Affordable Healthcare in India: Financial Challenges and Strategies

Ishiqa Multani

India’s healthcare sector is defined by striking contrasts: while it offers hospitals and universities which are shining examples of progress and are globally-lauded for their innovative contributions, citizens in rural and low-income areas are woefully underserved when it comes to accessing affordable quality healthcare.


The complexity of India’s financial challenges in the healthcare sector are compounded by the nation’s federalist approach to healthcare policies, practices, and funding wherein individual states maintain control over their state’s healthcare spending and resource allocation.

While there is the potential within this model to empower states to make the health of their citizens a priority, bureaucracy and an unwillingness to collaborate has resulted in a national healthcare system which is inconsistent and unreliable.

We cannot delay addressing this substantial deficit by developing a national public healthcare infrastructure that will ensure the successful delivery of quality care to all citizens.



Without such a system in place, we will continue to face the social and economic challenges which arise when our poorest and most vulnerable citizens receive little or no healthcare services.

India is in the midst of a public health crisis dominated by a rise in non-communicable diseases such as cancers and respiratory illness, which are worsened by a lack of diagnostic and treatment options. In addition, and perhaps most damning, the lack of preventative care in India has contributed to infant mortality and under-5 mortality rates, which is unacceptably high.

Many patients have been hindered by a lack of insurance while even those with insurance coverage for the private sector have avoided seeking care because of the staggeringly high out-of-pocket expenses associated with hospitalization and treatment.

Research conducted by Prinja, Kaur, and Kumar (2012) found that approximately 25% of hospitalized patients were pushed toward the poverty line due to the expenses of their treatment.

Patients have few feasible options: the private healthcare system is largely unregulated and often unscrupulous, while the public healthcare system lacks the staff, resources, and infrastructure necessary to provide adequate healthcare services to a large population.

While India currently spends approximately 1.3% of its GDP on healthcare, its public spending on healthcare as part of its total expenditures is lower than any other Asian country with the exception of Pakistan.

State and central governments combined yearly spending per capita on healthcare is less than 1500 INR approximately, and this severe lack of funding has had serious ramifications for the well-being of India’s populace and the stability of its healthcare system.


Universal Health Coverage has long been proposed as a solution to many of India’s current problems regarding infrastructure, funding, and access within the healthcare system.

Under proposals adopted by the High Level Expert Group on Universal Health Coverage, this approach to healthcare spending would ensure equitable access to healthcare for all Indian citizens and would provide the public health services which are necessary to implement preventative health programmes across the nation.

While the government might not be the only provider of healthcare services under a universal coverage plan, state and central government would cover schemes to ensure that no citizen would lack healthcare.

Under the HLEG proposal, all citizens would be entitled to universal healthcare which would be provided under a national health package offering primary, secondary, and tertiary care.

In fact, announcement of Ayushman Bharat, one of the most ambitious health mission’s Universal Health Coverage has achieved. Patient autonomy would be preserved because there would be the option of public sector facilities for services or private providers. India is fortunate to be a leader in healthcare innovation and education.


As such, we are in the unique position to have the wisdom and experience of many healthcare professionals, educators, researchers, and entrepreneurs available to us. Collaborations between the private and public sector could serve as a stepping stone to address the staggering inequities which currently exist within India’s healthcare system.

Much in the way that India has innovated to create a thriving medical tourism industry, so too must the nation harness its capacity for innovation to create opportunities for healthcare affordability for all citizens.

The private sector has set a remarkable example in its marriage between corporate social responsibility and public health, launching campaigns which address issues such as access to safe drinking water and maternal/child health.

Nevertheless, the burden for developing realistic healthcare strategies cannot be borne by the private sector alone; rather, a collaboration between the private and the public sector may be the best solution to this substantial challenge.


Primary among these challenges is a lack of our greatest resource: doctors, nurses, and other healthcare personnel, especially in rural, remote, and low income areas. India currently has a number of excellent universities which are producing knowledgeable and driven healthcare personnel with the potential to be leaders in their field.

We must capitalize on the strength of our universities to encourage enrollment in the healthcare industry and to ensure that our graduating students have incentives to remain in India for their careers and to work in areas which are currently underserved. We must ensure the creation of a strong and dedicated national healthcare system which can work in tandem with the states to oversee resource allocation and the implementation of a national public health programme which will address preventative health.

Many of the nation’s current challenges related to healthcare could be resolved by prioritizing preventative health and health education in our state and national healthcare programs, and capitalizing upon the wide range of knowledge, skills, and experience within the private sector through collaborative initiatives.

It is near-impossible to create a sustaining, accessible, and affordable healthcare system without a strong healthcare infrastructure.

Leadership is clearly required from our government to create a collaborative system which makes use of India’s ample talent in the healthcare industry to generate innovation and distribute healthcare resources throughout the nation. Our capability to innovate is our greatest strength, but affordable healthcare innovations must not get mired in the bureaucratic morass which all- too-often hampers positive change initiatives.

We must embrace free enterprise and open collaborations between the private and public sector because, in the long-run, the economic, social, and political well-being of India is dependent on a healthy populace.

Writer is Ishiqa Multani President, Sagar Group of Hospitals. Views expressed are a personal opinion.

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