This paper traces the evolution of public–private partnerships (PPPs) in India’s health sector during the past four decades. These partnerships have been transformed because of their engagement with commercialisation and financialisation. Drawing on political economy frameworks and policy analysis, it argues that PPPs cannot be understood as technical instruments. They are institutional expressions of broader neoliberal reforms that reshape the role of the state and expand market influence in health systems. The paper identifies four phases of neoliberalism in India — pre-liberalisation, liberalisation, post-liberalisation, and more recently deepening of financialisation. In each of these phases there was a continuum of neoliberal ideas with introduction of new actors, organisational forms, and financial arrangements. While PPPs have expanded their outreach in some areas, it has led to fragmentation of the health services, widened inequities, and strengthened financial interests of the for-profit sector. The consolidation of financial interests has strengthened corporatisation of health services in India. The paper highlights the implications of this trajectory for universal health coverage and calls for renewed public stewardship to ensure equity and accountability in health service system delivery.