With 66% of India’s population receiving treatment from a private hospital or clinic, this paper looks at the experience of women in this sector. The out of pocket healthcare expenditure for the treatment of reproductive health-related diseases in private facilities is 5.4 times higher than in public health; Around 75% of women delivering in private institutions in Gujarat experienced catastrophic health expenditure. While health insurance is expected to address out of pocket expenditure on healthcare, research on public health insurance does not do justice to women’s health needs. Almost two-thirds of all non-childbirth spending was on males under Rajasthan’s health insurance scheme. Higher out of pocket costs of healthcare disproportionately deter female utilization, especially among elderly patients. The female share of spending in the AP health insurance program was only 39%. As research from TN shows, complex processes of claiming insurance coverage are stacked against women. The absence of adequate regulation of costs and perverse incentives created by insurance schemes encourages unnecessary medical procedures like caesarean sections and hysterectomies. Despite the higher charges in private hospitals, they often lack basic standards of care. Segmenting the healthcare sector into a system where public hospitals are the site of care for the poor while private healthcare is the aspiration for those that can pay converts health from a right to a commodity. The paper makes recommendations for both strengthening equity, accountability and regulation of the private health sector and addressing the specific challenges faced by women.