Priced out of life: The silent crisis in India's healthcare... who pays attention, and who takes responsibility?

By Aysha* 

Manisha (name changed) has been living with a disease since the birth of her third child—over ten years now—in the New Seemapuri area of North East Delhi. She visited GTB Hospital, where a doctor told her that treatment would cost ₹50,000, as the hospital would charge for the cost of an instrument that needs to be implanted in her body. Several NGOs have visited her home, yet she has received no support for treatment and continues to live with the illness. Manisha is divorced, without access to ration or pension, and lives with her three children by begging outside a temple.

Samir, a migrant worker (name changed) working in Delhi, met with an accident. His family could not access a government ambulance. They were forced to take a loan of ₹27,000 from acquaintances to hire a private ambulance and transport his dead body back to their village in Uttar Pradesh. This has become a huge burden on the already struggling family.

Manisha and Samir’s struggles are not isolated incidents; they are stark symptoms of a healthcare system in India that remains fundamentally broken for millions. Manisha’s story echoes the experiences of many women and girls in New Seemapuri, while Samir’s case lays bare how poverty itself becomes a death sentence in a failed healthcare system. How can someone unsure of their next meal afford ₹50,000 for medical treatment? This raises serious questions about the accessibility and equity of our healthcare system.

On the ground, India’s healthcare system is largely out-of-pocket for the poor, pushing millions into poverty each year due to medical expenses. People are compelled to take loans, often at high interest rates, just to afford treatment. Those who cannot access credit are left untreated. Regional disparities persist, with states like Kerala and Tamil Nadu performing better, while Bihar, Uttar Pradesh, and Jharkhand continue to lag. Even in Delhi, the state government has made insufficient efforts to ensure healthcare access for all. Government hospitals and Primary Health Centres (PHCs) are often overcrowded, under-resourced, and unhygienic—many do not even have functional fans during the peak summer months.

Patients with mental health issues are unable to get all their prescribed medicines from government hospitals and are often forced to purchase them privately. These medicines are expensive, and when patients cannot afford them, they go without—worsening their condition. Mental healthcare remains heavily stigmatized and severely underfunded. Nearly 70–80% of healthcare expenses in India are borne by patients themselves, leading to widespread financial distress. Even with schemes like Ayushman Bharat, many treatments—especially for chronic conditions like cancer—remain out of reach.

The government must significantly increase public healthcare funding, expand the number of PHCs, and ensure they are fully staffed and equipped. Health insurance coverage must be broadened to reduce out-of-pocket expenses. Rural healthcare infrastructure needs urgent attention, and ambulance services should be available not just for patients but also to transport deceased persons with dignity. While programs like Ayushman Bharat and the National Health Mission (NHM) mark progress, systemic issues such as underfunding, inequality, and inefficiency continue to undermine the system.

A higher healthcare budget could be transformative for both vulnerable communities and the middle class. Despite Article 47 of the Constitution directing the state to improve public health and nutrition as a primary duty, health is not declared a fundamental right in India. The Directive Principles of State Policy (DPSPs) are not legally enforceable, unlike Fundamental Rights such as the Right to Equality or Freedom of Speech. Without specific laws, citizens cannot hold the government legally accountable for failing to provide adequate healthcare.

In contrast, countries like Brazil recognize health as a constitutional right and offer free universal care. The UK provides tax-funded, free-at-point-of-use healthcare. While these are higher-income nations, the principle of legislating health as a right is something India must seriously consider. India lags behind because healthcare remains a policy-driven welfare measure, not a legally enforceable right. The country urgently needs stronger legislation, increased funding, and improved governance. These changes would compel governments to invest in health, reduce out-of-pocket costs, and create legal accountability for denial of care.

Health must be treated as a political priority. The government should boost investments in primary healthcare, strengthen human resources, and ensure universal health coverage. Infrastructure must be improved by expanding PHCs, increasing ambulance availability, and securing reliable medicine supply chains. Civil society organizations must unite to demand that health be made a justiciable right and push for greater accountability and transparency in health budgeting.

Until health becomes a fundamental right, backed by adequate resources and uncompromising accountability, millions of Indians like Manisha and Samir will remain silenced—their lives tragically cut short by a system designed to fail them.

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*Convener, Right to Food Campaign