SYLLABUS
GS-2: Issues Relating to Development and Management of Social Sector/Services relating to Health.
Context: The Union Ministry of Health and Family Welfare recently released the National Health Accounts (NHA) Estimates for India 2022–23, highlighting trends in public health expenditure, out-of-pocket spending, and progress towards Universal Health Coverage (UHC) in India.
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• The National Health Accounts (NHA) estimates provide a systematic assessment of health expenditure flows in India using the internationally accepted System of Health Accounts (SHA) 2011 framework developed by the World Health Organization (WHO).
- India’s NHA estimates are prepared by the National Health Systems Resource Centre (NHSRC) under the Ministry of Health and Family Welfare.
• The 2022–23 report is the 10th edition of the NHA estimates and captures expenditure incurred by governments, households, private insurers, firms, and external agencies on healthcare services.
• The report highlights a long-term increase in public health expenditure and a sustained decline in Out-of-Pocket Expenditure (OOPE), indicating improved financial protection in healthcare.
Key Highlights of NHA Estimates 2022–23
• Rise in Government Health Expenditure (GHE)
- Government Health Expenditure (GHE) increased nearly threefold from ₹1.30 lakh crore in 2013–14 to ₹3.85 lakh crore in 2022–23.
- GHE as a share of GDP increased from 1.15% in 2013–14 to 1.43% in 2022–23. Under the revised GDP base year (2022–23 series), the share stands at 1.48%.
- GHE as a share of General Government Expenditure (GGE) rose from 3.78% to 4.89% during the same period, indicating increasing prioritisation of health in public spending.
- The share of GHE in Total Health Expenditure (THE) has increased by almost 15 percentage points, from 28.6% to 43.7% during the same period.
- In per capita terms, GHE has increased nearly 2.7 times, from ₹1,042 in 2013–14 to around ₹2,786 in 2022–23.
• Decline in Out-of-Pocket Expenditure (OOPE)
- Out-of-Pocket Expenditure (OOPE) as a share of Total Health Expenditure (THE) declined significantly by nearly 21 percentage points from 64.2% in 2013–14 to 43.4% in 2022–23.
- The decline reflects expanding public provisioning of healthcare services and wider coverage under government-funded health insurance schemes such as Ayushman Bharat–PMJAY, and increased public health spending.
• Increase in Social Security and Primary Healthcare Spending
- Social Security Expenditure (SSE) on healthcare increased from 6% to 9.9% of Total Health Expenditure between 2013–14 and 2022–23.
- The share of Private Health Insurance in THE has also increased, from 3.4% to 9.2%, clearly indicating improved health-seeking behaviour due to awareness and the population’s purchasing power.
- Government expenditure on Primary Healthcare more than doubled from around ₹0.5 lakh crore in 2013–14 to approximately ₹1.4 lakh crore in 2022–23.
- The report also noted an accelerated rise in public health expenditure during and after the COVID-19 pandemic period.
Significance of the Findings
• Progress Towards Universal Health Coverage: Rising public expenditure and declining OOPE indicate gradual progress toward Universal Health Coverage by improving financial protection against healthcare costs.
• Reduced Financial Burden on Households: The declining OOPE reduces the risk of catastrophic health expenditure and medical impoverishment among vulnerable households.
• Strengthening Public Health Systems: Increased spending on primary healthcare reflects greater policy emphasis on preventive, promotive, and community-based healthcare systems.
• Improved Health Financing Architecture: Rising social security expenditure indicates a gradual expansion of pooled healthcare financing mechanisms and government-supported insurance coverage.
Challenges and Concerns
• Low Public Health Expenditure: Despite recent improvements, India’s Government Health Expenditure still remains below the National Health Policy (NHP) 2017 target of 2.5% of GDP, limiting the overall capacity of the public healthcare system.
• Persistent Out-of-Pocket Burden: Out-of-Pocket Expenditure (OOPE), though declining, continues to remain high on medicines, diagnostics, and outpatient care, particularly affecting rural and low-income households.
• Regional Disparities in Healthcare: Significant inter-state variations persist in healthcare infrastructure, public spending, availability of medical personnel, and health outcomes, leading to uneven access to quality healthcare services.
• The “Missing Middle” Problem: While schemes like Ayushman Bharat (AB-PMJAY) cover the bottom 40-50% of the population, and corporate/government insurance covers the top tier, nearly 300 to 400 million working-class Indians (e.g., self-employed individuals, gig workers, street vendors, small shopkeepers) form a “Missing Middle”.