cash generally. there is insurance, and i’m sure many folks use it, but for most things it’s not worth the paperwork. total end-to-end cost for most things is less than what someone in the US would pay for a co-pay for the first appointment to even consider being treated.

most indian gov’t healthcare is horrendous and severely broken (vastly oversubscribed and underfunded), but private is very effective and quite affordable. there are some parts of gov’t healthcare that work okay (vaccinations).