Ask doctors in India about the patients they lose, and many will describe not those who never reached a clinic, but those who came, received a diagnosis, and never returned. The prescription was written. The test was ordered. Then the bill happened.
For a decade, India's health care conversation has rightly focused on access: More hospitals, wider insurance enrolment, stronger digital health infrastructure. That progress is real. But access only opens the door. Whether a family walks through it and keeps walking through it month after month depends on a less discussed question: can they pay for treatment at the moment it is needed?
The Union health ministry's latest National Health Accounts estimates show that out-of-pocket expenditure rose to 43.4% of total health spending in 2022-23, up from 39.4% the year before, reversing a decade-long decline. Indian households paid roughly ₹3.8 lakh crore for healthcare directly from their own pockets in a single year.
Insurance has expanded meaningfully. The NSO's 2025 survey on household health consumption found that 47.4% of people in rural India and 44.3% in urban India are now covered by at least one health insurance scheme, around three times the 2017-18 levels. Yet the same survey puts the average out-of-pocket cost of a single hospitalisation at ₹34,064, and over ₹50,000 in private hospitals. For many households, that is more than a month's income, due on the day of discharge.
Insurance was designed for the large, unpredictable event, and it does that job well. It was never designed for the steady, recurring cost of care most families actually live with: monthly medicines for diabetes or hypertension, diagnostic tests, OPD consultations, physiotherapy, dental work, and the co-payments and sub-limits that surface even within a valid policy.
{{/usCountry}}Insurance was designed for the large, unpredictable event, and it does that job well. It was never designed for the steady, recurring cost of care most families actually live with: monthly medicines for diabetes or hypertension, diagnostic tests, OPD consultations, physiotherapy, dental work, and the co-payments and sub-limits that surface even within a valid policy.
{{/usCountry}}These costs rarely arrive as a crisis. They arrive as a decision. Do we do the scan this month or next? Can the follow-up wait until salary day? Should we stretch this strip of tablets a little longer? Each choice looks like prudent budgeting. Together, they add up to delayed diagnoses, broken treatment regimens and, eventually, complications that cost far more than the care that was postponed.
I have stood on the patient's side of the billing counter during my own family's treatment. The hardest questions were rarely about which doctor to see. They were about how to fund what had already been prescribed, today, rather than after a reimbursement weeks later.
Health care affordability, in other words, is not only an insurance problem. It is a cash-flow problem.
Cash-flow problems have cash-flow solutions, and India has proven this elsewhere. No-cost EMIs made smartphones and appliances accessible to millions of households, not by lowering prices but by restructuring when and how those prices were paid. Health care deserves the same thinking, applied with far greater care.
The building blocks already exist. UPI reaches hospitals, pharmacies, clinics and diagnostic centres across the country. On top of that open rail, it is now possible to offer health care-specific financing at the point of care: instant medical credit for planned procedures, instalments on larger bills, employer-supported benefits for everyday OPD and pharmacy spends, and rewards that flow back into future health care rather than out of it.
The goal is not to replace insurance but to complement it, closing the gap between what a policy covers and what a family actually spends.
Health care finance carries a responsibility that consumer credit does not. A patient is not a shopper, and the purchase is not optional. Any financing model here must be transparent on cost, built around the borrower's ability to repay, and designed to reduce financial stress rather than defer it into debt. Health data must be handled only with explicit consent. And providers, insurers, lenders and employers must work as one connected system, not as separate counters a patient navigates alone.
Policymakers have a role too. Recognising health care as a distinct financial category, with its own norms for credit, payments and consumer protection, would help responsible innovation scale faster.
India has built impressive capacity to treat illness. The next step is ensuring that capacity is used, fully and on time, by the families who need it. That will depend as much on how we pay for care as on where we receive it.
Access to treatment means little if paying for it remains the barrier. Close that gap, and India's health care progress finally reaches the household.
(The views expressed are personal)
This article is authored by Chris George, co-founder & Group CEO, QubeHealth-Pay.