Traditional systems of medicine and public health insurance in India: clinical and health systems implications

Abstract

India’s health system is pluralistic, with traditional systems of medicine- collectively referred to as Ayush (Ayurveda, Yoga & Naturopathy, Unani, Siddha, Homoeopathy, and Sowa-Rigpa) coexisting alongside biomedicine. Despite policy initiatives to mainstream Ayush through the Ministry of Ayush, the National Ayush Mission (NAM), and co-located service delivery models, Ayush services remain excluded from India’s flagship publicly financed health insurance scheme, Ayushman Bharat- Pradhan Mantri Jan Arogya Yojana (AB-PMJAY). This exclusion represents a persistent policy gap that limits therapeutic choice and constrains the broader goal of universal health coverage. Beyond policy considerations, insurance exclusion has practical implications for clinicians and patients. Structural constraints within the Ayush sector, including limited health technology assessment and cost-effectiveness evidence, uneven infrastructure, fragmented integration with public health programs, and variable public trust, have restricted its role within insurance frameworks. For physicians, particularly those managing chronic and lifestyle-related conditions, the absence of insurance coverage for Ayush affects continuity of care, disclosure of concurrent therapies, and referral pathways. However, the implementation of clinical protocols and monitoring mechanisms, supported by referral pathways, could strengthen coordination of care while safeguarding patient safety.