Health insurance in India – NSS 2025 findings on coverage and financial burden for UPSC

Context: Health insurance in India

Findings from the 80th Round of the National Sample Survey (NSS) – “Household Social Consumption: Health” (2025) show that higher health insurance coverage has not improved access to care or reduced financial burden.

About National Sample Survey (NSS)

Data-backed Summary

1. Coverage increased, utilisation stagnant

  • Coverage: 47.4% rural (2025), 44.3% urban (2025)
  • Hospitalisation (per 1,000 persons):
    • 37 (2014) → 28 (2017–18) → 29 (2025)

2. Shift towards private healthcare

  • Public sector share in hospitalisation:
    • Rural: 41.9% (2014) → 44.7% (2017–18) → 39.2% (2025)
    • Urban: 32% (2014) → 35.8% (2017–18) → 32.2% (2025)

3. Rising Out-of-Pocket (OOP) expenditure

Public hospitals:

  • Rural: ₹5,709 (2017–18) → ₹9,940 (2025)
  • Urban: ₹6,582 (2017–18) → ₹8,627 (2025)

Private hospitals:

  • Rural: ₹28,655 (2017–18) → ₹51,677 (2025)
  • Urban: ₹34,031 (2017–18) → ₹57,752 (2025)

Total OOP:

  • Rural: ₹18,253 (2017–18) → ₹30,639 (2025)
  • Urban: ₹24,145 (2017–18) → ₹54,007 (2025)

4. Inequitable access

  • Only 13% poorest households (2025, urban) benefit from Government-Funded Health Insurance (GFHI)

5. Fiscal stress and structural issues

  • States like Haryana and West Bengal (~2025) spend ~15% of health budgets on insurance schemes
  • Public healthcare remains underfunded, private sector dominant
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