‘India’s Health Crisis Is One of Design, Not Capacity’: Lancet Commission
New Delhi: A commission of nearly 30 health experts convened by The Lancet has called for a fundamental overhaul of India’s healthcare system, urging a shift to an integrated, citizen-centric model that is publicly financed and publicly provided, with technology used to improve access, coordination, and health outcomes.
The recommendations, published on January 20 in The Lancet; one of the world’s most influential peer-reviewed medical journals, argue that India’s health challenges stem less from shortages of infrastructure or personnel and more from systemic fragmentation across financing, service delivery, and governance.
The commission brings together experts from institutions including Harvard Medical School, Johns Hopkins University, Ashoka University, the Indian Institute of Public Health, and IIM Bangalore, along with practitioners of Indian systems of medicine, underscoring its emphasis on pluralism and integrated care.
Fragmentation and insurance-led care under scrutiny
The commission argued that India’s current healthcare system remains deeply fragmented, insurance-led, and oriented towards episodic care, resulting in inefficiencies, inequities, and suboptimal outcomes; particularly for preventive services and long-term management of chronic diseases.
“The health system must move towards an integrated, citizen-centred care delivery system that is publicly financed and publicly provided,” the commission said, noting that such a model is essential for achieving Universal Health Coverage (UHC) while aligning healthcare delivery with people’s actual health needs.
While acknowledging the role of the private sector, the experts emphasised that private providers and technologies must complement, rather than dominate, a strong public health system. A publicly funded framework, the commission said, should serve as the backbone of India’s healthcare delivery architecture.
‘Design failure, not capacity shortage’
The commission also called for a shift in health workforce policies, urging a move away from narrow professional qualifications towards competencies, teamwork, and community engagement, particularly among frontline health workers.
It recommended building a system-wide integrated healthcare architecture linking providers, payers, and patients through coordinated care and interoperable health data systems to reduce duplication, costs, and gaps in care.
While technology could transform service delivery through digital platforms, AI, and advanced diagnostics, the experts cautioned that tech-led reforms must be anchored in strong public systems and guided by equity and public-interest safeguards.
Speaking to The Wire, public health scholar Dr Raman Kumar said India’s healthcare crisis is rooted in flawed system design rather than a lack of capacity.
“Fragmentation across financing, service delivery, and governance has weakened continuity of care,” he said, adding that evidence strongly supports a publicly financed, integrated model as the most effective route to universal health coverage and improved population health outcomes.
Push for system-wide integration
One of the most significant structural barriers identified by the commission is India’s insurance-led health financing model, which it said often discourages integrated care. Existing insurance legislation and payment mechanisms tend to reward fragmented, procedure-based interventions rather than long-term health outcomes, the report noted.
To address this, the commission recommended reforms to health financing and budgeting systems, including digitalisation of fund flows, simplification of financial procedures, and reduction of bureaucratic hurdles to improve fund utilisation and transparency.
Speaking to The Wire, health policy and health systems strategy expert Anita Jain said integrated care must be viewed as a systems efficiency imperative, not merely a public-sector ideal.
“When financing, data, and service delivery are aligned, outcomes improve and costs stabilise,” she said, adding that digital health tools and private providers can add value only when embedded within a strong, publicly anchored framework.
Reforming health financing and budgeting
The commission called for replacing rigid line-item budgeting with global budgets to give healthcare providers greater autonomy and incentivise quality and patient-centred care over service volumes. It also urged greater decentralisation, empowering state and local governments with clearer roles, stronger capacity, and more autonomy to implement context-specific health reforms.
The experts recommended shifting monitoring frameworks from input-based reporting to outcome-oriented metrics focused on health outcomes and patient experience, to strengthen accountability and trust.
In a changing global health landscape marked by institutional challenges at the World Health Organization and reduced US leadership, the commission said India has an opportunity to emerge as a stronger voice for the Global South. Healthcare reform, it concluded, requires sustained public investment, political commitment, and a clear focus on citizens’ needs.
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