India’s healthcare sector is one of the most dynamic and rapidly evolving in the world. With a population exceeding 1.4 billion, the country faces immense pressure to provide quality medical services to every citizen-from the most remote villages to the densely packed metros. Over the past several decades, India has built an extensive health infrastructure, improved key health indicators, and expanded insurance coverage. Yet, challenges like a heavy disease burden, urban-rural disparities, gender discrimination, and inadequate public spending continue to shape the sector’s trajectory. Let’s take a closer look at where India’s health sector stands today and what lies ahead.
Table of Contents
- The current state of India’s healthcare industry
- Evolution of India’s health infrastructure
- The public health network
- Key government initiatives shaping healthcare access
- Key health indicators and improvements
- Mortality and life expectancy trends
- Declining out-of-pocket expenditure
- The Indian health card: disease burden analysis
- The rise of non-communicable diseases
- Persistent infectious disease challenges
- Gender discrimination and its health impact
- How discrimination manifests in health outcomes
- The cycle of gender discrimination and health
- The road ahead: what needs to change
The current state of India’s healthcare industry
India’s healthcare industry has grown remarkably over the past two decades. The sector was valued at approximately US$ 372 billion in 2023 and is projected to reach US$ 638 billion by 2025, growing at a robust 17.5-22.5% compound annual growth rate. This expansion is driven by rising incomes, increased health awareness, a growing insurance market, and greater private sector participation.
The healthcare ecosystem in India is broad. It encompasses hospitals and clinics, diagnostic centres, medical device manufacturers, pharmaceutical companies, research institutions, and a vast network of support services. The hospital segment alone accounts for roughly 80% of the total healthcare system in India. Additionally, standalone health insurance companies captured 41% of the non-life insurance market by the end of FY25, up from 30% in FY20 , signalling a growing willingness among Indians to invest in health coverage.
Despite this growth, public health expenditure still falls short of the National Health Policy 2017 target of allocating 2.5% of GDP to healthcare. Government healthcare spending was around 2.5% of GDP in FY2025 , which includes both central and state contributions. The Union Budget 2025-26 allocated INR 95,957.87 crore to the healthcare sector, representing a 9.46% increase over the previous year. While this is a step forward, analysts note that as a share of total budget expenditure, health spending has actually been declining in recent years.
Evolution of India’s health infrastructure
India’s public health infrastructure has expanded significantly over the past five decades. The country has developed a multi-tiered system designed to reach citizens at every level-from sub-centres in villages to super-specialty hospitals in major cities.
The public health network
At independence, India had very limited modern medical infrastructure. Through sustained government investment, the country built a layered network comprising medical colleges, district hospitals, Community Health Centres (CHCs), Primary Health Centres (PHCs), and Sub-Health Centres. Today, the country has over 13.86 lakh registered allopathic doctors and 7.51 lakh AYUSH practitioners, yielding an overall doctor-to-population ratio of about 1:811. On the education front, 157 new medical colleges are being established by upgrading district and referral hospitals, of which 131 are already operational.
This public network is supplemented by a large private sector that includes corporate hospital chains, standalone clinics, nursing homes, and NGO-run facilities. Together, they form one of the largest health delivery systems in the developing world.
Key government initiatives shaping healthcare access
Several flagship programmes have accelerated improvements in health access. The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) has been transformative, providing health coverage to the bottom 40% of India’s most vulnerable populations. As of early 2025, over 40 lakh senior citizens have been enrolled following the scheme’s expansion to all persons above 70 years of age. The programme has played a significant role in reducing out-of-pocket expenses-with over ₹1.25 lakh crore in savings recorded for households.
On the digital front, the Ayushman Bharat Digital Mission has facilitated the creation of 72.81 crore health accounts , and e-Sanjeevani, the national telemedicine service, has emerged as one of the world’s largest telemedicine deployments in primary healthcare. These digital initiatives are helping bridge the gap between urban and rural healthcare delivery.
Key health indicators and improvements
India has achieved notable progress in improving the health status of its population over the past several decades. At independence, life expectancy was around 31 years, death rates were roughly 40 per thousand, and infant mortality was exceptionally high. Fast forward to the present, and the picture is significantly better-though still mixed.
Mortality and life expectancy trends
Life expectancy in India has more than doubled, rising from about 31 years at the time of independence to over 70 years today. Death rates have declined dramatically, and infant mortality has seen substantial improvements. Full immunisation coverage for FY24 stands at 93.5% nationally , reflecting the success of the Universal Immunisation Programme in protecting children from preventable diseases.
India’s maternal mortality ratio has declined from 556 in 1990 to approximately 113 per 100,000 live births in recent years-a nearly 80% reduction over three decades. However, this national average masks stark regional differences. States like Assam still report around 215 maternal deaths per 100,000 live births, while Kerala has brought the figure below 50 , comparable to some developed countries.
Declining out-of-pocket expenditure
One critical improvement is the reduction in out-of-pocket health spending. The share of government health expenditure in total health expenditure rose from about 28.6% in FY14 to 48% by FY22 , while out-of-pocket costs have steadily declined. This is largely the result of expanded public insurance schemes and increased government funding. Social security expenditure on health has also grown, increasing from 5.7% of total health expenditure in FY14 to 8.7% in FY22.
The Indian health card: disease burden analysis
Despite improvements in infrastructure and key indicators, India carries one of the heaviest disease burdens in the world. The country is dealing with a “dual burden”-traditional infectious diseases have not been fully eliminated, even as non-communicable diseases (NCDs) are surging.
The rise of non-communicable diseases
Non-communicable diseases now dominate India’s health landscape. NCDs account for 60% of all deaths in the country , and the leading individual causes of disease burden include diabetes, ischaemic heart disease, hypertensive heart disease, and chronic respiratory conditions. India is often referred to as the “diabetes capital of the world,” and the numbers bear this out. Diabetes prevalence is projected to keep increasing steadily through 2031, with the age-standardised prevalence rate expected to reach about 7,513 per 100,000 by 2027 , according to a recent study published in Frontiers in Endocrinology.
The India State-Level Disease Burden Initiative found that cardiovascular diseases, diabetes, chronic respiratory diseases, mental health disorders, musculoskeletal conditions, cancers, and chronic kidney disease have all increased their contribution to the total disease burden across all states since 1990. A group of risk factors-including unhealthy diet, high blood pressure, elevated blood sugar, high cholesterol, and being overweight-now together contribute roughly a quarter of the country’s total disease burden.
Persistent infectious disease challenges
While NCDs are rising, infectious diseases remain a serious concern, especially in poorer states. India accounts for roughly one-fourth of the global TB incidence, with approximately 2.8 million cases in 2022. Tuberculosis continues to be one of the top causes of disability-adjusted life years in the country. The co-occurrence of TB and diabetes is a growing concern-an estimated 20% of all TB patients in India also suffer from diabetes, with significantly higher odds of treatment failure, relapse, and death.
Diarrheal diseases, lower respiratory infections, iron-deficiency anaemia, and neonatal disorders also continue to be major public health challenges in many of the poorer northern states. This dual burden-with communicable and non-communicable diseases existing simultaneously-makes health planning and resource allocation particularly complex.
Gender discrimination and its health impact
Gender discrimination is one of the most persistent and damaging social determinants of health in India. It creates a cycle that affects not just the current generation of women but also the health outcomes of future generations.
How discrimination manifests in health outcomes
The high level of gender inequality in India directly and negatively impacts the health of women. This starts from birth. Girls continue to face higher mortality risks than boys in many parts of India, particularly in states like Uttar Pradesh, Bihar, Rajasthan, and Madhya Pradesh, where female infant mortality exceeds male infant mortality by 10-15%. Families with limited resources often prioritise healthcare, nutrition, and education for male children.
Studies have shown that boys are more likely to receive treatment at health facilities compared to girls, even when socioeconomic status is held constant. This disparity in healthcare access persists through adolescence and into adulthood. Data from the National Family Health Survey shows that only 12% of women aged 15-49 make decisions about their own healthcare, compared to 34% of men in the same age group , highlighting how deeply embedded these patterns are.
The cycle of gender discrimination and health
Gender discrimination creates a vicious cycle. Girls who receive less nutrition and healthcare grow into women who are more likely to be anaemic, physically weakened, and vulnerable during pregnancy. Poor nutrition and lack of awareness about available health services during childhood and reproductive years are major factors behind high maternal mortality. Early marriage leads to early pregnancy, which in turn leads to higher risks of complications for both mother and child. Low birth weight babies born to malnourished mothers are themselves more likely to face health problems, perpetuating the cycle into the next generation.
Nearly 70% of non-pregnant women and 75% of pregnant women in India have been found to be anaemic due to iron deficiency. Severe anaemia contributes to a significant proportion of maternal deaths. Nearly 23% of women are married before age 18 despite legal prohibitions, resulting in early pregnancies with associated health risks. And around 30% of ever-married women report experiencing physical or sexual violence , which further compounds health vulnerabilities.
India ranked 131st out of 148 countries in the 2025 Global Gender Gap Report, with an overall parity score of 64.1%. While some sub-indices like education and health survival show progress, research from the International Growth Centre confirms that substantial gender gaps persist in the utilisation of subsidised hospital care, driven not by different illness rates but by households’ willingness to allocate greater resources toward male members’ health.
The road ahead: what needs to change
India’s healthcare sector has come a long way, but the path forward requires addressing several structural challenges. Healthcare spending as a proportion of the total budget has declined in recent years, raising concerns about whether the pace of investment can keep up with growing demand. The government’s own Economic Survey acknowledges the need to keep increasing the share of public health spending in GDP.
Strengthening primary healthcare remains essential. India needs an estimated three million additional hospital beds to achieve the target of three beds per 1,000 people, along with 1.54 million more doctors and 2.4 million nurses to address workforce shortages. Closing the urban-rural divide, integrating disease control programmes for conditions like TB and diabetes, and addressing gender-based health inequities are all critical priorities.
The digital transformation underway-through telemedicine, health accounts, and drone delivery of medicines to remote areas-offers promising pathways. But technology alone cannot fix systemic issues. It must be paired with sustained investment, better training for healthcare workers, and policies that actively address the social determinants of health, including poverty, gender inequality, and malnutrition.
What do you think? Can India realistically achieve universal health coverage while also tackling its dual burden of communicable and non-communicable diseases? And how can the health sector better address the deep-rooted gender inequities that continue to affect women’s wellbeing across the country?
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