India's insurance-led Universal Health Coverage model has expanded access on paper while deepening health inequity in practice. Critically examine.

India's Government Financed Health Insurance schemes — led by PMJAY — have tripled coverage between 2017-18 and 2025, yet failed to deliver their core promise of financial protection.

Genuine Gains

• 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 Equity Fails

• OOP on hospitalisation more than doubled in both rural and urban areas
• Private hospitalisation costs: +70% rural, +80% urban
• 57% PMJAY enrollees used private hospitals → average OOP: ₹31,250 rural despite insurance
• Only 13% urban poorest actually using GFHI hospitalisation → elite capture confirmed
• Haryana + West Bengal: ~15% state budgets spent on GFHIs → reimbursement delays → private providers under-serving poor patients

The Core Contradiction GFHIs use public tax money to open private markets — "of the rich, for the profit, by the poor." Coverage without strengthened public systems produces coverage without care.

Verdict Insurance-led UHC is structurally insufficient. Ayushman Arogya Mandir — severely underfunded — must become the foundation, not the afterthought.

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