Towards a Resilient and Inclusive Healthcare System
The findings of the NSO 80th Round Survey provide compelling evidence of India’s progress in building a more accessible, affordable, and equitable healthcare system. The convergence of increased public investment, policy innovation, and institutional strengthening has led to measurable improvements in healthcare outcomes.
However, challenges remain, particularly in addressing the rising burden of non-communicable diseases, ensuring quality of care, and sustaining financial investments. Moving forward, the focus must shift towards strengthening health systems resilience, integrating digital health solutions, and enhancing human resource capacity.
As India advances towards the vision of Viksit Bharat 2047, the healthcare sector will play a central role in shaping human capital and economic productivity. The progress captured in the NSO survey is not merely a reflection of past achievements but a foundation for future reforms aimed at achieving universal, high-quality healthcare for all citizens
A Transformative Phase in India’s Public Health Trajectory
India’s healthcare system is undergoing a structural transformation, driven by sustained public investment, policy innovation, and institutional expansion. The findings of the National Statistical Office 80th Round Survey on Household Social Consumption on Health provide a comprehensive empirical basis to evaluate this transition. Covering over 1.39 lakh households across rural and urban India, the survey offers granular insights into access, affordability, utilisation, and evolving health-seeking behaviour. The data suggests that India is moving steadily towards the goal of universal health coverage (UHC), with measurable improvements across multiple dimensions of healthcare delivery.
Expanding Access: Strengthening the Public Health Infrastructure
One of the most notable outcomes highlighted in the survey is the significant expansion in access to healthcare services, particularly in rural areas. This progress is closely linked to the scaling up of primary healthcare infrastructure under initiatives such as Ayushman Bharat. The operationalisation of over 1.84 lakh Ayushman Arogya Mandirs has brought preventive, promotive, and basic curative services closer to communities, reducing geographic and economic barriers.
The Ministry of Health and Family Welfare has consistently increased budgetary allocations to strengthen healthcare infrastructure across primary, secondary, and tertiary levels. This expansion is not merely quantitative but also qualitative, with a growing emphasis on comprehensive care models that integrate diagnostics, treatment, and follow-up services. The hub-and-spoke diagnostic model, supported by sample transportation systems, has further improved access to quality diagnostic services even in remote regions.
Affordability and Financial Protection: Reducing the Burden of Healthcare Costs
A critical dimension of healthcare reform in India has been the reduction of out-of-pocket expenditure (OOPE), which historically accounted for a large share of total health spending. The survey reveals that the median OOPE per hospitalisation stands at approximately ₹11,285, indicating that more than half of hospitalisation cases involve relatively moderate expenses. More significantly, in public healthcare facilities, the median OOPE for hospitalisation is as low as ₹1,100, while outpatient care often incurs zero expenditure.
These outcomes reflect the tangible impact of initiatives such as free drug and diagnostic services, as well as subsidised treatment programmes. Schemes like the Affordable Medicines and Reliable Implants for Treatment (AMRIT) initiative have expanded access to essential medicines at significantly reduced prices. According to the World Health Organization, reducing OOPE is a critical indicator of progress towards UHC, as it protects households from catastrophic health expenditures and prevents poverty induced by medical costs.
Insurance Expansion: Scaling Financial Risk Protection
The expansion of government-financed health insurance schemes represents another major milestone. Coverage has increased more than threefold, reaching 45.5 percent in rural areas and 31.8 percent in urban areas. This growth is largely driven by flagship programmes such as Ayushman Bharat Pradhan Mantri Jan Arogya Yojana, which provides financial protection for secondary and tertiary care hospitalisation.
The NITI Aayog has emphasised that expanding insurance coverage is essential for achieving equitable healthcare access, particularly for vulnerable populations. The survey’s findings indicate that the benefits of these schemes are disproportionately accruing to the lower consumption quintiles, suggesting effective targeting and improved inclusivity.
Changing Health-Seeking Behaviour: Rising Demand for Healthcare Services
An important insight from the survey is the significant increase in the proportion of population reporting ailments (PPRA), which has nearly doubled since the previous survey round. While this may initially appear as a negative trend, it is in fact indicative of improved awareness and a shift towards proactive health-seeking behaviour.
This behavioural change reflects the success of large-scale awareness campaigns, community engagement initiatives, and improved accessibility of healthcare services. The World Bank has noted that increased reporting of ailments often correlates with better detection and early diagnosis, which are essential for effective disease management and improved health outcomes.
Epidemiological Transition: From Infectious to Non-Communicable Diseases
The survey also captures a broader epidemiological shift, with a decline in infectious diseases and a rising prevalence of non-communicable diseases (NCDs) such as diabetes and cardiovascular conditions. This transition is consistent with global patterns observed in developing economies undergoing rapid socio-economic change.
India’s policy response has increasingly focused on preventive healthcare and early screening. Community-based platforms and targeted screening programmes have played a crucial role in identifying NCDs at an early stage, thereby reducing long-term treatment costs and improving quality of life. The Indian Council of Medical Research has highlighted the growing burden of NCDs and the need for integrated care models to address this challenge.
Utilisation of Public Healthcare: Renewed Trust in Government Facilities
The data indicates a steady increase in the utilisation of public healthcare facilities, particularly for outpatient services in rural areas, where usage has risen from around 28 percent in 2014 to 35 percent in 2025. This trend suggests a growing trust in public health institutions, driven by improvements in service quality, availability of free medicines, and expanded infrastructure.
Such a shift is significant, as public healthcare systems play a central role in ensuring equitable access. Increased utilisation also enhances the efficiency of public investments, as higher patient volumes justify continued expansion and resource allocation.
Maternal and Child Health: Sustained Gains in Institutional Deliveries
India has made remarkable progress in maternal and child health, as reflected in the high rates of institutional deliveries. The survey reports that institutional births have reached 95.6 percent in rural areas and 97.8 percent in urban areas. This improvement is the result of sustained policy interventions, including conditional cash transfer schemes and enhanced maternal healthcare services.
Programmes such as Janani Suraksha Yojana and Pradhan Mantri Surakshit Matritva Abhiyan have played a pivotal role in promoting safe deliveries and reducing maternal and neonatal mortality. The United Nations Children’s Fund has recognised India’s progress in maternal health as a key contributor to global improvements in maternal and child health indicators.
Equity and Inclusion: Targeted Benefits for Vulnerable Populations
A notable finding of the survey is the decline in OOPE among the bottom consumption quintiles, indicating that government interventions are effectively reaching economically weaker sections. This aligns with the broader objective of ensuring that healthcare reforms are inclusive and equitable.
The focus on targeted interventions, combined with expanded insurance coverage and free service provision, has created a safety net for vulnerable populations. This is particularly important in a country with significant socio-economic diversity, where disparities in access and affordability have historically been pronounced.
Towards a Resilient and Inclusive Healthcare System
The findings of the NSO 80th Round Survey provide compelling evidence of India’s progress in building a more accessible, affordable, and equitable healthcare system. The convergence of increased public investment, policy innovation, and institutional strengthening has led to measurable improvements in healthcare outcomes.
However, challenges remain, particularly in addressing the rising burden of non-communicable diseases, ensuring quality of care, and sustaining financial investments. Moving forward, the focus must shift towards strengthening health systems resilience, integrating digital health solutions, and enhancing human resource capacity.
As India advances towards the vision of Viksit Bharat 2047, the healthcare sector will play a central role in shaping human capital and economic productivity. The progress captured in the NSO survey is not merely a reflection of past achievements but a foundation for future reforms aimed at achieving universal, high-quality healthcare for all citizens.
