“Establishing a central authority to create, enforce and celebrate standards, empower patients and foster collaboration among providers, payors, clinicians and patients, will be key. With decisive action, India can achieve affordable, world-class healthcare for all and emerge as a global model of equitable, efficient, and outcome-driven care.”Akshay Ravi, Partner, Healthcare Practice, EY-Parthenon India
83% patients in India increasingly seek objective, accessible information to guide their healthcare choices, with nearly 90% willing to pay more for certified quality, as per a latest report by FICCI and EY-Parthenon.
The report, titled ‘True Accountable Care: Maximizing Healthcare Delivery Impact, Efficiently’, outlines a pragmatic roadmap for making India’s healthcare system qualitative and affordable. While India’s healthcare efficiency outperforms global peers, structural and financial pressures reinforce the need for a national framework that sets clear minimum quality standards enabling patients to make informed healthcare choices.
Price efficiency is unmatched, but affordability remains fragile
On the EY-P Healthcare Productivity and Performance (HPP) Index1 [a composite measure developed for health system efficiency basis outcomes per rupee spent], India outranks compared countries on efficiency largely due to its cost advantage.
In leading private organized hospitals, the average daily revenue per occupied bed day (ARPOBD) remains ₹30,000 – 40,000, crossing ₹70,000 only for quaternary care hospitals in metros, which serve less than 5% of the private healthcare market2. The system has managed to keep long-term core price inflation to just 3 – 4% annually. Most of the 9 – 9.5% average long-term growth in inpatient realizations has been driven not by price hikes, but by changes in case mix and complexity: more tertiary procedures, deployment of advanced therapies and a shift toward more complex admissions as access, diagnosis and affordability have improved.
Yet, returns on capital employed (RoCE) in healthcare delivery average around 13%, below sectors like FMCG (25%) or retail (26%). And the estimated average private hospitalization spend (~INR 58,000) still exceeds the yearly consumption expenditure of nearly half of all households and ~70% of rural households3. Around 25 – 30% of the “missing middle” population continues to remain uninsured, relying heavily on out-of-pocket expenditure4.
The report stresses that sustaining these gains in the HPP index will require dual focus on driving improvement in quality and outcomes while controlling costs going forward.
Commenting on the findings of the report, Kaivaan Movdawalla, Partner and National Healthcare Leader, EY-Parthenon India. “India’s healthcare system has expanded rapidly over the past two decades and has had astounding successes, but the next two decades bring unprecedented pressures from an aging population to rising chronic diseases.”
“Our report shows strong alignment between patients who seek transparent quality data and clinicians willing to support standardized outcome measurement and reporting. This creates a unique opportunity to implement tiered reimbursement frameworks, strengthen accreditation and governance, and scale digital adoption. Our report provides a practical roadmap to navigate the complexity and urgency of India’s healthcare transformation.”
Adding to that, Varun Khanna Co-Chair, FICCI Health Services Committee and Group MD, Quality Care India Limited (Care, KIMS & Evercare) said, “This report is both a mirror and a map — reflecting how far India’s healthcare system has come and outlining where it needs to go next. The next phase must be about value, not volume: aligning incentives around outcomes, patient experience, and long-term health. The fact that nearly 90% of clinicians recognize the need for standardized pathways and outcome measures is a strong signal that the system is ready for this transformation.”
Dr. Harsh Mahajan Chair, FICCI Health Services Committee and Founder & Chairman, Mahajan Imaging & Labs said, “We hope our report serves as a catalyst for dialogue, collaboration, and coordinated action for the Indian healthcare industry. By advancing the principles of accountable care, we can reimagine India’s healthcare landscape – where quality and viability go hand in hand, where trust is strengthened, and where value-based outcomes become the foundation for a more resilient, equitable, and patient-centric system.”
Akshay Ravi, Partner, Healthcare Practice, EY-Parthenon India, adds “Today, both regulators and organized healthcare providers are demonstrating unprecedented intent to embed best-in-class global standards, while customizing them to the unique complexities of India’s healthcare landscape. The path forward must focus on clinical excellence and patient centricity, delivered through a thoughtful cohort based approach vs. a “one-size fits all” approach and supported by a tiered reimbursement system that rewards quality and outcomes.
“Establishing a central authority to create, enforce and celebrate standards, empower patients and foster collaboration among providers, payors, clinicians and patients, will be key. With decisive action, India can achieve affordable, world-class healthcare for all and emerge as a global model of equitable, efficient, and outcome-driven care,” said Ravi.
Key findings from the report:
Capacity has doubled, but complexity and needs are compounding exponentially
The report shows that beds per capita have grown nearly 2x since 2000 (0.7 to 1.3 per 1,000 people), while MBBS seats have expanded 5x, creating a stronger workforce pipeline. Infrastructure for advanced care has surged with cath labs per capita growing 58x, while linear accelerators (Linacs) per capita expanding 17x in the last two decades. India has rapidly narrowed the innovation adoption gap – cutting from a lag of over 10 years in the 1990s to just 2 years today for technologies such as AI-assisted radiology and hybrid cath labs.
Despite this, India still has one of the lowest hospital bed densities globally and a dual payor-provider fragmentation challenge with just 25–30 beds per hospital compared to over 100 internationally, and top 5 payors driving only ~40% of payouts versus 80%+ in other developed markets. Coupled with the vast disparities in access and affordability across geographies as well as patient sensibilities with respect to health, this places a formidable challenge to creating scaled solutions.
Driving a step change in paradigm, from an episodic, acute approach to a longitudinal, outcome drive approach, though is an urgent imperative today. The report notes that, in the absence of interventions, hospitalization needs may potentially increase 2.5-3x by 20475, requiring 20-30 lakh incremental beds and push health spend to 6-7% of GDP6. However, with a shift to a longitudinal care approach, there may be an opportunity to flatten this curve, reducing hospitalizations by 20-30% and containing spend to ~5% of GDP.
Patients demand transparency and trust
The survey finds that about 83% of patients increasingly seek objective, accessible information to guide their choices and would benefit from a single, trusted source of hospital ratings or clinical outcomes. Nearly 90% of patients who sought this information say they would pay more for certified quality. Yet, only around a third can easily access such information, relying instead on informal proxies like brand or doctor reputation (60%) and word-of-mouth (79%).
Patients also resonate with the concept of managed care: ~90% associate it with better chronic disease management and easier access to doctors. But 49% cite ‘limited diagnostic options’ and 48% ‘limited choice of providers’ as key barriers. The report recommends piloting provider-led networks, insurer-provider collaborations, and health-tech anchored chronic care programs.
Clinicians ready for outcome-based models and standardization
Similarly, clinicians show there is strong intent to measure and share outcomes (~ 65%), with many doctors supporting proactive reporting (~35%). Nearly 90% emphasized the importance of standardized clinical pathways and outcome measures to enable consistency in care. Around three-fourths highlighted the need to streamline processes with a focus on patient centricity and systematic quality approaches. While about 64% endorsed people-focused strategies, including training and multidisciplinary teamwork, 49% recognized technology as a vital enabler through tools like electronic health records (EHRs) for real-time tracking and decision support.
Incentivizing investments for quality care and integrating regulations
The report finds that quality investments are viewed as long-term cost optimizers; however, smaller nursing homes would require support to tide over short term profitability challenges. Coupled with the lack of a regulatory mandate, it is thus no surprise that fewer than 10% of private hospitals are NABH-accredited, and fewer than 2% of diagnostic labs have NABL accreditation today.
The report highlights several positive regulatory steps in recent years aligned with global best practices, including NABH’s expansion of accreditation programs, ICMR’s release of Standard Treatment Workflows across 28 specialties, progress on ABDM, QCI’s upcoming hospital grading framework, revamped VGF and PPP schemes to encourage private investment in underserved regions, and Ayushman Bharat payouts explicitly linked to quality proxies such as NABH empanelment or PG/DNB programs. It also notes the recent CGHS rate revision introducing tiered rates reflecting city-specific costs and rewarding accreditation and super-specialty status. Despite these advances, the report emphasizes that the challenge lies not in technical expertise or intent, but in the lack of robust mechanisms to drive adoption and collaboration across providers, payers, clinicians, and patients, underscoring the need for stronger central governance and payor-linked incentives to achieve clinical excellence.
Digital adoption will be the glue for accountable care
The report proposes the VALUE digital framework to strengthen accountable healthcare through five key elements: Vital Infrastructure (universal adoption of HIS, EMRs, PACS, LIS), Advanced Interoperability (secure, consent-based data sharing via ABHA), Leveraging Intelligent Systems (AI and Generative AI for decision support and predictive analysis), Unified Care (integrated platforms connecting providers, payers, and regulators), and Evidence-Based Governance (real-time dashboards and standardized outcome reporting). Together, these pillars make digital adoption the foundation for a more accountable, efficient, and future-ready healthcare system.
Recommendations: 7C healthcare framework for accountable care
The report introduces a seven-pronged framework – the “7C framework” – to guide India’s healthcare transformation towards accountable care. It emphasizes ‘Cohorting and segmentation-based approach’, ‘Clinical excellence’, ‘Cost consciousness’, ‘Care reimbursement’, ‘Care coordination’, ‘Consumer empowerment’ and ‘Connected ecosystem’. The framework is designed to move the sector from one-size-fits-all solutions to bespoke care pathways, ensuring both efficiency and equitable health outcomes.