Equity, Inclusivity, and Sustainability Issues in the Healthcare System of India: A Critical Review.
1
Public Health, MMBSHS Trust, Dehradun, India
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
ABSTRACT:
Introduction and
OBJECTIVES:
COVID-19 exposed the equity and inclusivity issues of healthcare systems globally. In India, healthcare is in the State List of the 7th Schedule of the Constitution. This study aimed to understand the equity, inclusivity, and sustainability issues in the Indian healthcare system, which serves a diverse country of 1.4 billion people.
METHODS:
We analysed population growth, government data, policy frameworks, NGO reports, and media reports of government healthcare expenditure, private vs public healthcare, healthcare resources, health service utilisation, and gaps in rural and urban healthcare after 2011.
RESULTS:
While India’s population increased by 13.25% from 2011 to 2020, health expenditure grew by only 0.39%. In 2024-25, government spending on healthcare was 1.9% of GDP, far below the finance commission’s recommendation to 2.5% of GDP by 2025. 80% of doctors work in urban areas where only 30% of the population lives, leaving rural and semi-urban areas with vacant doctor posts. Commercialisation of healthcare treats health as a commodity rather than a fundamental right, resulting in unnecessary tests, procedures, and surgeries, and over-medicalisation of health. The system forces healthcare providers to choose between business interests and ethics. Market-driven healthcare inflation increases the vulnerabilities of marginalised sections of society multiple times, pushing 50-55 million Indians below the poverty line every year. It is severely impacting and eroding the benefits and outcomes of the world’s largest publicly funded ambitious healthcare insurance scheme, Ayushman Bharat PM-JAY.
CONCLUSIONS:
Market-driven forces are nudging India’s healthcare policy frameworks towards profit-making privatization and commercialization, affecting Primary Health Care and National Health Mission (NHM) activities. It is creating a vicious cycle of commodification and over-medicalisation of health, widening equity and sustainability gaps by creating affordability, accessibility, and availability issues, and eroding confidence in public healthcare.
Introduction and
OBJECTIVES:
COVID-19 exposed the equity and inclusivity issues of healthcare systems globally. In India, healthcare is in the State List of the 7th Schedule of the Constitution. This study aimed to understand the equity, inclusivity, and sustainability issues in the Indian healthcare system, which serves a diverse country of 1.4 billion people.
METHODS:
We analysed population growth, government data, policy frameworks, NGO reports, and media reports of government healthcare expenditure, private vs public healthcare, healthcare resources, health service utilisation, and gaps in rural and urban healthcare after 2011.
RESULTS:
While India’s population increased by 13.25% from 2011 to 2020, health expenditure grew by only 0.39%. In 2024-25, government spending on healthcare was 1.9% of GDP, far below the finance commission’s recommendation to 2.5% of GDP by 2025. 80% of doctors work in urban areas where only 30% of the population lives, leaving rural and semi-urban areas with vacant doctor posts. Commercialisation of healthcare treats health as a commodity rather than a fundamental right, resulting in unnecessary tests, procedures, and surgeries, and over-medicalisation of health. The system forces healthcare providers to choose between business interests and ethics. Market-driven healthcare inflation increases the vulnerabilities of marginalised sections of society multiple times, pushing 50-55 million Indians below the poverty line every year. It is severely impacting and eroding the benefits and outcomes of the world’s largest publicly funded ambitious healthcare insurance scheme, Ayushman Bharat PM-JAY.
CONCLUSIONS:
Market-driven forces are nudging India’s healthcare policy frameworks towards profit-making privatization and commercialization, affecting Primary Health Care and National Health Mission (NHM) activities. It is creating a vicious cycle of commodification and over-medicalisation of health, widening equity and sustainability gaps by creating affordability, accessibility, and availability issues, and eroding confidence in public healthcare.
| eISSN: | 2654-1459 |
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