From 1947 till 2025, the government healthcare system has constantly been hollowed out, albeit slowly. But in the next 5 years, there is going to be a sudden shift towards an extremely expensive, insurance-based healthcare system (like the horrible system of USA) in India. And it is going to make it impossible for you to afford a hospital visit.

Two parallel forces will work hand-in-hand to make this happen. On one side, there will be the big money-led NDA/BJP government. On the other side, there will be the big money-led private equity firms, Indian (like Reliance) or multinational capital funds.

2026

Big money-led government: Make ABHA ID mandatory for all hospital visits, lab investigations, and prescriptions as part of a digital push under the buzzword of AI. Start maligning the National Health Mission as a waste of money.

Big money-led private equity: Consolidate the acquisition of large hospitals and expand medical tourism packages in large hospitals. Start expansion into acquiring medium and small hospitals (clinics, nursing homes, smaller cities). Build software that will power hospital systems across and sell it under the buzzword of scale. Lobby for the government to handover primary care to the private sector under the garb of universal health coverage.

2027

Big money-led government: Shut down NHM and make AB-PMJAY (Ayushman Bharat Pradhan Mantri Jan Arogya Yojana) the only component of health. Outsource primary care through “strategic purchasing” to private players. Tenders at the district level are making it accessible only to very big hospital chains.

Big money-led private equity: Grow small hospital networks aggressively, dangle big suitcases full of money to convince even the skeptical doctors to become part of the hospital chain. Build different models like franchisee, outlet, and network to ensure wide coverage. Bid for districts and take over the entire government healthcare machinery in the district. Keep costs to consumers low and even more attractive than alternatives (use financial reserves and government-funded insurance to achieve this).

2028

Big money-led government: Expand AB-PMJAY to the whole population with co-payment and bring convergence of all insurance schemes. Build a national database/platform for healthcare/insurance settlements that’ll be privately owned like NPCI and will operate outside the ABDM data framework. Aim to privatize all district hospitals and medical colleges, at least partially.

Big money-led private equity: Wipe out all competition through huge acquisitions, predatory pricing, regulatory capture, and services like AI-enabled care delivery or robotics. Tie up with major AI providers of the time in huge deals that cannot be made by smaller players. Even the last remaining standouts should feel stupid not to join the hospital chains. Start differential pricing schemes based on insurance co-payment premiums. Start cost-cutting measures like shutting down low-performing assets and mergers.

2029

Big money-led government: Election year. Open up the insurance platform itself to capital investment and advertise it as revolutionizing healthcare. Use 360° surveillance to increase premium costs for “bad” citizens. Deny insurance coverage to communities labeled hostile.

Big money-led private equity: Increase prices drastically. Increase barriers faced by the uninsured, even if they’re rich. Decrease salaries to staff, increase their targets. Prepare to offer an exit for investors.

2030

Big money-led government: Say we’re helpless.

Big money-led private equity: Say we’re helping.

Academia: Publish “A study on developing a framework to evaluate the impact of third-party payment systems on universal health coverage.”

People: Sell both kidneys.

This story was initially published in the author's personal blog linked here

Edited by Christianez Ratna Kiruba

Image by Gayatri