NSO Survey on Health

The National Statistical Office (NSO) 80th Round Survey on Household Consumption on Health provides a detailed assessment of India’s healthcare access, morbidity patterns, and financial burden of health expenditure. The findings highlight a paradoxical situation where healthcare access has improved significantly, but financial vulnerability has also increased due to high private sector dependence.

Morbidity Landscape in India

National Level Situation

The survey indicates that around 13.1% of India’s population reported illness within a 15-day reference period, reflecting a significant burden of disease in the country.

Urban–Rural Differences

Urban areas report a higher morbidity rate of 14.9% compared to 12.2% in rural areas. This does not necessarily indicate worse urban health but reflects better awareness, higher diagnosis rates, and lifestyle-related diseases such as stress and pollution exposure in cities.

Elderly Health Burden

The 60+ age group is the most vulnerable, with nearly 43.9% reporting ailments, which is almost four times the national average. This highlights the urgent need for structured geriatric healthcare systems in India.

Shift Toward Non-Communicable Diseases

A major epidemiological transition is visible, with Non-Communicable Diseases (NCDs) such as diabetes and hypertension becoming dominant after the age of 30, replacing infectious diseases as the primary health burden.

The Morbidity Paradox in India

Regional Contradiction

The survey reveals a striking paradox where Kerala reports morbidity above 25%, while states like Bihar and Uttar Pradesh report below 10%.

Interpretation of the Paradox

This does not imply better health in poorer states. Instead, it indicates underreporting due to low health awareness, weaker diagnostic infrastructure, and limited access to healthcare services. In contrast, higher morbidity in Kerala reflects better health awareness and stronger healthcare systems capable of detecting illness.

Maternal Health: Success with Structural Imbalance

India has achieved a major milestone with 96.2% institutional deliveries, reflecting strong progress in maternal health outcomes.

However, the system remains structurally imbalanced as a large share of deliveries and hospitalisations, especially in urban areas (64.6%), still occur in private hospitals. This reliance increases financial pressure despite public health improvements.

Financial Burden: Out-of-Pocket Expenditure Crisis

High Cost of Healthcare

The survey highlights a severe financial burden where private hospitalisation costs (₹50,508 on average) are nearly eight times higher than public hospitals (₹6,631). This creates a major affordability gap.

Risk of Poverty Trap

The median hospital expenditure of ₹11,285 is significant for low and middle-income households, making healthcare shocks a major driver of impoverishment in India.

Outpatient Care Advantage

Nearly half of outpatient services in public hospitals are provided free of cost, demonstrating the potential strength of the public healthcare system if adequately expanded.

Insurance Expansion and Structural Challenges

Health insurance coverage has improved significantly due to schemes like Ayushman Bharat (PMJAY), with rural coverage reaching 47.4% by 2025.

However, this has led to a structural issue where insurance funds are increasingly used in private hospitals, effectively shifting public resources to high-cost private care instead of strengthening public infrastructure.

Global Comparison of Health Financing

India’s healthcare financing structure remains weak in terms of financial protection.

High Out-of-Pocket Spending

India’s Out-of-Pocket Expenditure (OOP) is 43.89% of total health spending, which is significantly higher than high-income countries (13.35%) and even Sub-Saharan Africa (30.36%).

Comparison with China

China has reduced its OOP burden to 32.7% through strong public insurance expansion and infrastructure investment, highlighting the gap in India’s public health financing strategy.

Challenges in India’s Healthcare Sector

Limited Diagnostic Access

A major challenge in India’s healthcare system is the unequal distribution of diagnostic facilities, which are heavily concentrated in urban centres. This creates a significant gap in early disease detection and timely treatment, particularly in rural and remote regions where patients often reach healthcare facilities at advanced stages of illness.

Inadequate Healthcare Infrastructure

India continues to face a shortage of well-equipped hospitals, primary health centres, and advanced medical institutions, especially in rural areas. This infrastructural deficit limits the system’s capacity to provide timely, quality, and specialised care to a large segment of the population.

High Disease Burden and Spending Structure

India’s total healthcare expenditure is estimated at around 3.8% of GDP, which includes both public spending and out-of-pocket expenditure. However, a significant share of this burden is still borne directly by households, indicating that financial protection in healthcare remains weak despite rising overall spending.

Shortage of Skilled Healthcare Workforce

One of the most critical challenges is the severe shortage of trained medical personnel, including doctors, nurses, paramedics, and primary healthcare workers. The doctor-to-population ratio in India is approximately 0.7 per 1,000 people, which is far below the WHO recommended norm of 2.5 per 1,000 people. This shortage directly impacts service delivery and quality of care.

Government Initiatives for Improving Healthcare Access

Ayushman Bharat – PM-JAY

The Pradhan Mantri Jan Arogya Yojana (PM-JAY) provides health coverage of up to ₹5 lakh per family per year for secondary and tertiary hospitalisation, making it one of the largest publicly funded health insurance schemes in the world. Additionally, all citizens aged 70 and above are now eligible for coverage regardless of income status, expanding social protection for the elderly.

Affordable Medicines and Diagnostics

The government has introduced multiple initiatives to reduce healthcare costs. The Pradhan Mantri Bhartiya Janaushadhi Pariyojana ensures access to affordable generic medicines, while AMRIT pharmacies provide essential drugs and implants at subsidised rates, significantly reducing out-of-pocket expenditure for patients.

Maternal Health Initiatives

The Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA), launched in 2016, provides free antenatal care on a fixed day every month (the 9th day) for pregnant women. This ensures early detection of complications and improves maternal health outcomes.

Digital Health Infrastructure

The Swasth Bharat Portal integrates multiple national health programmes into a single platform, improving coordination and accessibility. In addition, eSanjeevani telemedicine service enables remote consultations, improving access to specialists, especially in rural and underserved areas.

Disease Control Programmes

India has strengthened targeted healthcare interventions through programmes such as the National TB Elimination Programme, which focuses on detection and treatment of tuberculosis, and the National Sickle Cell Anaemia Elimination Mission, which aims to eliminate the disease by 2047. The Pradhan Mantri National Dialysis Programme also provides free dialysis services, reducing financial burden on patients with kidney diseases.

Way Forward

Strengthening Healthcare Workforce

India needs urgent measures to address the shortage of healthcare professionals, particularly in rural and underserved regions. Expanding medical education, improving incentives, and strengthening training systems will be essential.

Expanding Digital Health Ecosystem

The expansion of the Ayushman Bharat Digital Mission can significantly improve healthcare efficiency by enabling better data integration, patient tracking, and service delivery through digital platforms.

Improving Rural Healthcare Access

A strong focus must be placed on expanding health infrastructure, diagnostic facilities, and specialist services in rural and remote areas. This is crucial for achieving balanced regional development and equitable healthcare access across the country.

Conclusion

India’s healthcare system is at a transitional stage where policy initiatives and digital innovations are expanding access, but structural challenges such as workforce shortages, infrastructural gaps, and high out-of-pocket expenditure continue to persist. Addressing these issues through strengthened public health investment, equitable distribution of resources, and workforce expansion is essential for achieving universal and affordable healthcare.