Every year on 12th December, Universal Health Coverage (UHC) Day is observed globally to highlight the need for accessible, high-quality, and affordable healthcare for all. This year’s theme brings attention to the growing challenge of unaffordable health costs, an issue particularly relevant for India as the country undergoes major shifts in its healthcare landscape.

India is experiencing a surge in non-communicable diseases (NCDs), as per the WHO - NCD India profile - 2018, NCDs are estimated to account for 63% of all deaths in the country. At the same time, fertility rates are declining and lifestyle-related conditions are increasing, intensifying the demand for continuous and long-term care. Private investment in healthcare infrastructure is also rising, expanding service availability but often at a cost that many households cannot manage.

As of October 2025, over 42 crore Ayushman cards have been issued under the Ayushman Bharat scheme, contributing to a reduction of more than ₹1.52 lakh crores in out-of-pocket expenditure. While this marks significant progress in improving financial protection, current schemes still fall short of comprehensively covering all income groups and age segments.

A Reality Check: India’s Current Position on UHC

At least 30% of the population, or 40 crore individuals are devoid of any financial protection for health, as per a report named, ‘Health Insurance for India’s Missing Middle’ published by Niti Aayog. This leaves large sections including newborns, elderly citizens, informal workers and gig economy workers without adequate protection. Insurance coverage is also limited in scope, especially for chronic or prolonged illnesses that require extended treatment and financial support. For instance, a kidney transplant in India, ranges anywhere from 4,00,000 to 12,00,000 lakh rupees, depending upon the choice of hospital and IPD stay, which surpasses the AB-PMJAY coverage by a margin. While government initiatives are commendable, emphasis on wider coverage needs to be initiated and programmed actively.

Furthermore, geographical disparities continue to influence access to healthcare. Rural and remote areas face persistent challenges related to availability of facilities, specialists, and referral systems affecting timely and effective care delivery.  

Strengthening Existing Schemes and Their Ecosystem

The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), which provides up to ₹5 lakh annually for secondary and tertiary care, is the world’s largest public health insurance program. However, to meet the country’s evolving needs, such schemes must increasingly function as ecosystem enablers, integrated with:

• Stronger primary care networks
• Adequate healthcare infrastructure
• Skilled and well-distributed workforce
• Technology-enabled

Strengthening these components will ensure that financial protection is complemented by improvements in quality, accessibility, and real-world outcomes.

The Cost of Providing Care

Cost of treatment in private hospital tends to be expensive because of multiple factors such as:

• CAPEX intensive nature of hospitals
• Specialist Salaries & Skilled Workforce
• No Subsidies to Private Hospitals 
• Cost of Care is driven by quality & patient-centric standards
• Compliance, Accreditation & Technology Costs

However, the government can look to intervene and reduce hospital and healthcare expenditure in the following manner:

• Provide loans at subsidized interest rates for hospital construction, medical equipment, and related infrastructure.
• Reduce or exempt GST on building materials, medical equipment, pharmaceuticals, and consumables to lower overall project and operational costs.
• Offer special concessional tariffs for water and electricity supply to healthcare facilities.
• Expedite the reimbursement cycle under both private and government insurance schemes to improve cash flow and reduce working capital pressure.

Building an Affordable and Inclusive Future for Healthcare

Promoting domestic manufacturing of medical devices and consumables through Make-in-India can significantly reduce treatment costs and improve long-term affordability. Broader reforms in the insurance sector including coverage for neonatal care, the elderly, and chronic conditions will be essential to move toward truly inclusive healthcare.

Achieving UHC in a diverse and populous country like India requires holistic, long-term, and integrated system strengthening, with equitable distribution of healthcare infrastructure and services across urban and rural regions. UHC Day serves as a reminder that while progress has been made, sustained efforts and coordinated reforms are crucial to ensure that every individual receives the care they need without financial hardship.

• By Dr Krutika, Doshi, Senior Manager, HOSMAC

Asia’s leading hospital planning, design and management consultancy.