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Beyond Reach: Soaring Healthcare Costs Force Even Insured Indians to Delay Treatment

Skyrocketing treatment costs, rising lifestyle diseases, and limited insurance benefits are creating a dangerous gap in India’s healthcare safety net

• By Pooja Chaturvedi Sah
• New Delhi
• Apr 15, 2025

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In what experts are now calling a national emergency, a series of recent studies have highlighted the mounting healthcare affordability crisis gripping India. Despite an expanding health insurance network and increased government spending, the country’s healthcare system is becoming increasingly inaccessible — even for those with insurance coverage. The GOQii India Fit Report 2025, based on behavioral insights from 6 million users and a survey of 2,000 individuals, reveals a disturbing trend: rising costs are forcing people to skip essential treatments, delay surgeries, and ration medication. Even insured households are reducing doctor visits due to high out-of-pocket expenses, reflecting a crisis that cuts across socioeconomic classes. “The rising cost of healthcare is not just a statistic—it’s a silent emergency unfolding in households across India,” said Vishal Gondal, Founder and CEO of GOQii. “We must rewrite the rules to ensure health is a right, not a privilege.” When Insurance Is Not Enough The report shows that 36% of insured individuals have reduced the frequency of their doctor visits due to escalating medical costs. In a more alarming statistic, nearly one in five Indians surveyed admitted to skipping essential medical treatment because of financial constraints. Even routine care is becoming unaffordable. The problem is particularly acute for chronic illnesses such as diabetes, hypertension, and cholesterol — conditions that require regular medication and monitoring. The situation is even more dire for the elderly and women, who are most affected by deferred or foregone care, according to the report. The Health Insurance Paradox: Coverage Without Care While health insurance coverage has more than doubled in the past decade — rising from under 20% in 2012 to 40% in 2023 — access to affordable care remains elusive. A key reason is growing mistrust in insurance providers. Many users cite claim denials, ambiguous exclusions, and limited coverage as reasons why they still rely on out-of-pocket spending. According to the GOQii survey: 71% of respondents said medical expenses have skyrocketed 12.3% have postponed care due to financial pressure 60% believe stronger government regulation is needed to control healthcare pricing Surgery Costs Skyrocket: A Decade of Medical Inflation A separate analysis by Policybazaar further underlines the gravity of the situation. The firm estimates that surgery costs in India have increased by 250–300% over the past decade, leaving millions financially vulnerable. For instance: Cancer surgery costs rose from ₹13.5 lakh in 2013 to over ₹50 lakh in 2024 Heart transplants now exceed ₹34 lakh, up from ₹9.8 lakh Even routine procedures like cataract removal now cost ₹1.26 lakh — up from ₹35,000 in 2016 “A ₹1 crore insurance policy today is equivalent to a ₹10 lakh cover ten years ago,” said Siddharth Singhal, Head of Health Insurance at Policybazaar. “This is not just a financial issue — it’s a health crisis.” Lifestyle Diseases on the Rise, Outcomes on the Decline The GOQii report also highlights a worrying trend in national health indicators. Over the past year: The proportion of people classified as "unhealthy" rose by 3.84% A staggering 64% of women were found to be in poor health, compared to 40% of men 48.7% of users reported high blood pressure 39% suffer from diabetes 24% have high cholesterol These numbers underscore the growing burden of lifestyle diseases, especially among aging populations, which is expected to further strain the healthcare system. Structural Shifts Underway — But Are They Enough? Despite the bleak outlook, some signs of systemic improvement are emerging. According to a recent CareEdge Ratings report, India’s health insurance coverage is expected to hit 50% by 2025, boosted by the government’s expansion of the Ayushman Bharat scheme to cover citizens above 70 years of age. CareEdge also noted a projected increase in India’s healthcare spending from 3.3% of GDP in 2022 to 5% by 2030, with per capita spending expected to rise from $80 toward levels closer to other developing nations. “India’s healthcare landscape is evolving rapidly,” said Krunal Modi, Director at CareEdge Ratings. “The government’s commitment, along with private sector participation, is laying a strong foundation for improved healthcare access and quality.” However, rural infrastructure gaps and workforce shortages continue to hamper progress. Public hospitals remain underfunded and overcrowded, while private facilities often remain out of reach for most Indians. Preventive Care and Wellness-Linked Insurance: A Way Forward? Amid the crisis, the GOQii report highlights an emerging trend that offers a ray of hope — the rise of wellness-linked insurance models. These policies incentivize healthier behavior with rewards such as digital coaching, regular screenings, and lower premiums. About 54% of survey respondents expressed interest in such plans. GOQii’s proprietary SAFE model (Sedentary, Active, Fit, Elite) claims to help users reduce hospital visits and lower long-term costs by rewarding healthy living. The Path Ahead: Policy Reform and Innovation Experts agree that India must take urgent steps to address the growing crisis. Key recommendations include: * Comprehensive insurance reform to make coverage broader and simpler * Greater government oversight on treatment pricing and hospital charges * Promotion of preventive care through behavior-linked insurance and digital coaching * Integration of AI and wearable technology to support early detection and reduce long-term healthcare costs With 75% of Indians still paying for healthcare out of pocket, the cost of inaction could be catastrophic — not just for individuals, but for the nation’s economy and public health system. Conclusion India stands at a crossroads. On one side is a healthcare system stretched by growing demand, spiraling costs, and chronic underfunding. On the other is the potential for transformation — through smart policy, digital innovation, and inclusive insurance reform. The data is clear: healthcare affordability is no longer a marginal issue — it is now a defining challenge of our time.