From Entitlements to Interfaces : Health IDs, Data Governance and the Transformation of Citizenship in India

India’s rapid expansion of digital health infrastructure marks a significant shift in how access to care is governed, experienced, and claimed. Anchored in initiatives such as the Ayushman Bharat Digital Mission (ABDM) and the introduction of Health IDs, the Indian state is increasingly mediating health entitlements through digital interfaces. This paper examines how the move from rights- and service-based entitlements to platform-mediated access is transforming the meaning and practice of citizenship in India’s health care system. Drawing on a political economy and governance perspective, the paper argues that Health IDs are not merely technical tools for interoperability and efficiency but key instruments of state restructuring. They reorder relationships between citizens, the state, and private actors by embedding access to public and private health services within data infrastructures governed through hybrid public–private arrangements. While digital identification promises portability, continuity of care, and system integration, it simultaneously introduces new forms of exclusion linked to digital literacy, data availability, and institutional capacity. The analysis foregrounds three interrelated governance challenges: first, the reconfiguration of state responsibility as the guarantor of care into a regulator and platform orchestrator; second, the emergence of new data governance regimes that raise questions of consent, surveillance, and accountability; and third, the stratification of health citizenship, as access increasingly depends on successful navigation of digital interfaces rather than universal provision. By situating India’s digital health reforms within broader debates on universal health coverage and welfare state transformation in low- and middle-income countries, the paper contributes to Health-PPG scholarship on how health technologies reshape social contracts, democratic accountability, and the politics of care.