Despite the implementation of various health initiatives, many Indian households continue to struggle with medical costs. This is due to a complex interplay of factors, including high out-of-pocket expenditure, inadequate insurance coverage, rising healthcare costs, and systemic challenges within the healthcare system.

One of the primary reasons for this struggle is the high level of out-of-pocket expenditure (OOPE) in India. Although OOPE has decreased from 64.2% in 2013-14 to 39.4% in 2021-22, it remains a significant burden for many families. This means that a large portion of healthcare expenses is directly paid by individuals and families, rather than being covered by insurance or government programs. High OOPE often leads to reduced spending on other essential needs and can push households into poverty. In fact, studies have shown that a considerable number of Indian households face impoverishment due to healthcare expenses.

Several factors contribute to these high out-of-pocket expenses. A major issue is the limited penetration of health insurance, particularly among the poorer sections of society. While government schemes like Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) aim to provide health coverage to vulnerable populations, many individuals remain uncovered or face coverage gaps. Even those with insurance may find that it doesn't fully cover the costs of treatment, leading to significant out-of-pocket payments. Additionally, delayed insurance claim processing and a lack of transparency can further exacerbate the financial burden on households.

The rising cost of healthcare services and medicines is another significant challenge. Medical inflation in India is among the highest in Asia, with costs of procedures and treatments increasing substantially. This increase in cost makes it difficult for families to afford necessary medical care, even for routine health issues. Measures to control drug prices have been implemented, but their effectiveness in making essential medications affordable remains a concern.

Systemic challenges within the Indian healthcare system also contribute to the problem. These challenges include:

• Inadequate infrastructure: Many hospitals and clinics, especially in rural areas, lack proper equipment, beds, and basic facilities.
• Shortage of medical professionals: There is a significant shortage of doctors, nurses, and other healthcare workers, particularly in rural areas.
• Lack of awareness: Many people, especially in rural areas, are not aware of available healthcare benefits and services.
• Accessibility issues: Access to quality healthcare services is limited in many parts of the country, especially in smaller towns and remote regions.

The Indian government has implemented several initiatives to address these challenges. The National Health Policy (NHP) aims to achieve universal health coverage by ensuring equitable, affordable, and quality healthcare for all. Ayushman Bharat PM-JAY, a key component of this policy, provides health cover to millions of poor and vulnerable families. However, despite these efforts, significant challenges remain in ensuring that healthcare is affordable and accessible for all Indian households.

Moving forward, a multi-pronged approach is needed to reduce the financial burden of healthcare on Indian households. This includes increasing public investment in health, strengthening primary healthcare services, expanding insurance coverage, regulating healthcare costs, and improving health awareness. Greater transparency and accountability in healthcare financing and service delivery are also crucial. By addressing these challenges, India can move closer to achieving universal health coverage and ensuring that healthcare is a right, not a privilege.