India's low-income workers struggle to access ESIC medical care despite vast coverage

A new report highlights the struggles of India’s low-income workers in accessing medical care. In 2024 The Employees’ State Insurance Corporation (ESIC) was established under the 1948 ESIC Act, modelled on Britain’s National Health Service. It provides social insurance for formal sector workers, offering medical care and income protection. Today, it covers about 3.84 crore insured persons and nearly 14.91 crore beneficiaries—around one-tenth of India’s population. For a worker earning Rs 15,000 monthly, the annual contribution is roughly Rs 7,200, shared between employer and employee.

The ESIC operates a vast network of hospitals, medical colleges, and land assets, with a reported corpus exceeding Rs 1 lakh crore. Its benefits include outpatient care, wage loss compensation, maternity support, disability pensions, and coverage for occupational diseases. Yet workers frequently report long queues, medicine shortages, poor information, slow referrals, and delays in cash benefits.

The Safe in India Foundation also found that many injured workers must pay out-of-pocket for basic diagnostics like ultrasounds. Rural areas see an even higher proportion of deaths without medical attention. Experts argue privatisation may not help, as low-wage workers face migration, short contracts, and reliance on employers for registration. Instead, proposed reforms include streamlining processes, publishing service standards, strengthening primary care, addressing staffing gaps, deploying digital tools, and improving governance. The ESIC remains a critical safety net for millions, offering benefits private insurance cannot match. However, persistent issues in access and service delivery must be addressed. Without reform, many workers will continue to face barriers to essential medical and financial support.