The National Sample Survey (NSS) 80th round on health shows improved access and insurance coverage, but rising morbidity, dependence on private care, and persistent out-of-pocket spending continue to expose households to financial risk
The National Sample Survey (NSS) 80th round on health, conducted between January and December 2025, gives India a full-year, post-pandemic picture of household-level morbidity, treatment-seeking, hospitalisation, childbirth, insurance coverage, and out-of-pocket spending. Considered India’s richest data source for population-level health indicators, the survey interviewed 1,39,732 households in rural and urban India and was designed to capture different aspects of health-seeking behaviour. Analysis of unit-level data from various rounds of the NSS health survey indicates that the proportion of households reporting any healthcare-related spending has increased considerably over the last three decades, from 22.7 percent in 1995–96 to 45.8 percent in 2025 (Graph 1). In parallel, real average per-household health expenditure at the national level rose from INR 1,778 in 1995–96 (in 2025 prices) to INR 7,002 in 2014, dipped to INR 5,236 in 2017–18, and further increased to INR 7,339 in 2025—representing a 4.13-fold real increase.
Graph 1: Proportion of Households in India Reporting any Health Spending
Source: NSSO unit-level survey data (various years), analysed using STATA and visualised using Claude. All estimates are weighted.
The morbidity data presented in the 2025 survey reveal a substantial rise in self-reported ailments. The proportion of persons responding as ailing (PPRA) in the previous 15 days has risen sharply over the long term. In rural India, PPRA increased from 5.5 percent in 1995–96 to 12.2 percent in 2025; in urban India, it rose from 5.4 percent to 14.9 percent (Graph 2). The NSS 80th Round puts the all-India PPRA for 2025 at 13.1 percent. The rise is better understood as a combined signal of disease burden, improved recognition, greater contact with care, and changing expectations of treatment. The counterintuitive dip in the proportion of individuals reporting morbidity, as well as in health spending, in the 2017–18 survey round triggered criticism that the round may have under-captured morbidity, hospitalisation, high-cost chronic ailments, and top-decile spending, a concern that deserves closer scrutiny, especially in light of the 2025 rebound.
Graph 2: Proportion of Persons Responded as Ailing (PPRA) during the last 15-day period
Source: Data from the NSSO Report compiled by the author and visualised using Claude.
The age and gender pattern of PPRA is especially revealing (Graph 3). In 2025, women reported higher morbidity than men: 14.4 percent against 11.8 percent at the all-India level. Urban women reported the highest morbidity, at 16.6 percent. India’s health system is increasingly dealing with an older, more chronically ill, and more treatment-aware population. Along with ensuring consultation and hospitalisation during acute episodes, ensuring that primary care, diagnostics, medicines, follow-up, and financial protection can keep pace with everyday chronic illness is emerging as an important policy challenge.
Graph 3: Proportion of Persons Responded as Ailing (PPRA) during the last 15-day period
Source: Data from the NSSO Report compiled by the author and visualised using Claude.
The age gradient presents this aspect in even sharper detail. Among those aged 60 and above, 42.5 percent of men and 45.4 percent of women reported illness in the previous 15 days (Graph 4). This proportion is likely to increase further as India’s population ages, and the healthcare delivery system will need to adapt quickly. As the senior population may face additional barriers in accessing emerging technology-driven innovations in healthcare, this poses an even greater challenge for policymakers.
Graph 4: Proportion of Persons Responded as Ailing (PPRA) during the last 15-day period
Source: Data from the NSSO Report compiled by the author and visualised using Claude.
Healthcare provider choice in the 2025 survey shows why the financial implications remain serious (Graph 5). For outpatient treatment, private doctors and clinics dominate in both rural and urban India, accounting for about 43 percent of treated outpatient spells in rural areas and 44 percent in urban areas. Public facilities still matter more in rural outpatient care, but less so in urban care. For hospitalisation, dependence on private hospitals is even stronger: 57.9 percent of rural and 64.6 percent of urban hospitalisation cases occurred in private hospitals. However, this requires an important qualification. The NSS places government-empanelled private hospitals under the private hospital category, including those empanelled through AB-PMJAY, CGHS, ECHS, state insurance schemes, ESI/ESIC, and similar arrangements. Hence, the ‘private’ category is not a pure market category. Still, from the household perspective, it shows that a large share of actual care is delivered outside the public facility network.
Graph 5: Choice of Provider, Outpatient Care vs Hospitalisation
Source: Data from the NSSO Report compiled by the author and visualised using Claude.
Childbirth-related data from the 2025 survey show that institutional delivery is now nearly universal in India: 96.2 percent of births took place in institutions in 2025, with rural institutional deliveries at 95.6 percent and urban institutional deliveries at 97.8 percent (Graph 6). Home births have fallen to 4.4 percent in rural India and 2.2 percent in urban India. Public facilities remain the primary site of childbirth overall, accounting for 61.7 percent of births, though urban India now shows a private-sector majority, with 50.8 percent of births taking place in private facilities.
Graph 6: Childbirth by Place of Delivery
Source: Data from the NSSO Report compiled by the author and visualised using Claude.
The 2025 round happens to be the first health survey after the launch of PMJAY, and as expected, it shows a substantial increase in population coverage of government-funded health insurance (Graph 7). Coverage under health insurance schemes rose from 14.1 percent to 47.4 percent in rural India and from 19.1 percent to 44.3 percent in urban India between 2017–18 and 2025. Coverage under government-sponsored schemes rose from 12.9 percent to 45.5 percent in rural India and from 8.9 percent to 31.8 percent in urban India, marking a major shift in the architecture of financial protection. The NSS also cautions that if a person is enrolled in multiple schemes, only one is recorded, suggesting a possible risk of under-reporting. More importantly, coverage does not automatically translate into adequate protection at the point of care.
Graph 7: Health Insurance Coverage across India
Source: Data from the NSSO Report compiled by the author and visualised using Claude.
Counterintuitively, despite the rapid expansion in health insurance coverage and rising morbidity, hospitalisation rates have remained relatively restrained (Graph 8). Rural hospitalisation cases per 1,000 persons rose from 13 in 1995–96 to 27 in 2025, while urban cases rose from 20 to 32. The peak was in 2014, at about 35 rural and 44 urban cases per 1,000. Following the 2017–18 dip, which may have been caused by survey-related factors, the rural all-person rate remained broadly unchanged at 27 per 1,000 by 2025, while the urban all-person rate declined further to 32 per 1,000. Determining the reasons for this trend would require further analysis.
Graph 8: Hospitalisation Cases per 1,000 Persons
Source: Data from the NSSO Report compiled by the author and visualised using Claude.
Lastly, the average out-of-pocket medical spending per hospitalisation stood at INR 34,064 overall, compared with INR 6,631 in public facilities and INR 50,508 in private hospitals. The 2025 survey report suggests that half of all outpatient visits to public hospitals were treated free of charge, while half of all hospitalisations in public hospitals involved expenditure of INR 1,100 or less. Yet, the financial risks associated with illness remain acute for poorer households (Graph 9). Even in the poorest quintile, average inpatient medical spending stands at around INR 25,704 in rural India and INR 25,178 in urban India, levels comparable to those of richer quintiles. Relative to household income within poorer households, such expenditure can be substantial and may trigger spiralling financial insecurity.
Graph 9: Average Out-of-pocket Medical Expenditure across Quintiles
Source: Data from the NSSO Report compiled by the author and visualised using Claude.
The 2025 NSS health survey points to a mixed picture in a transitional health system. India has made real gains in maternal care, insurance enrolment, and reported access. But higher morbidity reporting, the expanding needs of an ageing population, rising visibility of chronic diseases, strong dependence on private outpatient and inpatient care, and high episode-level medical spending show that the next stage of reform must move from nominal coverage to effective protection. Policy measures that manage to reduce actual household healthcare spending while expanding enrollment are imperative.
Oommen C. Kurian is Senior Fellow and Head of the Health Initiative at the Observer Research Foundation.
The author gratefully acknowledges Mr Rakesh Kumar Sinha for his valuable help with data analysis.
The views expressed above belong to the author(s). ORF research and analyses now available on Telegram! Click here to access our curated content — blogs, longforms and interviews.
Oommen C. Kurian is Senior Fellow and Head of the Health Initiative at the Inclusive Growth and SDGs Programme, Observer Research Foundation. Trained in economics and ...
Read More +
PREV
