From Clicks to Care: Universal Health Coverage for India’s Informal Workforce

 Introduction

The gig economy in India is now a major source of employment, with the National Institution for Transforming India (NITI) Aayog projecting it will increase to 23.5 million by 2030 (NITI Aayog, 2022). These workers, engaged in everything from app-based delivery services to online freelancing, operate in a space devoid of formal employment structures and legal safeguards. Not having access to health insurance is a critical problem, especially in terms of illness or injury (Mehrotra, 2023). Addressing this gap, the 2024-25 Union Budget proposed extending Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (PM-JAY) to gig and platform workers, providing family floater insurance of Rs 5 lakh (Government of India, 2024; Economic Times, 2025). Delhi was the 35th State/Union Territory to adopt PM-JAY which shows its growing acceptance (PIB, 2025). The scheme now includes gig workers, Accredited Social Health Activists (ASHA) and Anganwadi workers, also citizens above 70 years irrespective of their economic status. At the same time, the e-Shram portal, which has over 30.68 crore registered workers by March 2025, is aimed at enrolling gig and unorganised workers for social security benefits like health. With the aimed funding, targeted outreach has been undertaken to enroll gig workers with the aim of solving this interconnectivity paradox. However, problems like digital uneducation, inactively synthesizing, and benefit gaps continue to hinder participation (Jay & Jha, 2024).

 In this policy brief, we outline the gaps that need to be addressed to extend universal healthcare to gig workers in India, and recommend policies that would strategically incorporate them within existing frameworks, maximizing equitable access. This brief argues that any move towards comprehensive universal healthcare expansion for informal and gig workers in India demands a coordinated and comprehensive approach. This plan should include (1) establishment of technology-based enrolment systems to assure availability and operational efficiency; (2) creation of consolidated, publicly funded care systems that assure affordability and quality; (3) development of benefit packages designed around the specific needs and financial realities of gig workers; (4) the creation of new fiscal policies that strengthen health financing support.

Challenges

• Deficiency in Existing Mechanisms: Though programs like PM-JAY focus on covering healthcare costs, gig workers still face uncovered medical expenses in outpatient care, diagnostics, and mental health services (Chowdhury & Goli, 2024). Increased eligibility was announced in the 2024-25 Budget, however access on the ground remains patchy. These gaps continue to lead to out-of-pocket expenditure which works against financial protection intended through the scheme. For example, a staggering 70% of healthcare expenses incurred by gig workers are OPD-related. There is geographically inequitable access as urban gig workers have to wait a long time for appointments at empanelled hospitals and rural workers have to travel over 20km to get basic access (Jay & Jha, 2024).

• Enrolment Barriers: Heavy enrolment barriers, such as digital illiteracy and complexities in enrolment processes, impede access to healthcare schemes. Most moderated workers, especially from rural settings, do not have even the bare minimum level of digital literacy required for online registration. As an example, 45% of e-Shram registrants require some level of third-party assistance due to digital illiteracy (Ministry of Labour & Employment, 2024). Complicated bureaucratic workflows with excessive documentation requirements coupled with rigid, already low enrolment figures create inequitable access (Jay & Jha, 2024).

• Fiscal Constraints: Sustaining the informal sector of gig workers is a struggling issue for PM-JAY’s universal healthcare coverage. Currently, the allocation of Rs 7,200 crore (~$865 million) for the year 2024-2025 is insufficient to cater to gig workers’ needs (Government of India, 2024). It is estimated that funding needs to be boosted by at least 20% to facilitate this augmented coverage  (Mehrotra, 2023). The informal sector’s enormous size combined with limited fiscal resources demands innovative and effective financing strategies for delivering healthcare (Devadasan et al., 2013).

 • Accessibility Deficits: Cost limitations and enrolment barriers are not the only glaring gaps that prevent gig workers from getting adequate health care. Lack of knowledge around the program PM-JAY is another primary reason; only 18% of gig workers are aware of it (PIB, 2025; India Today, 2025). In addition, rigid notions pertaining to mental health exacerbates the problem (Chowdhury & Goli, 2024). Furthermore, the combination of knowledge scarcity, geographic isolation (mostly in rural areas), and limited finances with even partial coverage create a perfect storm for underutilization. This culminates into inefficient healthcare services use alongside adverse health outcomes (Bhat et al., 2018).

Policy Recommendations

Strengthening Technology-Based Enrolment

There is a strong tendency to make the gig-economy labour force ineligible to access healthcare solutions, which is highly explained by the inaccessibility of the platform and the illiteracy of digital technologies. To counter these odds, it would require implementing a broad based, multilingual and user-friendly technology platform. Integration with Aadhaar cards is one of the short-term solutions: e-Shram enrolments could be cross-referenced with the database of the PM-JAY project, based on current Aadhaar ID verification, which would automatically enroll workers not already registered in PM-JAY and minimize manual errors. In tandem to this, mobile simplified applications have to be pilot tested, with voice-guided assistance in Hindi, Marathi and other regional languages, in high-density gig worker states, e.g. Uttar Pradesh, Maharashtra, to make it more user-friendly (Jay & Jha, 2024). Integration with the commonly available tools like WhatsApp also has the potential to facilitate creating chatbots of registration on their platforms and interactive voice response (IVR) helplines to help the non-smartphone population access beneficiary authentication and authorization (BAA) registration. Widespread adoption will necessitate specific digital-literacy campaigns among rural and semi-urban areas, in which NGOs and Panchayat-level organizations can teach gig workers how to use healthcare portals (Gumber & Kulkarni, 2000).

Designing Inclusive and Custom Benefit Packages

The non-homogenous nature of gig work, i.e., full-time delivery workers to part-time freelancers, makes one, homogenous insurance model insufficient. A better structure will involve several coverage levels. As an example, a Basic Tier ( 10,000/year) could cover outpatient hospital consultations, diagnostic tests, and generic-only medicines, as is demonstrated by 70 percent of the total amount spent in healthcare. Mental health support, accident care and minor surgeries could be a part of a Premium Tier ( 25,000/year), some portion of which would be supplemented through gig platforms in their corporate social responsibility (CSR) or environmental, social, and governance (ESG) program (Jay & Jha, 2024). The portability is at least as important; the gig workers should be in a position to access benefits in different states via a single digital health PM-JAY identification number, which is especially relevant to the migrant laborers. In addition, insurance schemes need to be made occupation-sensitive, say, when delivery riders have to be offered more robust accident cover, and, freelance workers could avail of benefits related to stress management  (Prinja et al., 2012).

Innovating Financial Mechanisms

To secure a sustainable healthcare funding related to the gig workers, it will be essential to adopt hybrid-based mechanisms that provide cases equitably. The most likely model could divide the expenses as follows: 50% subsidies by central and state health funds, 30% platform contributions depending on the income or hours of the worker, and 20% employee contributions that are taken as micro-deductions on salaries. Tax rebates or special treatment in government procurement may be given to companies that will have at least 75 percent of the workforce enrolled in the platform. The second model would be community insurance pools, whereby the more gig workers within a specific geographical unit, or cluster of such units, such as delivery hubs or tech clusters, pay premiums towards joint coverage, managed by NGOs or local cooperatives (Gumber & Kulkarni, 2000).

 Spreading More Awareness and Outreach

 The main obstacle is awareness; 18% of the gig workers are aware of their benefits under PM-JAY. To this purpose, a specific, multilingual and community-based communication approach is essential. The visibility can be substantially increased by requiring platforms like Zomato, Swiggy, Ola, and Urban Company to have a PM-JAY notification, in at least 10 regional languages (India Today, 2025). It would also be worth having a peer educator program where ASHA workers could educate by becoming gig health ambassadors and providing awareness programs at delivery hubs and meeting points (PIB, 2025). Wider marketing attempts might be performed by public-private advertising on TV, radio, and social media with the help of accessible messages to create credibility and promote registration.

Strengthening Current Mechanisms

The process of healthcare is dependent on the reinforcement of the existing institutional mechanisms which should be sustainable, just as it should be comprehensive. Strategic input must be implemented, including a wider scale of Pradhan Mantri Jan Arogya Yojana (PM-JAY), which includes providing outpatient department (OPD) care, a program that costs an annual investment of 1,000 crore in the National Health Mission (Government of India, 2024). To complete this, strong accountability systems including the black listing of institutions that do not offer their services to concerned workers and the setting of quarterly third party audits to check its adherence are crucial. The dispute related to rejection of claims or temporary shutdown of services should be addressed by a grievance-redressal mechanism based on a 24/7 system that is operationalized as helplines, mobile portals, and community officers. Also, the need to align PM-JAY with other related social-security schemes (e.g., accident insurance, maternal benefits, and pensions in e-Shram) would help minimize fragmentation and lead to an increased take-up of the scheme portfolio (Mehrotra, 2023; Virk & Atun, 2015).

Conclusion

In the country, the gig economy is a substantial source of employment, though the gig workers are underrepresented in crucial coverage necessities. The new right to expand PM-JAY to the newest subset of users, gig workers, is a positive step, but a number of barriers like digital illiteracy, little understanding, insufficient healthcare, and a small benefit shape will always act as deterrents. Considerable enrollment of gig workers into the national healthcare framework will thus entail inclusive, technology-driven, and economically viable policy initiatives. Specific benefit packages, the ability to use multilingual platforms, hybrid funding rates and awareness-building campaigns are some of the necessary elements of this undertaking. The lack of such strategies endangers the postponement of meaningful changes in healthcare access by millions of gig workers. In addition, this concern extends beyond a conventional wellbeing of the gig workers, but it defines a fundamental step towards inclusive and sustainable economic growth.

References

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