Health insurance is seldom bought for infants and is mostly inaccessible to seniors | Photo Credit: erdikocak

The National Sample Survey’s decennial surveys on household expenditure on health are an authoritative source of data and insights on how Indians deal with ailments, access healthcare, approach childbirth and foot their medical bills. On the face it, the 80th round of this survey (data from January to December 2025) has a lot of good news. It shows a sharp expansion in health insurance coverage and improved reach of healthcare facilities, compared to the previous survey in 2017-18. But a deeper dive also suggests new challenges.

One, after a dip in the previous round (2017-18) to 7.5 per cent, the latest survey shows a spike in the number of persons reporting ailments to 13.1 per cent. Infections have seen a decline from 2.5 per cent to 2.3 per cent of respondents, but persons reporting chronic ailments such as diabetes and cardiovascular issues jumped two to threefold. This is not necessarily a negative. It likely reflects better detection and reporting thanks to greater awareness and access to diagnostic facilities. However, given that chronic ailments require constant and expensive treatment, this has likely multiplied medical expenses of households. Two, in a very positive development for maternal and infant health, Indians have taken to institutional births in a big way, with 95.6 per cent of rural births and 97.8 per cent of urban ones now happening at hospitals. However, private hospitals gaining a larger share of childbirths in both rural and urban areas (28.8 per cent and 50.8 per cent respectively) despite steeply higher costs, suggest that public facilities haven’t yet gained the trust of families.

Three, hospitalisation rates remained minimal (1 to 2.5 per cent) for those between 5 years and 45 years of age. The incidence was much higher for infants under five (over 4 per cent) and seniors over 60 (7-10 per cent). This raises questions over the usefulness of India’s health insurance industry which focuses mainly on cover for the working age population. As things stand, health insurance is seldom bought for infants and is mostly inaccessible to seniors. Four, India’s health insurance coverage seems to have expanded substantially, thanks to government schemes such as Ayushman Bharat. In the latest round, as many as 47.4 per cent of rural respondents and 44.3 per cent of urban ones reported having a health insurance cover, compared to 14.1 and 19.1 per cent in 2018.

However, this sits uncomfortably with the large out-of-pocket expenses that households continued to incur on healthcare. Though private hospitals cost about seven times more than public ones, Indians favour the former. They incurred average expenses of ₹34,064 per hospitalisation, ₹14,775 for childbirth and ₹861 on outpatient treatments out of their own pocket. These numbers were up sharply from the previous round. Overall, policymakers need to focus on building trust in and access to, public healthcare and drive better design of health insurance products.

Published on April 26, 2026