India's Health Insurance Must Catch Up With the Growing Need for Home-Based Care
As India's population ages and chronic illnesses become increasingly common, healthcare experts are calling for a fundamental shift in the country's health insurance model. Doctors, geriatric specialists, public health experts, and patient advocates argue that insurance policies must move beyond covering only hospitalisation and begin supporting home-based care, which has become an indispensable part of treatment, rehabilitation, and long-term recovery.
The Hidden Cost of Recovery
For 31-year-old Kolkata resident Srijita Basak, the financial burden of caring for her elderly parents did not end when they were discharged from the hospital.
Her mother underwent knee replacement surgeries on both knees, while her father required multiple spinal surgeries after a serious fall. Although their health insurance covered most of the hospital expenses, the family received no reimbursement for the prolonged care required at home.
The costs quickly mounted. Home nursing, physiotherapy, medicines, specialised medical equipment, and even renting a hospital bed had to be paid entirely out of pocket.
"We've spent several lakh rupees over the last three years, and there is still no end in sight," she says.
Her experience is increasingly becoming the norm for Indian families.
India Is Growing Older—But Not Necessarily Healthier
India's healthcare landscape has changed dramatically over the past seven decades.
Life expectancy has increased from just 41 years in 1950 to nearly 72 years in 2024. By 2050, the country's elderly population is expected to reach approximately 347 million.
Longer life, however, has also brought a greater burden of chronic diseases such as diabetes, hypertension, dementia, Parkinson's disease, stroke, arthritis and cancer. India also accounts for nearly 11% of the world's road traffic accidents, leaving many patients with disabilities requiring prolonged rehabilitation.
Together, these demographic and medical trends are creating unprecedented demand for professional healthcare delivered at home.
Reflecting this growing need, India's home healthcare market was valued at $16.3 billion in 2025 and is projected to expand to $74.57 billion by 2034, making it one of the fastest-growing healthcare sectors in the country.
Yet insurance coverage has failed to keep pace.
An Insurance System Designed Only for Hospitals
India's health insurance system remains overwhelmingly focused on acute hospitalisation.
Once a patient is discharged, insurance support largely disappears, even though recovery may continue for weeks, months, or even years.
Patients recovering from:
- Major surgeries
- Stroke
- Hip or knee replacement
- Cancer treatment
- Serious injuries
- Dementia
- Parkinson's disease
- Spinal disorders
often require continuous nursing care, physiotherapy, wound dressing, mobility assistance, medication management, nutritional support and regular monitoring—all within their homes.
These services frequently cost between ₹30,000 and ₹1 lakh every month, placing enormous financial pressure on families.
Healthcare experts point out that while hospitals treat the disease, recovery actually happens at home.
Chronic Illness Creates the Greatest Financial Burden
According to geriatric psychiatrist Dr. Srikala Bharath, India's healthcare and insurance systems continue to prioritise acute episodes requiring hospitalisation, while chronic illnesses impose the greatest long-term emotional and financial burden on families.
Patients living with dementia, Alzheimer's disease, Parkinson's disease, stroke-related disabilities and terminal illnesses often require years of continuous care rather than repeated hospital admissions.
Recognising home-based care as an integral component of healthcare is therefore essential, experts argue.
Dementia Care: An Overlooked Crisis
Families caring for dementia patients face especially severe hardships.
Professional caregivers are often required around the clock to supervise patients, administer medicines, maintain hygiene and ensure safety.
Yet almost all of these expenses are borne directly by families because insurance provides virtually no support.
The emotional burden is equally severe, with family members often sacrificing careers and personal well-being to provide full-time care.
Domiciliary Hospitalisation: Limited and Inadequate
Although some insurance companies provide what is known as domiciliary hospitalisation, experts stress that this is not a substitute for comprehensive home healthcare coverage.
Such benefits usually apply only when a treating doctor certifies that hospital-level treatment can be safely delivered at home.
Even these benefits have become increasingly restrictive.
Many insurers have reduced coverage, introduced reimbursement-only claims, capped payouts as a percentage of the insured amount, or excluded domiciliary treatment altogether due to concerns about fraudulent claims.
Consequently, the vast majority of long-term caregiving expenses remain uncovered.
The Shortage of Skilled Caregivers
Financial challenges are compounded by another serious problem—the lack of professionally trained caregivers.
Families across the country report that many home nurses supplied through agencies possess little formal training in elderly care.
Prakash, a government employee from Thiruvananthapuram, experienced this firsthand after his father developed Alzheimer's disease.
He hired numerous caregivers over several years, but most lacked even basic understanding of dementia.
Some resigned within days because they found the patient "difficult," failing to recognise that behavioural changes were symptoms of the disease rather than deliberate non-cooperation.
Others could not administer insulin injections, manage prescribed medicines or monitor vital signs correctly.
Similar experiences have been reported by families caring for visually impaired, bedridden and chronically ill elderly patients.
Families Pay the Price
When professional care is either unavailable or unaffordable, family members often become full-time caregivers.
Many reduce working hours or leave employment entirely.
This creates not only financial hardship but also psychological stress, social isolation and declining household income.
Public health experts warn that inadequate home care frequently results in:
- Poor rehabilitation
- Preventable infections
- Pressure sores
- Permanent disability
- Medication errors
- Repeated emergency admissions
- Increased healthcare expenditure
Ironically, failing to invest in home care often increases the overall cost of healthcare.
Learning From Other Countries
Several countries have already recognised long-term care as an essential component of healthcare.
Japan and Germany have developed dedicated long-term care insurance systems that help finance professional caregiving services at home, reducing pressure on hospitals while improving quality of life for elderly citizens.
Experts believe India must begin moving towards a similar model.
Promising Initiatives in India
Some encouraging efforts have already begun.
Kerala has introduced a government-approved six-month Caregiver Certificate Course, aimed at creating a trained workforce capable of providing professional home-based care while generating dignified employment.
In another notable initiative, the Self Employed Women's Association (SEWA) has partnered with Pallium India to train women in palliative and nursing care.
Graduates from the programme are already providing professional services in homes and hospitals, with demand significantly exceeding available supply.
Healthcare professionals believe such initiatives should be expanded nationwide.
The Way Forward
Experts argue that India's response must extend well beyond insurance reform.
Priority areas include:
- Expanding insurance coverage to include long-term home healthcare.
- Financial support for family caregivers.
- National standards and regulation for home healthcare agencies.
- Professional certification and accreditation of caregivers.
- NABH accreditation for home care providers.
- Better wages, training and career pathways for caregivers.
- Development of integrated community-based care services.
- Greater focus on rehabilitation, preventive care and ageing in place.
Home-based care should encompass not only medical treatment but also assistance with daily living, emotional support, social engagement and caregiver counselling.
Conclusion
India's healthcare system has evolved significantly in treating acute illnesses, but it has yet to adapt to the realities of an ageing population.
Millions of families are quietly bearing enormous financial and emotional burdens because the healthcare system effectively stops supporting patients once they leave the hospital.
Expanding insurance coverage for home-based care, building a skilled caregiving workforce, strengthening community support systems and recognising long-term care as a healthcare priority are no longer optional—they are essential.
As India prepares for a future with hundreds of millions of senior citizens, ensuring dignified, affordable and professional care at home will become one of the country's most important public health challenges.


