Every few years, the National Statistical Office (NSO) holds up a mirror to the nation’s health. The 80th round of the Household Social Consumption Survey, released recently, is that mirror. What it reflects is not a simple story of progress or failure, but both at once, demanding to be read together.
The gains are genuine. Institutional deliveries have risen to 95.6% in rural areas. Govt health insurance coverage has expanded more than threefold in rural India since 2017-18, from 12.9% to 45.5% of the rural population. The use of public health facilities for outpatient care has grown. These are real improvements in real people’s lives, and they deserve acknowledgement.

But the same survey also tells us this: one in eight Indians is currently sick. The disease rate has more than doubled since 1995-96. Cardiovascular diseases have nearly tripled in seven years — from 1,333 cases per 100,000 population in 2017-18 to 3,891 in 2025. The average out-of-pocket expenditure (OOPE) on hospitalisation stands at Rs 34,064 — while the median is Rs 11,285, meaning costs are heavily skewed toward the most serious cases. And in India’s poorest states — Bihar, Jharkhand, Uttar Pradesh —patients at govt hospitals are paying more than the national average, not less.

NCD tsunami

The cardiovascular finding deserves to be read slowly. A near-tripling of heart disease burden in seven years is not a statistical fluctuation. It is an epidemiological signal that tells us India’s disease profile has fundamentally shifted, faster than its health system has adapted.
India’s NCD burden — tripling cardiovascular disease, skyrocketing cancer costs, rising diabetes — is a primary care failure, a public health failure, a failure to invest upstream before patients arrive at a ward

What makes it more urgent is who is being affected. The survey shows cardiovascular disease hospitalisation rising sharply in the 30-44 age group, with young adults between 15 and 29 also showing increasing vulnerability. This is the working-age population — economically active, disproportionately uninsured in the private sector, and almost entirely absent from India’s non-communicable disease (NCD) policy frameworks, which are calibrated around the elderly. I know something of what it means to be ill in this age bracket. Diagnosed with cancer in my mid-thirties, I navigated a system that had not been designed with someone like me in mind —not in its protocols, not in its research, not in its financial protection mechanisms. The NSO data tells me that this experience is no exception.

What the averages conceal

The survey’s most striking finding on equity is one that has received the least attention: in India’s poorest states, the public hospital is the most expensive hospital. Bihar’s average OOPE per hospitalisation at a govt facility is Rs 10,553. In Uttar Pradesh, it is Rs 12,878. In Jharkhand, Rs 12,364. The national average is Rs 6,631. The households least able to absorb health costs are paying the most — at the facilities that exist precisely to protect them.

Cancer is identified as the costliest hospitalisation condition — at Rs 1,04,424 per case, it is nearly 50% more expensive than heart disease treatment. For a family in Bihar or Jharkhand, that can be a financial sentence. Insurance coverage expansion, however welcome, does not automatically reach those who need it most: in states where implementation is weakest, among populations with the least capacity to navigate enrolment processes.

Data gap mirrors policy gap

Yet the survey itself embodies the very problem it documents. It measures hospitalisation costs in granular detail but does not report total OOPE on outpatient care — even though that data was collected. Jan Swasthya Abhiyan, which reviewed the report, called this a major analytical shortcoming. It is also a political one. A health data framework that centres hospitals is the mirror image of a health system that centres cure over prevention.
India’s NCD burden — tripling cardiovascular disease, skyrocketing cancer costs, rising diabetes — is not primarily a hospitalisation failure. It is a primary care failure, a public health failure, a failure to invest upstream before patients arrive at a ward. The survey tells us what the system spent on treating disease. It has almost nothing to say about what was spent — or not spent — preventing it.
A health system that has expanded insurance coverage while watching cardiovascular disease nearly triple has not solved the problem; it has insured people against a crisis it has not prevented. Investing in keeping people out of hospitals, not just treating them once they arrive, should be the real priority.
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Views expressed above are the author's own.

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