2 and tier-3 cities, building primary networks, and training specialists so that growth translates into inclusion.
India’s health care is at an inflection point. Insurance must cover everyday care, providers must scale efficiently, prevention must cut long-term costs, and technology must drive access. With aligned investment and bold public-private partnerships, we can design a system that is not episodic or exclusionary, but universal, resilient, and sustainable. Health care must move from being a privilege to becoming every Indian’s right.
Sangita Reddy is Joint Managing Director, Apollo Hospitals Group
Published – August 29, 2025 12:08 am IST
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