India's expanding health insurance coverage has reduced financial risk but has not eliminated health inequity. Critically examine with reference to recent survey data.

India's PMJAY-led insurance expansion tripled coverage between 2017-18 and 2025 — yet NSS 80th Round data reveals persistent inequity beneath this achievement.

Where Financial Risk Reduced

• Rural coverage: 12.9%→45.5%, Urban: 8.9%→31.8%
• Institutional deliveries: 95.6% rural, 97.8% urban
• Median outpatient OOP at public facilities = ₹0

Where Inequity Deepens

• OOP on hospitalisation more than doubled despite coverage expansion
• 57% PMJAY enrollees used private hospitals → average OOP: ₹31,250 rural despite free treatment promise
• Only 13% urban poorest actually using GFHI hospitalisation → elite capture confirmed
• Private hospitalisation costs: +70% rural, +80% urban
• GFHIs use public tax money subsidising unregulated private markets — "of the rich, for the profit, by the poor"

Verdict Insurance promises protection — yet OOP doubled. Coverage without strengthened public systems produces coverage without care. Ayushman Arogya Mandir — severely underfunded — must become the foundation, not the afterthought.

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