Key points
- India runs a mixed system: public provision alongside insurance schemes, with no single universal system.
- Ayushman Bharat PM-JAY gives cashless hospital cover of ₹5 lakh per family per year to 12 crore families, and to all citizens aged 70 and above since October 2024.
- Care is delivered by a large private sector alongside public facilities, with primary care through Health and Wellness Centres.
- Public facilities are largely free; households still paid 43.9% of health spending out of pocket in 2023 (WHO Global Health Expenditure Database).
- Life expectancy at birth was 71.0 years in 2023, and health spending was 3.3% of GDP in 2023 (WHO Global Health Estimates; World Bank, WHO Global Health Expenditure Database).
Direct answer: India runs a mixed system: public provision alongside insurance schemes, with no single universal system. Ayushman Bharat PM-JAY gives cashless hospital cover of ₹5 lakh per family per year to 12 crore families, and to all citizens aged 70 and above since October 2024. Care is delivered by a large private sector alongside public facilities, with primary care through Health and Wellness Centres. Public facilities are largely free; households still paid 43.9% of health spending out of pocket in 2023 (WHO Global Health Expenditure Database). Life expectancy at birth was 71.0 years in 2023 — and healthy life expectancy 60.6 years — and health spending was 3.3% of GDP in 2023 (WHO Global Health Estimates, October 2026; World Bank, WHO Global Health Expenditure Database).
At a glance
| Item | Detail |
|---|---|
| Model | Mixed — public provision + insurance schemes |
| Who pays | Tax-funded public facilities plus Ayushman Bharat PM-JAY, Employees' State Insurance and private insurance |
| Who delivers | Large private sector alongside public facilities; primary care via Health and Wellness Centres |
| What is free at the point of use | Public facilities largely free; PM-JAY gives cashless hospital cover of ₹5 lakh per family per year |
| Life expectancy at birth | 71.0 years (2023, WHO Global Health Estimates) |
| Health spending | 3.3% of GDP (2023, World Bank, WHO Global Health Expenditure Database) |
| Source for the model and coverage | Commonwealth Fund — India country profile |
Figures are a snapshot checked 7 November 2026, not a live feed. No country is ranked as best.
How the system works
Health in India is a state subject: the states run most public facilities, and the central government funds national programmes and regulates insurance. Public facilities — primary health centres, community health centres, district hospitals and medical colleges — are open to all and largely free. Primary care is being reorganised through Ayushman Bharat Health and Wellness Centres, which upgrade existing sub-centres and primary health centres to offer a wider package of services close to home.
Insurance sits alongside public provision rather than replacing it. The largest scheme is Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY), launched in 2018: cashless cover of ₹5 lakh per family per year for secondary and tertiary hospital care, for 12 crore families — the economically vulnerable bottom 40% of the population. In September 2024 the Cabinet approved extending the cover to all citizens aged 70 and above regardless of income, and the extension began on 29 October 2024, covering about 6 crore senior citizens in 4.5 crore families. More than 42 crore Ayushman cards had been created by 31 October 2025 (Ministry of Health and Family Welfare, Rajya Sabha reply). Formal-sector workers are covered separately by Employees’ State Insurance, and central government employees by the Central Government Health Scheme.
Who pays, and what people pay
The government share of total health spending rose from 28.6% in FY14 to 40.6% in FY19 (Ministry of Finance, January 2023), but households still pay the largest single share directly. Out-of-pocket spending was 43.9% of total health spending in 2023 (WHO Global Health Expenditure Database), mostly medicines and private consultations. A patient with a PM-JAY card pays nothing at an empanelled hospital for covered treatment; a patient without cover, or using a provider outside the schemes, pays the bill or buys private insurance. Private insurance is growing but still covers a minority, and most private cover is bought by employers or by better-off households.
What is free, and what is not
Public facilities are largely free at the point of use, and PM-JAY hospital care is cashless for its beneficiaries. What is not free is the margin: medicines bought outside the public system, private consultations and diagnostics, and hospital care for people outside the schemes — which is most of what the 43.9% out-of-pocket share pays for. The boundary is set by which scheme, if any, covers the patient, and by whether the care is available at a public facility nearby. Life expectancy fell during the pandemic, from 70.5 years in 2019 to 68.1 in 2021, and recovered to 71.0 in 2023 (WHO Global Health Estimates) — but healthy life expectancy was only 60.6 years in 2023, so about ten of those years are lived in less than full health.
How it compares
India spends 3.3% of GDP on health (2023), the fourth-lowest share in this set, after Pakistan (2.5% of GDP in 2023), Indonesia (2.7%) and Ethiopia (2.8%) and well below the OECD average of 9.3% (2024). Its life expectancy of 71.0 years is 10.1 years below the OECD average of 81.1 years (2023). India is not in the OECD tables, so its figures come from WHO and World Bank sources for 2023 rather than the OECD’s 2024 dashboards. Its distinguishing feature is the gap between the scale of its public schemes and the share households still pay: the world’s largest government-funded health insurance scheme by eligible families, sitting alongside out-of-pocket spending of 43.9% — the fifth-highest share in this set, after Nigeria (71.9%), Pakistan (52.9%), Ethiopia (46.3%) and the Philippines (44.4%). Compare countries side by side in the Health System Comparison tool, or read the other profiles in the country index.
Frequently asked questions
Does India have universal healthcare?
Not as a single system. Public facilities are open to all, and Ayushman Bharat PM-JAY covers hospital care for 12 crore of the poorest families plus all citizens aged 70 and above — but there is no one scheme covering everyone for everything, and households still paid 43.9% of health spending out of pocket in 2023.
What is Ayushman Bharat PM-JAY?
The Pradhan Mantri Jan Arogya Yojana: cashless cover of ₹5 lakh per family per year for secondary and tertiary hospital care, for the economically vulnerable bottom 40% of the population. In October 2024 it was extended to all citizens aged 70 and above, regardless of income.
Is treatment at a government hospital free?
Largely, yes: consultations and medicines at public facilities are mostly free or carry small charges. But many people use private providers, where they pay directly or through insurance, and medicines bought outside the public system are a large part of what households pay.