Walk into a district hospital that has just been upgraded under any of the recent public health programmes and count the origin labels. The gloves, the intravenous sets, the catheters, the disposable syringes are all Indian, and very likely made by companies that also ship the same products to Europe and Africa.

The CT scanner, the MRI machine, the patient monitors, the immunoassay analyser in the laboratory and the implants in the orthopaedic ward are not. Some pieces do carry a 'Made in India' sticker, but that only means they were assembled here. The X-ray tube and the detector inside still weren't.

India makes what is cheap and produced in the hundreds of millions, and imports what is expensive and precision-engineered.

Six years of policy attention, a production-linked incentive scheme, an export push and a stated ambition to become a manufacturing hub for medical devices have not altered that shape. They have made both sides of it bigger.

It matters because these are the machines that set the price of the most expensive care in the system, and a bill paid in dollars grows with every fall in the rupee, whatever the ‘Make in India’ count says.

The Math Hasn’t Moved

India imported close to Rs 89,000 crore of medical devices in FY26, up 17% from about Rs 76,000 crore in FY25, on figures the industry association AiMeD released in June.

Exports have not kept pace. The last full-year figure on record is from FY25, between Rs 31,120 crore and Rs 33,824 crore depending on the rupee conversion used for the $4,014 million Parliament was told about in July 2025.

Set against FY26 imports, that makes the import bill roughly 2.7 times exports and the deficit more than Rs 55,000 crore.

Go back to FY20, and imports were Rs 41,709 crore, according to the series the Department of Pharmaceuticals has placed on the open-data platform. The jump of 41% in FY22 alone set the pace. The compounding since then is a little over 13% a year.

The Directorate General of Commercial Intelligence and Statistics count, the commerce ministry's official series, runs higher still. As reported by Medical Buyer, it has FY26 imports at Rs 94,664 crore against exports of Rs 28,106 crore, a ratio of 3.4 to one.

One caution before anyone repeats those numbers. The report carrying them was published on 19 March 2026, twelve days before the fiscal year closed, which makes the print a partial-year reading, most likely April to December.

FY24 full-year exports on the same series were Rs 31,673 crore, so a lower FY26 figure only makes sense if it is partial, and if the import side is similarly truncated, the full-year deficit is wider than the headline.

Different outlets also use different scopes, and a broader classification puts FY25 imports at Rs 1.37 lakh crore against Rs 42,360 crore of exports.

Every version of the series, narrow or wide, agrees that imports grow faster than exports, and that the ratio has run between about two and three and a half to one for the whole period.

Hospital-level import dependence, at 70 to 80% of what is used, appears in every industry and government source going back to the start of the decade, from AiMeD in 2023 to the US Trade Department and the IMPRI policy review this year.

It has not budged in any of them, even though the 2023 National Medical Devices Policy set out to bring it down to about 30%.

What Causes The Deficit?

The category breakdown of FY24 imports, from AiMeD's analysis of commerce ministry data, has an explanation.

Electronic equipment, meaning imaging, monitoring and the like, accounted for Rs 44,132 crore of the bill.

Consumables, where India is strong, were Rs 7,430 crore. In-vitro diagnostic reagents came to Rs 6,477 crore and implants to Rs 5,087 crore. Disposables, another Indian strength, were Rs 4,090 crore.

Consumables make up close to half of India's device exports. Electro-medical equipment makes up about 60% of imports.

India has world-scale capacity where unit prices are in rupees and margins depend on volume and process discipline, and almost none where unit prices are in crores and margins depend on intellectual property.

High-end CT and MRI are overwhelmingly imported from the original equipment manufacturers.

Where assembly does happen in India, as the Department of Pharmaceuticals' report on the sector acknowledged in 2023, domestic value addition is capped at around 40 to 50%, because the X-ray tubes that generate the beam and the flat-panel detectors that capture the image, the two most expensive parts of any imaging system, are bought in.

For much of the imaging and implant range, no domestic alternative meets the required specification.

The clearest sign of that is the argument now running over second-hand machines.

Smaller-city hospitals install refurbished imported CT and MRI scanners to get around the price of new ones, a market Business Standard put at about Rs 1,500 crore last week, and almost a year after the Centre set up an interministerial committee to write rules for such imports, none have been notified.

AiMeD wants the route shut on safety and ‘Make in India’ grounds. Nobody in that argument is proposing an Indian-built scanner as the alternative, because at the specifications those hospitals need, there is not one.

The PLI Hasn’t Produced Substitution

The medical-device PLI was designed for this problem. Its Rs 3,420 crore outlay, running from FY21 to FY28, pays about 5% on incremental sales for five years, and its four target segments are cancer care and radiotherapy, radiology and imaging, anaesthetics and cardio-respiratory and renal devices, and implants.

That is a list of the import categories, not the export ones. That was deliberate.

The scheme was pointed at the categories India imports because that is where the deficit is. Consumables and disposables, where Indian firms already compete globally, were left out.

So the question is whether a scheme aimed at the right categories has produced anything within them. On its own terms, it has.

Of the projects approved from 77 applications, 27 by the July 2026 Parliament reply, 24 have been commissioned, and 57 devices have entered production, with realised investment of about Rs 1,153 crore.

Cumulative incentivised sales stand at Rs 12,344 crore and cumulative exports at Rs 5,869 crore, by the government's own figures, which run to September 2025.

Only Rs 157 crore had actually been disbursed to December 2025, because payouts follow incremental sales over time rather than capacity commissioned.

The beneficiary list is led by Wipro GE Healthcare, Siemens Healthineers, Philips, Nipro and Meril, which is to say mostly multinationals localising assembly.

Cumulative PLI sales over five years equal about 13 to 14% of a single year's import bill.

On the DrugsControl series, imports rose from about Rs 76,000 crore in FY25 to about Rs 89,000 crore in FY26, an increase of roughly Rs 13,000 crore in one year. That is roughly what the PLI has sold in its entire life.

The deeper issue is what the scheme rewards. Incentives are paid on assembled output.

The components that drive the import bill — the X-ray tubes, the flat-panel detectors, the sensors and the reagent chemistries — are still imported, and nothing in the design of the scheme required that to change.

The scheme has added assembly capacity and export volume to a value chain whose core is still bought abroad.

The government's answer so far is a set of smaller schemes rather than a redesign. A Rs 500 crore Strengthening of Medical Device Industry scheme launched in November 2024 sets aside Rs 180 crore for a one-time capital subsidy of 10 to 20%, capped at Rs 10 crore per project, for making key components and raw materials in India.

A Rs 5,000 crore Promotion of Research and Innovation in Pharma MedTech (PRIP) scheme opened its second call for applications this month.

Four medtech parks are being built in Himachal Pradesh, Tamil Nadu, Madhya Pradesh and Uttar Pradesh, and the 2023 policy's 30% dependence target still stands on paper.

None of this is scaled to the problem.

A Rs 10 crore subsidy per project is a rounding error against a Rs 44,000 crore electronics import line, and there is still no scheme that pays for a tube, a detector or a reagent chemistry rather than the box they go into.

How Capital Reads The Sector

The only listed pure-play on imaging import substitution, Fischer Medical Ventures, has a market capitalisation of about Rs 2,359 crore against an electronics import line of Rs 44,000 crore a year.

The companies that actually localise scanners, Wipro GE, Siemens and Philips, are not listed in India at all.

The money is instead in the exporters. Poly Medicure, with around 11% of the global IV-catheter market and about 72% of Q1 FY27 revenue from exports, trades at 54.8 times trailing earnings, and Cupid, whose Rs 208 crore of FY26 exports are almost entirely multilateral and government tenders, at 365 times.

Indian listed capital prices the consumables side as a global oligopoly and treats the imaging side as too small to own.

The Real Gap

None of this is a failure of ambition. The scheme targeted the right categories and the exporters are world-class.

The deficit is growing because demand for imaging, implants and precision diagnostics is outrunning a domestic capability that is thin where the money is, and nothing so far has put money into the tube, the detector or the reagent rather than the box they go into.

Until that changes, India will keep exporting the syringe, importing the scanner, and calling the difference a manufacturing success.