Achieving Universal Health Care (UHC) in India requires a fundamental transformation in both health financing and governance, according to a major analysis published in The Lancet. Building on the findings of the Lancet Commission on a Citizen-Centred Health System for India, the report presents a citizen-centric roadmap aimed at delivering UHC within the next decade.
Crucially, the proposed approach places citizens—rather than institutions—at the centre of the health system. By prioritising patient needs, preferences, and outcomes, the Commission argues that India can transition toward a more equitable, efficient, and responsive healthcare model.
Progress Achieved, but Structural Gaps Persist
India has made notable progress in public health outcomes, including improvements in life expectancy and reductions in maternal and infant mortality. However, despite these gains, deep structural weaknesses continue to undermine effective healthcare delivery.
Specifically, the health system suffers from fragmented governance, poor coordination across levels of care, and an institutional focus on facilities rather than patients. In addition, weak accountability mechanisms, health worker absenteeism, and misaligned financial incentives limit service quality. As a result, many patients—particularly from low-income households—turn to private healthcare providers despite facing high out-of-pocket costs. Consequently, the Commission calls for a comprehensive redesign of the health system architecture.
Financing Reform: Adopting a “Money-Follows-the-Patient” Model
At the core of the report lies a strong recommendation to shift India’s financing framework toward a “money-follows-the-patient” model. Under this approach, households would register annually with a primary care provider of their choice, whether public or private.
As reported by ocacademy, government funding would then flow directly based on patient enrolment and health outcomes, rather than historical budgets or facility-based allocations. Importantly, this system links financing to unique health identifiers, such as the Ayushman Bharat Health Account (ABHA) ID, ensuring traceability and accountability.
By aligning funding with patient choice and performance, the model incentivises providers to improve care quality, discourages unnecessary interventions, and strengthens accountability—particularly within public health facilities.
Digital Health as a Key Enabler
To support this financing shift, the report highlights the critical role of digital health infrastructure. Initiatives such as the Ayushman Bharat Digital Mission (ABDM) provide the backbone for implementing patient-linked financing and care continuity.
More broadly, technology-enabled healthcare delivery—including telemedicine, electronic medical records (EMRs), and digital referral systems—can significantly improve access, especially in underserved and rural areas. However, the authors caution that technology alone cannot drive reform. Instead, digital tools must operate alongside governance and financing systems that reward quality, continuity, and patient-centred care.
Phased Implementation Through Local Pilots
Given India’s complex federal structure, the report recommends a phased and decentralised implementation strategy. Rather than attempting a nationwide overhaul at once, the authors advocate testing integrated financing and governance reforms through district-level pilot programmes.
This incremental approach allows policymakers to identify operational challenges, adapt reforms to local contexts, and build institutional capacity before scaling nationally. As a result, the reform process becomes more resilient, evidence-driven, and sustainable.
A Roadmap for Citizen-Centred Health Reform
Overall, the Lancet analysis presents a clear two-pillar framework—patient-centric financing and strengthened governance—as the foundation for achieving Universal Health Care in India. By aligning financial flows with patient choice, leveraging digital health systems, and implementing reforms in a phased manner, the roadmap offers a pragmatic pathway to building a health system that truly serves its citizens.