India’s health insurance gaps hinder universal coverage, finds study

India’s push for universal health coverage (UHC) through health insurance is falling short, with millions still facing high medical costs, a new study in The Lancet Regional Health - Southeast Asia reveals.

Across the WHO South-East Asia Region (SEAR), uneven coverage and systemic barriers threaten equitable healthcare access.

The study, based on Demographic and Health Surveys from 2015 to 2022, shows only one in five women in SEAR has health insurance, compared to one in four men.

In India, where private providers account for 60-80 per cent of outpatient visits and out-of-pocket costs make up nearly 50 per cent of healthcare spending, schemes like the Pradhan Mantri Jan Arogya Yojana provide free hospital care for the poor, but fall short due to limited treatment coverage.

Regionally, Indonesia achieves 57 per cent coverage, while Myanmar languishes at 1 per cent. Wealthier, better-educated individuals are more likely to be insured, while those with less education or media exposure often lack access. Government policies, scheme design and distrust in formal systems further curb enrolment.

Marginalised groups—rural residents, informal workers and people with disabilities—face significant hurdles.

In Indonesia, 30 per cent of disabled individuals remain uninsured, despite higher medical costs and frequent care needs. India shares similar challenges, with coverage gaps exposing vulnerable populations to catastrophic expenses.

The study urges stronger regulations, digital innovation and improved health literacy to bridge these gaps.