For millions of Indians, the promise of universal health coverage (UHC) feels more like a distant dream than a reality. Long queues, distant hospitals, repeated investigations and out‑of‑pocket payments for medicines and diagnostics persist even for those enrolled in government schemes. A new Lancet Commission report, released on 22 January 2026, calls this gap the country’s most pressing health challenge and proposes a citizen‑centred roadmap to turn UHC from a policy into lived experience.
Background and Context
India’s health system has expanded rapidly over the past decade. The National Health Policy 2017, the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM‑JAY), and a surge in digital health platforms have all been heralded as steps toward universal coverage. Yet, the reality on the ground remains fragmented. The Lancet Commission’s study, drawing on data from 2020‑2024, shows that public health spending remains below 2% of GDP, while insurance schemes focus almost exclusively on hospitalisation, leaving outpatient care, medicines and diagnostics—often the biggest cost drivers for families—poorly protected.
“India healthcare UHC is no longer a question of intent or ambition,” says Vikram Patel, co‑chair of the Commission and a professor at Harvard Medical School. “It is a question of how care is delivered, coordinated and governed.” The report’s findings underscore that the system’s structural weaknesses—staff shortages, weak accountability, broken referral pathways—are eroding the gains made by policy initiatives.
Key Developments
The Commission’s citizen‑centred approach is built on three pillars: data‑driven insights, community engagement and systemic reforms. Its flagship study surveyed nearly 50,000 households across 29 states, revealing stark disparities:
- Despite enrolment in PM‑JAY, 68% of respondents still travel more than 30 km for a single consultation.
- 42% report repeating diagnostic tests within a month, inflating costs and delaying treatment.
- Out‑of‑pocket spending on medicines and diagnostics accounts for 55% of total health expenditure for low‑income families.
District‑level analysis of 687 districts further highlighted uneven performance. In some districts, primary health centres (PHCs) operate at 90% capacity, while in others they are underutilised, leading to a “one‑size‑fits‑all” policy that fails to account for local capacity and needs.
Mirai Chatterjee, Commissioner and Director of SEWA Social Security, notes, “What stands out is that the report is citizen‑centred. It listens to the lived experiences of people, not just policy makers.” The Commission recommends a shift from a hospital‑centric model to a community‑centric model, with robust primary care as the backbone of UHC.
Impact Analysis
For students and young professionals, the report’s implications are far‑reaching. As India’s workforce ages, chronic diseases such as diabetes, hypertension and cardiovascular conditions are becoming more prevalent. The Commission warns that without a coordinated primary care system, the burden on tertiary hospitals will increase, driving up costs and reducing access for the most vulnerable.
Students in health‑related fields will see a growing demand for training in community health, telemedicine, and health informatics. The report’s emphasis on digital platforms—already a key driver of health service delivery—suggests that future curricula will need to integrate data analytics and patient‑centred care models.
For those planning to start a health‑tech venture, the findings highlight opportunities in outpatient coverage, medicine pricing transparency and integrated referral systems. The Commission’s roadmap calls for public‑private partnerships that streamline service delivery and reduce duplication.
Expert Insights and Practical Tips
Industry leaders echo the Commission’s focus on primary care and coordination. Dr Harsh Mahajan, Founder & Chairman of Mahajan Imaging & Labs, says, “Strengthening preventive and primary care through Ayushman Arogya Mandirs is key. We need to bring diagnostics closer to the community, not just to hospitals.”
Dr Dharminder Nagar, MD of Paras Health, adds, “In states like Bihar and Uttar Pradesh, patients still face long travel, repeat tests and high costs despite falling out‑of‑pocket spending nationally. We need faster PM‑JAY empanelment, expanded outpatient coverage and better public‑private coordination.”
Practical guidance for individuals:
- Know your entitlements: Verify which services are covered under PM‑JAY and other schemes. Keep a record of your enrolment number.
- Use community health workers: In many districts, Accredited Social Health Activists (ASHAs) can guide you to the nearest PHC and help with referrals.
- Leverage digital platforms: Apps like eSanjeevani and mHealth portals can reduce travel time and provide teleconsultations.
- Track expenses: Maintain a health expense diary to identify patterns and negotiate better prices for medicines.
For health‑care providers, the Commission recommends:
- Implementing robust electronic health records to track patient journeys across facilities.
- Establishing clear referral protocols to avoid duplicate investigations.
- Investing in workforce training, especially in rural PHCs, to improve service quality.
Looking Ahead
The Lancet Commission’s roadmap is not a one‑time fix but a continuous process. It calls for a phased approach: first, strengthening primary care infrastructure; second, integrating digital health solutions; third, ensuring financial protection for outpatient care and medicines.
Policy makers are expected to roll out a revised National Health Policy in 2027 that incorporates these recommendations. The government has already announced a pilot program in 12 districts to test integrated care models, with a view to scaling up nationwide.
Students and professionals should monitor these developments closely. The evolving health landscape will shape career opportunities, research priorities and the overall health security of the nation.
In the words of Vikram Patel, “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.” The road ahead will require sustained political will, community engagement and a commitment to equity.
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