Data from the survey reveals that in Bihar, the average out-of-pocket expenditure per hospitalisation case at a government hospital is Rs 10,553. In Uttar Pradesh, this amounts to Rs 12,878, and in Jharkhand, Rs 12,364. All three are among India’s poorest states by per capita income, yet all three charge patients more at government hospitals than the national average of Rs 6,631.
The contrast with better-performing states is striking. Tamil Nadu’s public hospitals report only Rs 1,357 per case, while Odisha is at Rs 2,496 and Chhattisgarh at Rs 3,913. Even within the same broad public system, the cost burden varies nearly tenfold. That gap points to differences in how well hospitals are stocked, staffed, and able to absorb the cost of treatment before the patient pays out of pocket.
The contrast with southern and western states is stark. Tamil Nadu records average out-of-pocket expenditure at government hospitals of just Rs 1,357 per case, roughly one-eighth of what a patient pays in Uttar Pradesh. Andhra Pradesh records Rs 4,972, Telangana Rs 3,711, and Chhattisgarh Rs 3,913. Gujarat stands at Rs 3,619, Rajasthan at Rs 4,177, and Odisha — a state with poverty levels not very different compared to the worst three — at just Rs 2,496.
The pattern holds even within states with strong public health reputations. Kerala records Rs 9,313 per government hospital case — lower than Bihar, Jharkhand, and Uttar Pradesh, but still 40.5 per cent above the national average.
Among the worst performers, the Northeast stands out. Manipur records Rs 16,007 per government hospital case, an amount that is more than double the national average. Nagaland reaches Rs 16,342. Himachal Pradesh, despite its relatively higher income levels, records Rs 13,084.
Among Union Territories, Chandigarh is an outlier at Rs 24,013 per government hospital case — by far the highest in the country.
On a broader level, the report notes a sharp rise in insurance coverage, which nearly tripled in rural India from 14.1 per cent to 47.4 per cent, and more than doubled in urban areas from 19.1 per cent to 44.3 per cent, between 2017–18 and 2025. The report, however, simultaneously shows that the average out-of-pocket hospitalisation cost remains high at Rs 34,064, with a median value of Rs 11,285.
