Universal Health Coverage (UHC) in India- Explained Pointwise

India aims to ensure universal health coverage with the opening of Jan Aushadhi Kendras under the  Pradhan Mantri Bhartiya Janaushadhi Pariyojana (PMBJP). The scheme reaffirms the government’s commitment to Universal Health Coverage (UHC) and to ensure that no citizen is left behind in availing quality health services.

What is Universal Health Coverage (UHC) and its Key Principles?

Universal Health Coverage (UHC)– According to the WHO, UHC means that all people have access to the full range of quality health services they need, when and where they need them, without financial hardship. It is embedded in the Sustainable Development Goals (SDG target 3.8).

UHC covers the full continuum of essential health services, from health promotion to prevention, treatment, rehabilitation, and palliative care across the life course. It is guided by the principles of equity, non-discrimination, and the right to health, focusing on reaching marginalized populations to ensure no one is left behind.

 Key Aspects and Principals of UHC

1. Equitable Access- Healthcare services should be accessible to everyone, regardless of socio-economic status.

2. Quality Healthcare- Services must be of good quality to improve health outcomes.

3. Financial Protection- No one should be forced into financial distress due to medical expenses.

What has been the evolution of UHC globally and in India?

Evolution of UHC in India

India’s commitment to UHC is reflected in its policies, programs, and constitutional provisions. Articles 39(e), 42, and 47 of the Indian Constitution mandate the State to improve public health and ensure access to quality healthcare. Some significant initiatives under the UHC which has evolved over decades include-

What is the Significance of UHC in India?

1. Economic Growth- Countries that invest in UHC experience faster economic growth due to improved workforce productivity and reduced poverty. E.g. China’s UHC reforms (1990s–2010s) significantly reduced poverty and boosted economic gains, showcasing how strong healthcare systems can support national economic growth.

2. Reduction in Out-of-Pocket (OOP) Expenditure- Healthcare costs push millions into poverty every year. UHC ensures that no one has to choose between healthcare and financial stability. E.g.
a. Countries with strong UHC models (e.g., Thailand’s Universal Coverage Scheme) have reduced OOP expenses to below 15% of total health spending.
b. India’s AB-PMJAY , has resulted in ₹1.25 lakh crore in OOP savings, significantly reducing catastrophic health expenditure (CHE) for inpatient care.

3. Improved Health Outcomes- UHC enhances population health by improving access to preventive, primary, and specialized care. States with higher public health expenditure (Kerala, Tamil Nadu, Himachal Pradesh) have better health indicators compared to states with high AB-PMJAY enrollment but weaker public health infrastructure.

4. Disease Burden Reduction- As per World Bank preventive healthcare and early screening can save ₹4.8 lakh crore in productivity losses by 2030 by addressing non-communicable diseases (NCDs) like diabetes, hypertension, and heart diseases.

5. Social Equity & Reducing Healthcare Disparities– UHC ensures that healthcare is not a privilege but a right, especially for vulnerable groups such as Scheduled Tribes, women, and low-income communities. E.g. According to the NSS 75th Round, marginalized communities bear the highest OOP expenses, making UHC critical for reducing health inequities.

6. Boosting Medical Tourism & Global Healthcare Leadership- India’s medical tourism sector generated $7.69 billion in 2024, with projections to reach $14.31 billion by 2029. Affordable, high-quality healthcare and advanced medical procedures attract international patients, reinforcing India’s status as a global healthcare hub.

What are the Challenges in Achieving True UHC?

1. Inadequate Public Health Expenditure- India’s public health expenditure (PHE) remains low at 1.9% of GDP (Economic Survey 2024-25), below the WHO-recommended 5% GDP target. This results in substandard quality of public healthcare. E.g. India loses 6% of GDP annually due to premature mortality and morbidity (Lancet Report)

2. Regional Disparities- Healthcare infrastructure is unevenly distributed, with urban areas having access to superior facilities compared to rural areas. E.g. While 70% of India’s healthcare professionals are located in urban regions, 65% of the population resides in rural areas.

3. OOP Expenditure & Financial Risk Protection- OOP spending accounts for 48.2% of total health expenditure (National Health Accounts 2022). Over 60 million people are pushed into poverty annually due to healthcare costs.

4. Limited Coverage of Outpatient Care- AB-PMJAY (World’s Largest PFHI Scheme), covers only inpatient care, neglecting outpatient services (OPD), diagnostics, and medicines, which accounts for the largest share of OOP expenses, which remains largely unaddressed.

5. Government vs. Private Sector Dependence- Two-thirds of outpatient care is provided by the private sector, leading to heavy private-sector dependency in UHC expansion. Government health insurance schemes like Employees’ State Insurance (ESI) and CGHS, outperform AB-PMJAY in financial risk protection due to OPD inclusion but are limited in scope (i.e., only for salaried workers).

6. Neglect of Primary Health Care- The National Health Mission (NHM) allocations have stagnated, while AB-PMJAY’s budget has grown. This has led to a widening gap between primary and hospital care.

7. Low Focus on Preventive Healthcare- Preventive measures like immunization, screening, and lifestyle changes remain underused despite being cost-effective. E.g. According to NFHS-5, in 2021, India’s full immunization coverage was just 76.4%, leaving many children at risk.

8. Low Health Awareness– Factors like low educational levels, poor functional literacy, and limited focus on health contribute to low awareness about personal well-being. E.g. Many Indian women remain unaware of the benefits of exclusive breastfeeding for children, resulting in issues like stunting and malnutrition.

9. Quality & Accessibility Issues- Many AB-PMJAY empaneled hospitals are concentrated in urban areas, limiting access for rural populations. Supply-side constraints (doctors, hospital beds, diagnostic facilities) reduce the scheme’s efficiency.

10. Low Insurance Penetration- According to NHFS-5, only 41% of Indian households had a member with health insurance or financial coverage.

What should be the way forward for strengthening UHC in India?

1. Increase Public Health Spending- Raise public health spending to 3-5% of GDP over the next decade. Implement taxation-based financing (sin taxes, corporate health levies) and Increase state-level autonomy in healthcare financing. E.g. NHS Model UK.

2. Strengthen Primary Healthcare (PHC) & Preventive Care- Increase NHM funding & integrate outpatient services in Ayushman Bharat, expand PHCs with 24/7 services & focus on disease prevention. E.g. Tamil Nadu’s PHC Model which have robust PHCs with decentralized planning & drug supply chain.

3. Integrating Outpatient Care in PFHI- Introduce co-payment models where patients share costs only for OPD services, ensuring financial sustainability.

4. Improve Healthcare Financing through Risk Pooling & Insurance Expansion- Integrate fragmented insurance schemes into a single national framework, and expand contributory health insurance for informal sector workers. E.g. Japan’s Universal Insurance Model.

5. Strengthen Public Health Infrastructure & Human Resources- Increase medical college seats & incentivize rural postings, expand nurse-led PHCs & mid-level health providers. E.g. Canada’s Decentralized Healthcare Model.

6. Leverage Digital Health & Telemedicine- Scale up ABDM for seamless health data integration, expand AI-driven disease surveillance & diagnostics. E.g. Estonia’s Digital Health Model which has 100% electronic health records (EHRs) linked to national ID.

India’s journey towards UHC is at a critical juncture. While Ayushman Bharat has expanded financial protection for inpatient care, gaps in outpatient services, primary healthcare, and financial sustainability persist. As Economic Survey 2024-25 notes, UHC must be seen as a long-term commitment, not a quick-fix insurance model. To truly achieve Health for All, India must ensure that UHC does not merely shift costs but genuinely alleviates the financial burden of healthcare.