Tertiary Healthcare, Meaning, Schemes in India, Challenges

Tertiary healthcare is the third and most specialised level of India’s healthcare system, providing advanced diagnosis, treatment and super-specialised care for complex and critical conditions. It acts as the apex of the referral chain, supported by medical colleges, super-speciality hospitals, cancer institutes and transplant centres. India has significantly expanded its tertiary-care capacity through PMSSY, Ayushman Bharat-PMJAY, cancer-care programmes and digital-health initiatives. The expansion of medical colleges and PG seats has also strengthened the specialist workforce.

However, tertiary healthcare remains constrained by regional concentration, shortage and maldistribution of super-specialists, high treatment costs, infrastructure gaps and unequal access. The way forward lies in strengthening secondary–tertiary linkages, decentralising specialised services, expanding specialist capacity, improving financial protection and integrating technology, research and quality standards.

Tertiary Healthcare Meaning

Tertiary healthcare is the third and most specialised tier of healthcare delivery, providing advanced, technology-intensive care for complex and serious conditions. It is generally delivered by super-specialists in specialised hospitals/institutions, usually through referral from secondary care. It forms an important component of universal health coverage.

• Super-specialised care: Provided by cardiologists, neurologists, oncologists, nephrologists, transplant surgeons, etc., beyond the general specialist care available at the secondary level.
• Advanced infrastructure: Equipped with ICUs, cath labs, MRI/CT/PET scanners, dialysis units, transplant facilities, radiotherapy and robotic surgery.
• Referral-based care: Ideally accessed through referral from secondary healthcare; however, in India, direct walk-ins and bypassing of secondary care are common due to weak referral linkages.
• Education & research: Major tertiary institutions function simultaneously as treatment centres, medical education institutions and research centres.
• Complex interventions: Provide advanced diagnosis, complex treatment, major surgery and critical care requiring highly specialised expertise and sophisticated technology.
• Major institutions: Include AIIMS/INIs, government medical college hospitals, regional/state cancer institutes, super-speciality government hospitals and large private tertiary hospitals.

Tertiary Healthcare in India

India’s tertiary healthcare capacity has expanded substantially, particularly through the growth of medical colleges, MBBS and PG seats, and AIIMS institutions. This expansion is strengthening both the doctor pool and specialist capacity required for advanced healthcare delivery.

• Medical colleges: The number of medical colleges increased from 387 before 2014 to 846 in 2026, representing a growth of 118.6%.
• MBBS seats: MBBS seats increased from 51,348 before 2014 to 1,39,864 in 2026, registering a growth of 172.4%.
• PG specialist seats: PG seats increased from 31,185 before 2014 to 86,360 in 2026, recording a growth of 176.9%.
• AIIMS expansion: There was 1 operational AIIMS (New Delhi) before 2014.
  • Under the Central Sector Scheme for new AIIMS, 22 AIIMS have been approved, with UG courses started in 19, expanding the institutional base for tertiary care, medical education and specialised services.
• New medical colleges: Under the Centrally Sponsored Scheme (CSS) for establishing new medical colleges by upgrading district/referral hospitals, 157 new medical colleges have been approved.
  • Upgradation of existing medical colleges: The CSS for strengthening state/central government medical colleges has supported 4,977 MBBS seats in 83 colleges at an approved cost of ₹5,972.20 crore, along with 4,058 PG seats in 72 colleges under Phase-I costing ₹1,498.43 crore and 4,000 PG seats in 65 colleges under Phase-II costing ₹4,478.25 crore.
  • Phase-III expansion: The Cabinet has approved 5,000 additional PG seats and 5,023 MBBS seats, with an enhanced cost ceiling of ₹1.5 crore per seat. 
  • Both schemes are to be implemented by 2028–29.
• Super-speciality infrastructure: Under Pradhan Mantri Swasthya Suraksha Yojana (PMSSY), 75 Super Speciality Block projects have been approved in the government medical colleges, of which 71 are complete, strengthening tertiary and referral-level care.

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Tertiary Healthcare Schemes 

Tertiary healthcare in India is supported by schemes that focus on specialised infrastructure, financial protection, advanced treatment, referral linkages, digital health and medical-value travel.

• Pradhan Mantri Swasthya Suraksha Yojana (PMSSY): Launched in 2003 and approved in 2006, PMSSY aims to establish AIIMS-like institutions, upgrade Government Medical Colleges/Institutions and reduce regional imbalances in tertiary care.
• Ayushman Bharat - PM-JAY: Launched in 2018 and implemented by the National Health Authority (NHA), PM-JAY provides financial protection of ₹5 lakh per family per year for secondary and tertiary hospitalisation; by mid-2026, it had generated 44.14 crore cards and supported 12+ crore hospitalisations, with approximately ₹1.8 lakh crore disbursed.
• National Organ Transplant Programme (NOTP): The programme strengthens organ and tissue transplantation through NOTTO at the national level and ROTTOs/SOTTOs at regional and state levels, focusing on organ procurement, transplantation infrastructure, training, coordination and registries.
• Strengthening of Tertiary Care for Cancer: The programme supports advanced cancer-care infrastructure through 19 State Cancer Institutes and 20 Tertiary Care Cancer Centres, while new AIIMS are also being equipped with comprehensive cancer-treatment facilities to improve access and address geographical gaps.
• National Cancer Grid (NCG): Established in 2012, NCG is a collaborative network led by the Department of Atomic Energy and Tata Memorial Centre, comprising 380+ cancer centres, research institutes, patient groups and professional societies, promoting standardised cancer care, research and knowledge sharing.
• Rashtriya Arogya Nidhi (RAN) / Health Minister's Cancer Patient Fund (HMCPF): RAN (1997) and HMCPF (2009) provide financial assistance to eligible, economically vulnerable patients requiring treatment for specified serious diseases, including cancer; HMCPF provides up to ₹15 lakh for eligible cancer patients operating through 27 Regional Cancer Centres.
• Pradhan Mantri National Dialysis Programme (PMNDP): Launched in 2016–17 under NHM, PMNDP primarily provides dialysis at district hospitals while enabling referral of severe nephrology cases to tertiary centres, strengthening the secondary–tertiary nephrology continuum.
• Ayushman Bharat Digital Mission (ABDM): Launched in 2021, ABDM creates an interoperable digital-health ecosystem through ABHA, Health Facility Registry, Healthcare Professionals Registry and other digital-health infrastructure. 
  • As of 17 September 2026, over 97.61 crore ABHA IDs were operational, with 119.95 crore health records linked.
• PM-ABHIM – Critical Care Component: Launched in 2021, PM-ABHIM strengthens district-level critical-care capacity through Critical Care Hospital Blocks and establishes referral linkages with tertiary institutions for the management of complex and severe cases.
• Heal in India Initiative: The initiative promotes India as a medical-value-travel destination by leveraging its advanced tertiary-care infrastructure, skilled specialists and cost advantage, while facilitating foreign patients through measures such as the e-Medical Visa.

Tertiary Healthcare Challenges 

Tertiary healthcare in India has expanded considerably, but significant gaps remain in geographical distribution, specialist availability, affordability, referral systems, infrastructure, research and equitable access.

• Regional and urban concentration: Tertiary institutions remain concentrated in metros, major cities and a few states, while the Northeast, hill and high-focus states continue to have inadequate tertiary capacity, creating geographical inequity.
• Specialist and super-specialist shortage: Despite substantial expansion of PG seats (Doctorate of Medicine), DM/MCh specialists remain inadequate and are concentrated in urban and private institutions, leaving public tertiary hospitals overstretched.
• High cost and catastrophic expenditure: Tertiary procedures such as cardiac surgery, cancer therapy, organ transplantation and neurosurgery are highly expensive; although PM-JAY has improved financial protection, inadequate package rates for some complex procedures remain a concern.
• Demand–supply gap in organ transplantation: Against 89,839 people on the major-organ waitlist, only around 20,019 transplants were performed in 2025, reflecting a limited deceased-donor pool, infrastructure constraints, awareness gaps and coordination issues.
• Weak referral system: Weak secondary care → direct tertiary-care visits → overcrowding → longer waiting times → inefficient use of tertiary resources, as specialist shortages at CHCs and district hospitals encourage patients to bypass the secondary level.
• Data and compliance gaps: 217 of 804 registered transplant hospitals failed to report to the National Registry in 2025, indicating weaknesses in monitoring, regulatory compliance and data quality.
• Capacity–education mismatch: Historically, the expansion of undergraduate medical education outpaced the growth of postgraduate capacity, contributing to shortages of specialists; recent expansion of PG seats is helping narrow this gap.
• Research and innovation gap: Despite institutions such as the National Cancer Grid, clinical research output remains below potential, while trial infrastructure and translational research capacity require strengthening; large patient volumes are not being fully converted into research and innovation.
• Inequity of access: PM-JAY has improved financial access, but physical access remains unequal, with remote, hill and tribal populations facing long-distance travel, accommodation costs, lost wages and other indirect expenses.
• Medical tourism vs domestic access: India’s growing medical-value-travel sector can strengthen its global healthcare position, but it also raises concerns regarding allocation of tertiary capacity, affordability and priority for domestic patients, requiring a balance between global healthcare competitiveness and domestic equity.
• Public–private imbalance: Advanced tertiary services are disproportionately concentrated in private institutions and urban centres, creating affordability and accessibility barriers for poorer and geographically remote populations.

Tertiary Healthcare Way Forward 

The way forward should focus on regional deconcentration, specialist expansion, stronger referral systems, affordable advanced care, and improved quality and research capacity, while ensuring that tertiary healthcare remains equitable and accessible.

• Regional deconcentration: Accelerate completion and operationalisation of approved AIIMS and prioritise PMSSY upgradation in the North-East, hill states, high-focus states and other underserved regions.
• Sustain PG expansion: Continue the PG-over-UG growth trajectory, expand DM/MCh and other super-speciality capacity, link specialist training with underserved areas where appropriate, and improve specialist availability at district and secondary levels.
• Strengthen referral discipline: Develop a robust secondary-to-tertiary referral system using ABDM infrastructure for e-referrals, Health Facility Registry, digital patient records and continuity of care, while reserving tertiary hospitals for genuinely complex cases.
• Close the organ-donation gap: Strengthen NOTTO/ROTTO/SOTTO coordination, scale up deceased-donor transplantation, implement e-Pratyaropan, Brain Stem Death Certification Guidelines and Swap Transplantation Guidelines, and ensure mandatory reporting by registered transplant hospitals.
• Rationalise PM-JAY package rates: Periodically revise package rates to make them cost-linked, evidence-based and sustainable, ensuring continued private-sector participation in complex procedures without shifting costs to patients.
• Decentralise cancer and NCD care: Expand Day Care Cancer Centres at district hospitals to provide routine treatment, follow-up and management of early-stage cases closer to patients, while reserving tertiary centres for complex cancers, advanced procedures, high-end treatment and research.
• Strengthen research capacity: Replicate the National Cancer Grid model across cardiology, nephrology and neurology, with greater emphasis on shared databases, standardised protocols, clinical trials, translational research and AI/digital health.
• Reduce indirect costs: Provide support for transport, accommodation and patient navigation, particularly for patients from remote, hill and tribal regions, to improve effective access to tertiary care.
• Balance medical tourism with domestic equity: Promote Heal in India while ensuring adequate domestic-patient capacity, affordable access and priority for critical domestic cases, so that commercialisation does not undermine the equity objective of public healthcare.
• Quality and accreditation: Expand NABH/NQAS-equivalent accreditation across tertiary public hospitals and standardise clinical protocols, patient safety, infection control, treatment outcomes and quality monitoring.