While insurance coverage protection has expanded, now accounting for 38% of the market and reaching over 50 crore folks, these good points haven’t curbed OOPE, which nonetheless dominates health spending.
Nearly half of India’s population is now covered by health insurance coverage, finds a survey report launched on Monday by the Statistics Ministry. However, the common out-of-pocket bills (OOPE) per hospitalisation proceed to stay excessive, topping ₹34,000 in non-public and charitable healthcare amenities.
The findings are primarily based on responses from about 1.4 lakh households surveyed between January and December 2025 as half of the eightieth spherical of the National Sample Survey (NSS).
Health insurance coverage protection has risen sharply, the report famous. In 2017-18, in the course of the earlier NSS health survey, solely 14.1 per cent of rural residents and 19.1 per cent of city residents had been insured.
By 2025, the protection had elevated to 47.4 per cent in rural and 44.3 per cent in city areas. This growth coincided with the discount of GST on particular person and household health insurance coverage premiums to zero from 18 per cent, efficient September 22, 2025.
Govt schemes
Coverage below government-sponsored schemes grew even sooner, rising from 13 per cent in rural areas and 9 per cent in city areas in 2017-18 to 45.5 per cent and 31.8 per cent, respectively, in 2025. The Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), launched in September 2018, provides annual health cowl of as much as ₹5 lakh per eligible family and has enrolled practically 12 crore households.
Experts, nonetheless, provided a nuanced evaluation of this growth. “The increase is driven largely by government-funded health assurance schemes such as Ayushman Bharat PM-JAY rather than direct private insurance,” stated Indranil of OP Jindal University. Mohan Rao, a former professor on the Centre of Social Medicine and Community Health, Jawaharlal Nehru University, added that the scheme has successfully subsidised non-public healthcare provision on the price of strengthening public health infrastructure.
Out-of-pocket spend
Despite the broader protection, price disparities stay stark. The common OOPE per hospitalisation stood at ₹6,631 in authorities or public amenities, however jumped to ₹39,530 in charitable or NGO-run hospitals and ₹50,508 in non-public hospitals, together with these empanelled below authorities schemes.
The 2017-18 NSS didn’t present comparable OOPE estimates. However, a research by Indranil, which deflated prices to 2014 costs, estimated outpatient OOPE at ₹16,128 in rural and ₹20,814 in city areas throughout that interval.
Other key findings
About 13.1 per cent of individuals reported sickness within the 15 days earlier than the survey, with city areas (14.9 per cent) barely larger than rural (12.2 per cent). The common hospitalization fee was 2.9 cases per 100 individuals over the previous one year.
While insurance coverage protection has expanded, now accounting for 38 per cent of the market and reaching over 50 crore folks, these good points haven’t curbed OOPE, which nonetheless dominates health spending.
With non-public premiums rising (a 25 per cent soar for 52 per cent of policyholders within the final 12 months) and schemes like AB-PMJAY specializing in inpatient empanelments, households proceed going through catastrophic prices, as evidenced by research like Reshmi et al (BMJ 2021) and Samir Garg et al (EPW, April 2024).
Published on April 20, 2026