Why healthcare still fails millions—and how India can fix it: Lancet Commission’s citizen-centred roadmap | India News

NEW DELHI: For millions of Indians, healthcare still means long queues, distant hospitals, repeated tests, and paying out of pocket for medicines and diagnostics—even when they are officially “covered”. Families drain savings to manage chronic illness, elderly patients struggle across multiple providers, and those in rural or marginalised communities face delays or poor-quality care. Universal Health Coverage (UHC) exists on paper, but for many, it remains fragmented in practice.The Lancet Commission on a Citizen-Centred Health System for India says this gap between promise and lived experience is now the country’s central health challenge. Drawing on extensive national data, the report concludes that India is no longer constrained by lack of intent or ambition. Health schemes, hospitals, and digital platforms have expanded rapidly, but weak implementation, poor coordination, and governance gaps continue to undermine patient care.A nationwide citizens’ survey of nearly 50,000 households across 29 states found that people continue to travel long distances, repeat investigations, and spend heavily on medicines and diagnostics despite being enrolled in government schemes. “What stands out is that the report is citizen-centred,” said Mirai Chatterjee, Commissioner and Director, SEWA Social Security. District-level analysis of 687 districts also reveals stark variation in performance within the same state, showing that identical national policies produce very different outcomes depending on local capacity and the strength of primary care.The data highlights a persistent financing mismatch. Public health spending remains below 2% of GDP, while insurance schemes focus largely on hospitalisation, leaving outpatient care, medicines, and diagnostics—the biggest costs for families—poorly protected. Case studies and interviews with health workers and administrators point to fragmented governance, staff shortages, weak accountability, and broken referral systems as reasons why well-designed programmes falter on the ground.Summarising the findings, the Commission states that the main barriers to UHC are no longer political will or infrastructure gaps, but uneven quality of care, inefficient spending, fragmented delivery, and poor governance. Access has expanded, it notes, but assurance has not.At the heart of its roadmap is a call to rebuild the public health system as the backbone of universal coverage. Vikram Patel, Commission co-Chair and Professor at Harvard Medical School, said only a high-performing, publicly financed and publicly provided system—with nationwide reach from community health workers to tertiary hospitals—can deliver health equity at scale.Industry leaders echoed the focus on primary care and coordination. Dr Harsh Mahajan, Founder & Chairman, Mahajan Imaging & Labs, said strengthening preventive and primary care through Ayushman Arogya Mandirs is key, while Dr Dharminder Nagar, MD of Paras Health, noted that patients in states such as Bihar and Uttar Pradesh still face long travel, repeat tests, and high costs despite falling out-of-pocket spending nationally, underscoring the need for stronger public–private coordination, faster PM-JAY empanelment, and expanded outpatient coverage.Based on more than four years of research (2020–2024), the Commission says India can still turn UHC from a promise into a lived reality—if it fixes how care is delivered, not just how it is announced.