Critically evaluate the shift from public to private healthcare in India. What implications does this have for equity in healthcare access and costs for different socio-economic gr

India's healthcare shift toward private provisioning — accelerated by PMJAY and Government Financed Health Insurance schemes — has expanded coverage while deepening financial inequity.

Case for Private Shift

• Insurance coverage: Rural 12.9%→45.5%, Urban 8.9%→31.8% between 2017-18 and 2025
• Institutional deliveries: 95.6% rural, 97.8% urban → private capacity filling critical gaps
• Median outpatient OOP at public facilities = ₹0 → access gains real

The Equity Failure

• OOP on hospitalisation more than doubled in both rural and urban areas
• Private hospitalisation costs: +70% rural, +80% urban
• Only 13% of urban GFHI hospitalisation users belong to poorest class → elite capture
• 57% PMJAY enrollees used private hospitals → average OOP: ₹31,250 rural, ₹34,259 urban despite insurance
• Haryana + West Bengal: ~15% state health budgets spent on GFHIs → reimbursement delays

Verdict GFHIs use tax money to subsidise private profit — "of the rich, for the profit, by the poor." Coverage without strengthened public systems produces coverage without care. Ayushman Arogya Mandir — severely underfunded — remains the neglected corrective.

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