India’s ambition to achieve Universal Health Coverage (UHC) by 2030 is faltering under the weight of low public spending, rising privatisation, and deepening inequality in access to care. Leading doctors and public health experts warn that the current system, heavily dependent on out-of-pocket spending and private providers, risks leaving millions behind.

Geetanjali Minhas of Governance Now spoke with a range of experts, practitioners and activists on this critical issue in the latest episode of Checks and Balances. 

You can watch the discussion here: https://www.youtube.com/watch?v=faaMYBTrlc4

Here are the excerpts of what they said:

According to Professor K. Srinath Reddy, renowned public health expert, chancellor, PHFI, University of Public Health Sciences and Chair, Centre for Universal Health Assurance, Indian School of Public Policy, the country’s progress is uneven and inadequate. “We have made major investments in infrastructure and medical education,” he says, “but these gains are yet to translate into accessible, affordable care for the common citizen.”

Numbers behind the crisis
India spends around 3.8% of its GDP on healthcare, far below the 5–6% recommended by the World Health Organization (WHO). Of this, only 1.84% comes from the government, while households bear over half of all health costs directly.

The result is devastating: about 7% of Indians are pushed into poverty each year due to medical expenses. “Out-of-pocket expenditure has fallen from 70% two decades ago to around 39% today,” Prof. Reddy notes, “but much of this is due to infrastructure spending, not improved financial protection.”

India’s service coverage index, a measure of access to essential health services, stands at just 70%, with rural and poorer states lagging far behind.

We must spend smarter and fairer
Prof. Reddy calls for a sharp increase in both central and state health budgets, urging states to allocate at least 8% of their budgets to health and not just for buildings and equipment. 

“India’s health workforce distribution is alarmingly unequal,” he explains. “In Goa, there is one doctor for every 353 people; in Bihar, it’s one for 28,400.”

He proposes a National Health Service cadre under the National Health Mission, where young doctors serve 3–5 years in underserved areas in exchange for incentives such as postgraduate admission priority.

He also stresses the revival of family medicine as a cornerstone of primary care. “Strong primary healthcare is the foundation of universal coverage. It prevents disease, enables early detection, and ensures continuity of care,” he says.

India’s poor paying the price for policy failure
For Indranil, Co-Convenor of the Jan Swasthya Abhiyan (JSA), a platform of 21 networks and organisations that co-ordinates activities and actions on health and health care across the country, India’s health crisis is a symptom of chronic neglect. “If Rs 100 is spent on health in India, more than half comes directly from people’s pockets – the highest in the world,” he says.

He points out that Sri Lanka spends three times more per capita, while Thailand and Malaysia spend ten times more. Within India, the poorest states such as Bihar, Uttar Pradesh, Jharkhand, Chhattisgarh, and Madhya Pradesh spend less on health than some sub-Saharan African countries.

“This is not just about money; it’s about political will,” Indranil says. “States like Rajasthan and Tamil Nadu, which invest in free medicines and diagnostic schemes, show what’s possible.”

Privatisation, corporate control and commodification of care
Health activists warn that privatisation is reshaping the very philosophy of healthcare. “We are witnessing a growing role of finance capital in Indian hospitals,” Indranil says. “When investment funds like BlackRock control healthcare, patient welfare takes a backseat to shareholder returns.”

Dr. Nagraj Huilgol, a senior cancer specialist in Mumbai and a commentator, echoes this concern. “Medicine has moved from being a service to a commodity,” he says. “In corporate hospitals, doctors are no longer independent healers. They are revenue generators.”

He points to India’s decision in 2000 to allow 100% foreign direct investment (FDI) in healthcare as a turning point. “That opened the floodgates for corporate expansion,” he explains. “Eighty percent of doctors now work in the private sector. The government has effectively abdicated its responsibility to the poor.”

Insurance schemes and the illusion of coverage
The government’s flagship Ayushman Bharat PM Jan Arogya Yojana (PM-JAY) was designed to offer free coverage to the poor. Yet, experts say its reach remains limited, and its benefits skewed.

“In metro cities, no tertiary hospital accepts Ayushman cards,” says Dr. Abhishek Bhargav, a consulting physician at Nanavati Max Hospital in Mumbai. “The intent is good, but implementation is weak.”

Dr. Huilgol calls the insurance boom an illusion: “The average insurance cover is Rs 2–3 lakh, barely enough for two or three days in a corporate hospital. Meanwhile, 48% of Indians still pay out of pocket, and 43 million people have fallen below the poverty line because of medical bills.”

Prof. Reddy argues for a single-payer system that merges public and private insurance pools to ensure equitable risk-sharing and universal portability. “We need to move from fragmented schemes to integrated care,” he says. “A capitation-based payment model can reward prevention and quality, not volume.”

Doctors under pressure, patients losing trust
Corporate hospitals, experts warn, have turned doctors into employees chasing financial targets. “Hospitals expect doctors to generate revenue,” says Dr. Bhargav. “Senior doctors can resist, but juniors often cannot.”

Dr. Huilgol adds, “Star doctors today are soldiers in the army of investors. Their job is to bring in profits. When they stop being profitable, they are dispensable.”

The moral cost, he adds, is immense. “Patients are losing trust. Doctors are losing autonomy. Medicine is losing its soul.”

Hidden costs of corporate medicine
Overcharging, over-investigation, and pharmacy monopolies have become common, says Dr. Bhargav. “Patients are often forced to buy medicines from hospital pharmacies, where margins can reach 70% – 80%. Diagnostic labs push unnecessary packages of tests. It’s a racket that preys on fear.”

Indranil adds that the price of medicines has risen by over 10% annually, especially for chronic diseases. “Outpatient costs not hospital bills are what ruin families. We need free essential drugs in all public facilities,” he insists.

Prof. Reddy points to Tamil Nadu’s pooled procurement system and the National Cancer Grid at Tata Memorial Hospital in Mumbai which achieved an 86% reduction in drug prices, as models that could be replicated nationwide.

A system built on exploited labour
At the grassroots level, health infrastructure remains severely understaffed. According to JSA, community health centres face up to 80% vacancies in key specialist posts and frontline workers – ASHAs, nurses, and Anganwadi staff  are “grossly underpaid and overworked.”

“We are running the system on women’s unpaid and underpaid labour,” Indranil says. “If we want universal care, we must start by valuing the people who deliver it.”

The path forward: health as a public good
Despite the systemic rot, experts agree that reform is possible but only if the government reclaims its role as provider and regulator.

JSA’s key demands include raising total public health expenditure to 3.5% of GDP, filling staff vacancies, providing free medicines and diagnostics, and strictly regulating private hospitals and drug prices.

Dr. Bhargav calls for third-party audits of hospitals and insurers, coverage for outpatient care, and stronger consumer protection. “Healthcare must work for patients, not profits,” he says.

Prof. Reddy underscores that money alone won’t fix the system. “Achieving universal health coverage requires not just more funding, but smarter, ethical spending,” he says. “We must ensure that every Indian can access healthcare without financial or geographic barriers.”

Dr. Huilgol, reflecting on his decades in medicine, feels that we need to return to a paradigm where healthcare is about healing, not profit. “Corporate hospitals may serve 10% of India, but the other 90% need compassion, not commerce.”

A moral imperative
As India races toward its 2030 target for Universal Health Coverage, experts agree on one point: the current trajectory is unsustainable. Without major investment, regulation, and an ethical reset, the dream of health for all may remain just that – a dream.

“Healthcare has become a minefield for profit extraction,” says Dr. Huilgol. “If we don’t rethink our priorities, the poor will suffer, doctors will burn out, and the system will collapse under its own greed.”