India’s ambition to become a developed nation by 2047 cannot be met by counting hospital beds, cards issued, or apps downloaded alone. The decisive variable is quality of care—what patients actually experience and the outcomes they achieve. Quality is the bridge between entitlement and health; without it, coverage schemes risk becoming promises that do not travel the last mile.

The groundwork exists. Over the past decade, access has expanded. For instance, institutional deliveries and childhood immunisation rose sharply in NFHS-5, marking a broadening of basic services. But the same dataset shows systemic deficits—anaemia, child undernutrition, and uneven postnatal checks—that point to a delivery system still struggling with continuity and standards of care. Expanding reach without deepening quality yields partial progress—numbers actually move, but outcomes lag. 

At the same time, trends on healthcare financing from the National Health Accounts (NHA) confirm a welcome shift. Government health expenditure (GHE) has climbed to 1.84% of GDP in 2021–22, and the government’s share of total health expenditure rose to 48%. Crucially, the OOP share has fallen—from 62.6% in 2014–15 to 39.4% in 2021–22. This trajectory points the right way, but the level remains high for a country aiming at universal health coverage with dignity and protection. Together, these patterns reveal both progress and persisting gap. Healthcare access has widened, but financial protection and clinical quality remain fragile.

Why quality matters become stark in household experience?
The National Sample Survey (NSS 75th round) shows that a majority of hospitalisations occur in private facilities (55% overall; 61% urban), with public use stronger in rural areas (46%). The price of that choice is steep: average medical spending per hospitalisation in private facilities ranges around ₹26,000–₹38,000, compared to roughly ₹4,000–₹5,000 in public hospitals. Households primarily finance care from income/savings (about 80% rural, 84% urban), with not-insignificant reliance on borrowing. These are the contours of financial stress that quality primary care and reliable public hospitals are meant to avert. 

The government’s scale-up of primary care through Ayushman Arogya Mandirs (AAMs) is therefore pivotal. As of 31 March 2024, 1,72,148 AAMs had been operationalised, with extensive screening for non-communicable diseases and over 21.6 crore teleconsultations on eSanjeevani. But volume is not the same as value; screening that does not consistently lead to timely referral, safe treatment, and patient-centred follow-up will not deliver the health gains a developed India expects.

Quality improvement programmes provide the scaffold. The National Quality Assurance Standards (NQAS)—ISQua-accredited and recently updated—set facility-level benchmarks across patient rights, clinical care, infection control, and outcomes; LaQshya targets respectful, safe intrapartum care. These are the right instruments for system-wide improvement; the task now is to make them ubiquitous, measurable, and tied to incentives.

What, then, must change to align quality with the 2047 horizon?
First, measure what matters and publish it. India needs a single public “quality dashboard” that integrates NQAS assessments, adverse event reporting, antibiograms, waiting times, and patient-reported experience/outcome measures (PREMs/PROMs). Quality cannot remain a compliance file; it must be public knowledge and managerial currency. NQAS already provides a rigorous spine—extend it to cover the full continuum, including primary care and digital pathways.

Second, buy quality—not just services. PM-JAY empanels thousands of hospitals; its strategic purchasing power should reward demonstrable quality (e.g., LaQshya/NQAS-certified labour rooms, adherence to clinical bundles, low complication rates) and penalise unsafe or unnecessary care (such as non-indicated caesareans). The financing tilt is feasible: with GHE up and OOP down, the next step is to link payments to performance transparently. 

Third, fix the last mile of people and processes. Shortages of specialists at community health centres (CHCs) remain severe, constraining safe surgery, obstetric, and critical care services and driving avoidable referrals. Tackling this requires bundled solutions which includes contracts that rotate specialists across a district network, tele-mentoring from medical colleges, and targeted incentives for hard-to-serve blocks—backed by PM-ABHIM investments in diagnostics and critical care blocks.

Fourth, make primary care the centre of gravity. AAMs must move beyond screening counts to chronic-care management—registries, continuity plans, and team-based care (community health officers, nurses, ASHAs) that reduce avoidable hospitalisations and catastrophic spending. Publishing standard referral protocols and feedback loops to AAMs will convert activity into outcomes.

Finally, put patients’ rights at the core. Respectful care, informed consent, grievance redress, and language access are not “soft” extras—they are quality. Embedding patient rights in assessments and contracts will improve trust, adherence, and ultimately outcomes. NQAS already includes a patient-rights domain; make it binding and visible.

A Viksit Bharat will be judged not by how many people hold a card or visit a centre, but by whether mothers deliver safely without debt, whether chronic diseases are controlled, whether infections are prevented, and whether patients are treated with dignity. India has put the financing and the scaffolding in place. The next decade must convert those inputs into quality—measured, purchased, and felt at every bedside.

Arvind is a PhD Scholar, UGC- Senior Research Fellow, Department of Politics and Public Administration, University of Madras, Chennai