Here’s a question nobody in Indian healthcare wants you to ask.
When your mother is admitted to a hospital with chest pain, and the doctors run an ECG, a stress test, a full cardiac panel, and an angiogram — and then put in a stent — who exactly is making decisions in your interest?
Not yours. Not hers.
The answer, uncomfortable as it is, is nobody.
The doctors followed protocol. The hospital ran its machines. The insurer looked for the exclusion clause. And you got a bill for ₹5.44 lakh that you hadn’t budgeted for between rent and groceries.
Nobody did anything wrong. That’s the problem.
The system isn’t broken. It’s working exactly as designed.
India’s healthcare market runs on a structural tug-of-war that is as old as private medicine itself. On one side, you have providers — hospitals, doctors, diagnostic labs — whose revenue goes up every time they do more. Another test. Another specialist consultation. Another night in the ICU. On the other side, you have payers — insurers — whose profits go up every time they pay less. Find the exclusion. Flag the pre-existing condition. Dispute the line item.
Everyone behaves rationally. Everyone optimises for their own survival. And the patient sits in the middle, paying the price for a system that was never designed around them.
This isn’t a uniquely Indian problem. It’s the central dysfunction of every for-profit healthcare market in the world. In the US, Kaiser Permanente figured out the solution eighty years ago: own the insurance and the hospital. If you’re both the payer and the provider, the most profitable outcome is the same as the best medical outcome — keep the patient healthy, keep them out of the hospital, and never give them a reason to file a claim. A teleconsult today is cheaper than a hospitalisation next year. A preventive screening now is cheaper than a chronic disease later.
It’s an elegant idea. Embarrassingly obvious, in hindsight.
In India, nobody had cracked it. Until a computer science student in Manipal decided to find out why.
The student who followed the thread.
Debarun Karmakar was in his third year at MIT Manipal when The Ken announced its annual case study competition in September 2025 — challenge: pick a real-world company and design a plan to disrupt it using AI. He chose Narayana Health, India’s largest private hospital network, partly because he’d spent his childhood in and out of hospitals, and partly because Kasturba Medical College was literally a ten-minute walk from his dorm.
For three months, he walked the wards. Talked to doctors, administrators, hospital leadership. Even got an audience with Narayana Health’s CEO, Viren Shetty.
What he found, underneath the operational noise, was the same fault line that runs through every healthcare system in the world: payers and providers whose financial survival depends on outcomes that are fundamentally at odds with each other.
His solution? Smush them together.
He didn’t make it past the semifinals. But he left convinced there was something real here. So he did what any good researcher does — he kept pulling the thread.
And eventually, he found Even.
Two Italians, one Indian, zero medical expertise. Go.
Even Healthcare was founded in 2020 by Mayank Banerjee, Matilde Giglio, and Alessandro Ialongo. The apparent mismatch between their backgrounds and their industry makes more sense when you understand that Even isn’t, at its core, a healthcare company. It’s a fairness company.
For Mayank, the founding impulse was personal. Growing up, he’d seen first-hand how the outcome of a medical emergency in India depended less on how sick you were and more on how much money was in your pocket. With 55 million Indians pushed into medical bankruptcy every year by a single hospital bill, the injustice wasn’t abstract — it was structural.
Even started as a hospital membership plan. Pay a fixed monthly fee, get your hospital bills covered across their partner network. Simple.
Five years and several pivots later, it has morphed into something far more ambitious: a universal healthcare subscription. One plan. Unlimited doctor consultations. Unlimited diagnostics. Hospitalisation cover backed by insurance partners. And crucially — Even employs its own doctors, runs its own clinics, and as of mid-2025, opened its first hospital on Race Course Road in Bangalore. Built from scratch. In seven months. Currently rated 4.9 stars on Google.
More hospitals are in the pipeline.
Why this is harder than it sounds.
If integrating payers and providers is such an obvious fix, why hasn’t anyone done it at scale in India?
Because the moment you try, you inherit all the problems of both sides of the system simultaneously. You’re running a hospital (capital-intensive, operationally brutal) and an insurance business (regulatory maze, actuarial complexity) and trying to make the unit economics work for a population that largely hasn’t bought formal health coverage before.
Narayana Health tried it. Their own insurance product, Narayana One Health, launched in mid-2024. Viren Shetty himself has acknowledged publicly that the execution has proven harder than expected.
Even’s answer is to start small, stay integrated, and prove the model works before scaling it. The subscription isn’t just a product — it’s the core mechanism that aligns incentives. When Even makes more money by keeping you healthy than by treating you when you’re sick, every decision in the system bends toward prevention.
This is not a new idea. It’s a proven one. The question is whether it can work in India, at India’s price points, for India’s missing middle.
The cold email that changed things.
Debarun turned his research into a 20,000-word Substack essay called The Hospital Rake. Then, in a move that is either extremely confident or extremely naive, he cold-emailed it to Even’s CEO.
It worked.
Mayank called it the best thing anyone had ever written about Even. The kind of piece that usually takes multiple hours of investor conversations to convey. He invited Debarun to join the Founder’s Office for his December break.
Even, as of January 2026, has raised $70 million in total — including a $20 million round that closed this year. Its cap table includes Khosla Ventures, 8VC, and Peter Thiel’s Founders Fund. It is, at this point in time, the only Indian company in Founders Fund’s portfolio.
And yet, it is more well-known in San Francisco than it is in India.
That gap — between what Even is building and how little attention it has received in the Indian tech ecosystem — is precisely why this story matters.
What Even is really trying to prove.
This isn’t just a startup trying to build a successful business. If Even’s model works, it becomes a blueprint. A proof that you can build a healthcare system in India that is simultaneously more equitable, more profitable, and more replicable than anything that currently exists.
Those are the stakes.
The incumbents — the large hospital chains, the traditional insurers — can see exactly what Even is doing. The problem is they can’t just copy it. The integrated model requires you to actually align your incentives, which means cannibalising your own existing revenue streams. It’s the classic innovator’s dilemma, playing out in wards and waiting rooms across Bangalore.
For now, Even is a Bangalore story. A ₹70-million bet on a model that is eighty years old in America and brand new in India.
But if it works here — with India’s scale, its price sensitivity, its regulatory environment, its 860 million people who still don’t have any health insurance — it won’t stay a Bangalore story for long.