Each year, the cost of health care pushes some 39 million people back into poverty, according to a study published in the Lancet medical journal. Patients shoulder up to 80 percent of India's medical costs. Their share averages about $66 (3,000 rupees) annually per person - a crippling sum for the 800 million or so Indians living on less than $2 a day. 

A diagnosis of asthma, a broken leg or a complicated childbirth can mean having to choose between medicine or food, spending on treatment or relying on prayer.

While India boasts an economic growth rate near 9 percent, the wealth has done little to help millions burdened by poverty and disease. The poor, aside from struggling to afford care, also face extreme shortages of doctors and medicines.

The situation is particularly dire in rural areas, where more than 70 percent of the country's 1.2 billion people live. Some desperate patients resort to seeing quacks. Others pay bribes. Many simply don't seek help until it is too late.

The World Bank and other experts have warned that failure to address the country's health care woes could take a toll on long-term growth - especially as two-thirds of the population is under 35 and would form the backbone of India's work force for decades.

Yet India's government spends comparatively little on health care: just 1.1 percent of the country's GDP, a figure that hasn't changed much since 2006 when China was spending 1.9 percent; Russia, 3.3 percent and Brazil, 3.5 percent, according to World Health Organization figures.

"The political will is simply not there yet. We have to help realign the country's priorities," said Dr. K. Srinath Reddy, president of the Public Health Foundation of India and part of a government-commissioned committee recommending reforms.

Statistics that might highlight areas of need are scarce, thanks to erratic case reporting, few autopsies and a tradition of quick cremation that destroys evidence of disease. WHO reports often leave India out for lack of data. A recent study in the Lancet suggests malaria deaths could be 10 times higher than estimated.

India, which says hospital costs impoverish a quarter of all patients, has vowed to raise spending on health to 3 percent of GDP by 2015 and provide universal primary health care - but it's an unfilled promise that's been made before.

The Lancet, in a series on India in January, urged the government to double its pledge to 6 percent by 2020 or jeopardize its ability to shake off poverty.

"What is the point of economic success if there is nothing in it for the population?" Lancet editor Richard Horton said. "In a short amount of time you can do a lot - if you have the right leadership, the right administration and the public will. India has the people and it has the funds. We'll see if they can do it."

Meanwhile, India boasts a thriving medical tourism industry with shiny private clinics luring tens of thousands of foreigners for everything from bargain tummy tucks to experimental stem-cell treatments in an industry estimated to be worth nearly 100 billion rupees ($2.3 billion). The pharmaceutical industry is making lifesaving drugs at cut-rate costs, private hospitals are pioneering advances in open-heart surgery and medical schools are churning out physicians eager to work in the West.

For most Indians, however, this is happening in another world.

Uttar Pradesh, one of India's poorest states and home to the padlock-manufacturing city of Aligarh, is a land of barren rural landscapes pocked by crumbling mud huts, wandering cattle and roadside shacks selling potato chips and curry.

Its infant mortality rate - 96 of every 1,000 newborns die - makes it one of the worst places on Earth to be born. The average Indian rate is better at 63 but still grim compared with China's 15 deaths out of every 1,000 births.

The state's leader, Mayawati, who uses only one name, rose from India's lowest caste to power and prominence. She calls health care a top priority. Yet since taking office in 2007 she has spent just $224 million on medicines for the state's 195 million people, while spending $569 million to build memorial parks and statues of leading dalits - also known as untouchables - such as herself.

In rural India, the poor often have to walk kilometers (miles) to reach a clinic, with no guarantee of finding a doctor or the medicine they need. On any given day, at least 40 percent of government doctors are absent - often busy moonlighting for higher pay at private clinics. Drug supplies are also erratic; last year, India was short 35 million vaccine doses for diphtheria and 30 million for tetanus, a Health Ministry report said.

Many patients simply rely on traditional holistic medicine approaches such as ayurveda, or seek help from quacks, who have become so common the government uses them as information sources on everything from environmental contamination to polio outbreaks.

They advertise in graffiti scrawled across roadside buildings in rural Uttar Pradesh, promising treatments for venereal disease, erectile dysfunction, urinary tract infections - and charging according to what patients can pay.

In the meantime, private health care is booming, with clinics and insurance schemes multiplying and driving up costs. There are piecemeal efforts to help: a national mission launched in 2005 to improve rural care, and some states offering to cover hospital bills for the poorest.