Rebuilding India’s health care for a billion people

This article is authored by NK Ganguly, former director general, Indian Council of Medical Research.

India’s health care system stands at a defining moment. As the country progresses towards developed-economy status, a central concern remains: can it provide timely, safe and affordable care to more than a billion people whose health needs are rapidly evolving? Today, the Indian health ecosystem reflects both significant strain and meaningful opportunities for improvement, particularly from the perspective of patients who depend on it most.

Health care(Getty Images/iStockphoto)

A recent reminder of this came when Nature released its global ranking of the top 200 research hospitals. The absence of an Indian hospital on the list is not simply a matter of prestige; it highlights the need to strengthen research environments that ultimately influence patient care, treatment standards and access to new therapies.

India’s disease burden intensifies this challenge. The country carries nearly a quarter of the world’s illnesses but contributes less than two per cent of global health spending. Non-communicable diseases already account for most deaths and are expected to rise further. More than 100 million Indians live with diabetes, and communicable diseases continue to affect millions each year. Since the pandemic, people are seeking care earlier and more consistently, and public programmes such as Ayushman Bharat – PM-JAY and Ayushman Arogya Mandirs have helped many enter the formal system for the first time.

Despite this, patients still face significant barriers. India requires large-scale investment in hospital infrastructure, yet public facilities on which the majority depend are under growing strain. Shortages of staff, long waiting times for critical conditions, and limited access to advanced treatments affect the quality and timeliness of care. Even when new therapies exist, they often remain out of reach for most households. These gaps raise important questions about equity and the ability of the system to serve those who rely on it most.

The workforce challenge compounds this. Many experienced clinicians move towards private or international settings where research and training opportunities are stronger. While private hospitals contribute meaningfully to the system, strengthening public institutions remains essential for ensuring that all patients not only those who can afford it receive consistent, high-quality care.

Other countries offer learning opportunities. China, Thailand and South Korea have strengthened patient access by aligning education, regulation and service delivery. Within India, institutions such as Christian Medical College, Vellore, demonstrate how integrated training, research and patient care can reinforce one another.

Medical education plays a crucial role in shaping patient outcomes. In many institutions, large class sizes restrict clinical exposure, and the rapid increase in seats has not been matched by investment in faculty, laboratories or practical training. Dentistry is already facing an oversupply of graduates; medicine risks a similar trajectory. Without careful attention, this could affect the competence and confidence of new doctors and, ultimately, the quality of care available to patients.

Financial pressures also influence what patients experience at the point of care. Health care delivery remains a low-return sector with limited long-term capital. Rising wages, increasing treatment complexity and currency challenges place additional strain on institutions. India remains a cost-efficient destination for treatment, but maintaining this advantage—and ensuring that quality remains accessible—requires more stable and sustainable financing structures focused on patient benefit.

Strengthening the health system must begin with reforms that enhance access, affordability and quality for patients. Key priorities include:

• Move from voluntary to structured coverage: More predictable health coverage across both formal and informal sectors can reduce out-of-pocket spending and ensure that people receive care when they need it
• Create a national high-risk support fund: Pooling the costs of chronic and high-risk conditions can help patients access early screening, better long-term management and protection from catastrophic expenses
• Improve accountability through transparency: An ABDM-linked national fraud registry can protect patients, reinforce trust and support fair practices across the system
• Enable rational pricing for sustainability: Reviewing tariff structures can help providers maintain essential services, upgrade facilities and invest in staff—benefits that directly affect patient care
• Standardise care pathways for high-burden diseases: Evidence-based protocols can reduce treatment variation and improve outcomes for common conditions seen across the country
• Reward quality and accreditation: Linking reimbursements to safety and clinical outcomes can ensure that patients receive care in facilities that meet basic quality standards
• Encourage innovation in care packages: Preventive, home-based and rehabilitative services can help identify illness earlier, reduce complications and ease pressure on hospitals—improving patient experience overall
• Support research across sectors: Encouraging hospitals with advanced facilities to invest in research—supported through appropriate funding—can expand access to new treatments and strengthen care for patients nationwide

Above all, India’s progress will depend on long-term investment in people and institutions. Well-equipped teaching environments, strong public hospitals and robust research systems are essential for ensuring that every patient, regardless of location or income, can depend on reliable and high-quality care.

India stands at a crossroads, but also at a moment of opportunity. With balanced reforms, transparent governance and sustained investment focused on public interest, the country can build a health system that is modern, equitable and firmly centred on the needs of its citizens.

This article is authored by NK Ganguly, former director general, Indian Council of Medical Research.