NEW DELHI: India carries 20% of the global disease burden but accounts for only 1% of global health spending, experts said here on Wednesday, highlighting that a vast “missing middle” of around 430 million people remains outside effective healthcare coverage.
Out-of-pocket spending accounts for 44% of health expenditure in India, among the highest globally.
While 60% of Indians are covered by some form of insurance, only 20% have private insurance, with the remaining 40% covered through government schemes.
Highlighting the “missing middle”, experts said 430 million Indians remain outside effective coverage, too affluent for public schemes yet unable to afford private insurance.
Experts also pointed out that India has 0.9 doctors, 1.8 nurses, and 1.6 beds per 1,000 people, and would require 1 million doctors, 3.5 million nurses, and 1.45 million additional beds by 2035.
Non-communicable diseases are growing at a CAGR of 2–9%, with onset occurring 10–15 years earlier than global averages.
Speaking at the NATHEALTH 12th Annual Aarogya Bharat Summit 2026, Ameera Shah, President, NATHEALTH, and Promoter and Executive Chairperson, Metropolis Healthcare Ltd, said, “Despite our progress, nearly 44% of health expenditure in India still comes directly from the patient's pocket, and over 400 million people, the 'Missing Middle' remain without effective coverage.”
“By expanding private insurance penetration and leveraging digital health infrastructure, we can reduce the financial shock of medical emergencies for millions of families. Our goal is to ensure that world-class diagnostics and treatment are not just available, but are also affordable and accessible to every segment of society,” she said.
Dr Sangita Reddy, President-Elect, NATHEALTH, and Joint Managing Director, Apollo Hospitals, said, “India has already demonstrated a unique global advantage: the ability to deliver world-class clinical outcomes at nearly one-fifth of global costs. However, to sustain this 'Indian model' of high-value healthcare, we must evolve our financing architecture.”
“The next phase of our growth depends on how effectively we expand insurance penetration and encourage innovative funding models that support preventive care.
The NATHEALTH thought leadership report provides a practical roadmap to move from a fragmented system to an interoperable financing ecosystem, ensuring that India remains the world's most compelling destination for affordable, high-quality healthcare.”
At the event, Praxis Global Alliance, in collaboration with NATHEALTH, which represents small and medium hospitals and nursing homes, also released the ‘India Health Financing Position Paper 2026’, which examines the evolving landscape of healthcare financing in India and outlines pathways to strengthen the financial architecture supporting the country’s healthcare system.
Aryaman Tandon, Managing Partner and Co-Founder at Praxis Global Alliance, a management consulting and advisory services firm, said, “India stands at a defining moment in its healthcare journey. We have built a cost-competitive, technology-enabled, and clinically sophisticated delivery ecosystem, but its potential is constrained by a financing architecture that remains fragmented, under-penetrated, and insufficiently aligned with outcomes.”
“With approximately 430 million Indians outside or ineligible for public coverage and out-of-pocket expenditure at nearly half of all health spending, the human and economic cost of inaction is immense. This report lays out a sequenced, evidence-based reform agenda that can move India from a system built around sickness to one designed for wellness and from fragmented risk pools to a universal, interoperable financing ecosystem. The opportunity is significant: a US$700 billion healthcare market by 2030, generating millions of quality jobs and positioning India as one of the world's most compelling healthcare destinations,” he said.
Experts said India’s healthcare ecosystem has expanded significantly over the past two decades, supported by growing infrastructure, stronger domestic manufacturing, and increased private sector participation.
However, rising incomes, shifting disease patterns, and higher healthcare utilisation are creating new demands on the system.
As India aspires to become one of the world’s largest economies, the healthcare sector must evolve in parallel, not only in scale but also in the sophistication of its financing frameworks, they added.
The report notes that while India’s healthcare sector could approach US$700 billion by 2030, the financing architecture supporting this growth remains fragmented and under-penetrated, with out-of-pocket spending still accounting for a large share of healthcare expenditure.
Drawing on industry data, global benchmarks, and stakeholder consultations, the paper highlights both India’s strong healthcare foundations and the need to strengthen financing frameworks, insurance coverage, and infrastructure to support long-term system sustainability.