Indian cities may turn into illness zones unless we act with alacrity

Survey evidence reveals uneven health services, falling financial coverage and sharp divergences in care-seeking behaviour

- RAJESH SHUKLA

India’s urban transformation is often framed as a story of rising aspirations and expanding opportunity. Yet, the health systems serving these cities tell a different story. PRICE's analysis of its ICE 360 data (2023), combined with findings of the latest National Family Health Survey (NFHS), reveals an urban health ecosystem that is increasingly fragile. Instead of the steady progress expected from rising incomes and better connectivity, the evidence points to inconsistent insurance coverage, rising out of pocket expenditure and uneven service utilization patterns shaped by gaps in institutional trust and service reliability.

This fragmentation reflects deeper structural imbalances. Urban growth has outpaced the evolution of health financing and public provisioning. As a result, the capacity to pool risk, assure quality and ensure equitable access varies sharply across cities. Large metropolitan regions, intermediate cities and fast-growing urban clusters face different forms of vulnerability, yet all share a mismatch between health risks and system preparedness.

Basic indicators highlight the magnitude of the problem. Only 11% of households reported paying a health-insurance premium, even though 34% experienced hospitalization and 68% sought doctor consultations or diagnostics. High utilization paired with minimal financial protection reveals a system in which households must absorb most of the cost of illness. Indian demand for healthcare has risen but the mechanisms for reducing financial exposure have not kept pace.