Diagnostics as the first line of defence

This article is authored by Surendran Chemmenkotil, managing director, Metropolis Healthcare Ltd.

India is at a pivotal point in its health care journey. The country faces a dual burden: non-communicable diseases such as diabetes, cardiovascular illness, and cancer are rising sharply, while infectious diseases continue to resurface in new forms. Treatment costs are escalating, but far too many patients are still being diagnosed late.

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In such a scenario, preventive health care is not an option but a necessity. And at the centre of every prevention effort lies diagnostics. A simple blood test can reveal early signs of kidney dysfunction, high cholesterol or vitamin deficiencies; an imaging scan can pick up the beginnings of cancer; a pathology screen can confirm infections before they spread. Diagnostics provide the evidence on which doctors and patients make timely decisions often changing the course of a disease entirely.

Yet despite this central role, diagnostics remains under-recognised in health policy. The sector, valued at $14–15 billion, still struggles with inconsistent quality, patchy access, and limited financial support for preventive testing. To truly embed diagnostics within India’s preventive health framework, we need a comprehensive strategy built around three priorities: Quality and standardisation, access to smaller towns, and financing preventive testing.

Reliable diagnostics depend first and foremost on quality. Yet around 90% of laboratories in India remain unaccredited, resulting in uneven standards and risks to patient safety. The Clinical Establishments Act was designed to address this, but enforcement has been inconsistent across states.

Further, regulations currently require pathology reports to carry a physical signature from a qualified pathologist. While this is intended to assure accountability, it inadvertently creates access bottlenecks. Smaller towns often do not have enough experienced pathologists, which means reports are delayed or validated by less qualified professionals. With secure digital platforms now widely available, it should be possible for a senior expert in a metro city to remotely review and digitally sign a report generated in a Tier 2 or Tier 3 laboratory. This would improve quality, maintain accountability, and extend the reach of expertise to where it is most needed.

Diagnostics infrastructure has grown steadily in India’s metropolitan areas, but smaller towns remain underserved. Many diagnostic centres operate from within small clinics, often lacking advanced equipment and consistent oversight. In regions such as eastern India, logistical barriers compound the problem: a sample may take as long as five days to reach a central laboratory, delaying diagnosis and care.

This gap has real consequences. A delay in identifying conditions like tuberculosis, for example, can result in both worsened outcomes for the patient and wider community spread. Addressing this requires deliberate investment in region-specific infrastructure, better logistics systems that ensure timely transport of samples, and the training of allied health professionals who can manage operations locally. Public–private partnerships, combined with targeted incentives for national diagnostic providers to expand into smaller towns, can make advanced testing more widely available.

Perhaps the most overlooked element of India’s diagnostic landscape is its exclusion from most health insurance policies. While preventive testing is proven to reduce long-term costs, routine diagnostics are usually paid for out of pocket. This discourages regular health checks, particularly among lower- and middle-income households, leading to late detection and higher treatment costs.

By including preventive diagnostics within both public and private insurance frameworks, India could create a financial environment that encourages people to test earlier and more often. The benefits are systemic: patients receive timely care, the overall cost burden of treatment falls, and insurers benefit from reduced claims for advanced interventions. Such a shift would align financial incentives with the national goal of prevention-led health care.

Diagnostics is not simply a support function; it is the first line of defence in building a healthier nation. A comprehensive strategy one that enforces quality standards, extends expert reach through digital validation, builds infrastructure and logistics in smaller towns, and integrates preventive testing into insurance cover can place diagnostics firmly at the core of India’s health system.

With the right policy attention and industry collaboration, India can move decisively from reactive treatment to proactive prevention, improving outcomes for millions while reducing the long-term cost of care.

This article is authored by Surendran Chemmenkotil, managing director, Metropolis Healthcare Ltd.