80% of the population is uninsured [1]. They go to underresourced government or religious-charity run hospitals when severely ill but otherwise have limited access to medical care by western standards.

The upper middle class increasingly have insurance like people in the US, and the very wealthy pay for treatment directly. Both groups seek care at private hospitals that have equipment and staff that would rival those in wealthy countries - often set up and funded by Indian physicians abroad.

My family have to invested in such hospitals and I have toured them. No doubt they do charitable work on the margins, but they likely can't scale to a pandemic.

1. https://en.m.wikipedia.org/wiki/Health_insurance_in_India

Generally, the good ones are paid. For hospitalization one can take insurance where premium is paid annually.

There are government hospitals and they are average. They are better avoided by people who can afford private clinics.

But for epidemic causing diseases the government is very active and proactive when they understand the protocol. If you are in quarantine, they will give your free medicines for you and the people you contacted, free and hygienic food, will sanitize your house and neighborhoods if needed. If you hospitalized yourself to a private hospital, the cost is yours. But otherwise the government will take care of hospitalization. Their quarantine beds are nothing less than world-class. However, things can be drastically different and painful for your care taker once out of quarantine. ICUs (non-quarantine) in government hospitals have a higher rate of passing on a secondary infection.

Even at the costly private hospitals, cost of healthcare is quite low in India compared to the western countries and quality is similar. But they are not adequate for the pandemic of Covid19 scale

Free to use based on need. You can also buy private catastrophic insurance. It's also mostly affordable (unless you need specialist surgery). States have their own hospitals and prioritize their residents. You need a local id card and there are separate queues/checkin procedures for state residents (vs out of state) at government hospitals. Unlike the US, everything is priced (menus) and surgeries and hospitalizations are not seen as a way to gouge patients (i.e. a senior doctor poking their head in your room and glancing at your chart will not incur a 4 figure "consultation fee"). One thing they do there that I wish US hospitals did was: at the end of your surgery, they give you a list of all the consumables used (gauze/gloves/bandages/sutures/ports/i.v. tubes etc) and you're asked to either pay for them or buy those from a pharmacy of your choice and deliver them to the hospital.

There are public hospitals which are very low-cost but lack infrastructure, and there are private hospitals which are expensive but tend to offer better services. Insurance for private hospital chains or groups exists but not everyone has it. AFIAU, even private healthcare is relatively cheaper than many western countries.

We have a mix of private and public healthcare. Most of the lifting is done by private healthcare system (government seems to encourage that).

Public healthcare is abysmal unless you are in a tier 1 city or higher. Central government does little and most responsibilities is on the state government so you would see varied healthcare in different states.

I don't see many people using insurance to pay their bills. Most of it is paid by their pockets. It's changing but I don't want a situation where majority of the people have health insurance and companies start abusing the lowest section of the population who wouldn't be able to afford it. It's already happening. If you let clinics know that you are covered by insurance, they will do more quite a lot more tests and make you sit there.

There are free govt run hospitals but they are unhygienic and don't have enough facilities.

The private hospital sector is better though. But not everyone can afford it.

Free to use Civil hospitals, free medical insurance for low income groups, almost free life insurance for low income group. Strong pharma and clinical base, as India is largest manufacturer of generic drugs. Still, hospitals are not proportional to population, so to flatten the curve this was required.

Conditions of Public hospitals hugely depends on the state. States like Kerala has good public hospitals while other states have very pathetic health system.

https://en.m.wikipedia.org/wiki/Kerala_model

Healthcare provided by government hospitals is free/subsidized. Though the number of such hospitals/doctors are not sufficient for our population.