Public Health Spend Nearly Triples In A Decade, Household Burden Falls: Report

India's public spending on healthcare has nearly tripled over the past decade, with government health expenditure rising from Rs 1.3 lakh crore in 2013-14 to Rs 3.85 lakh crore in 2022-23, according to the latest National Health Accounts (NHA) estimates released by the Union Health Ministry on Wednesday. The report also showed a sharp decline in the burden on households, with out-of-pocket expenditure (OOPE) dropping from 64.2 per cent of total health expenditure in 2013-14 to 43.4 per cent in 2022-23, signalling a greater role of public financing and health insurance coverage in the country's healthcare system.

The NHA estimates for 2022-23, prepared by the National Health Accounts Technical Secretariat under the National Health Systems Resource Centre, highlighted that government health expenditure as a share of GDP increased from 1.15 per cent in 2013-14 to 1.43 per cent in 2022-23. Under the revised GDP base year series of 2022-23, the figure stands at 1.48 per cent.

The report noted that government spending on health received a significant boost during the COVID-19 pandemic, when expenditure rose to 1.84 per cent of GDP in 2021-22. The additional spending included emergency response measures under ECRP-I and II and the nationwide COVID vaccination programme.

"Given these additional spending by the government as a one-time measure, OOPE as percentage of Total Health Expenditure (THE) during this period also declined to 39.4%," the ministry stated.

The share of government health expenditure in total health expenditure increased from 28.6 per cent in 2013-14 to 43.7 per cent in 2022-23, reflecting what the report described as a growing prioritisation of healthcare in public spending.

"This shift underscores the important role of public financing in the health system and signals that policy efforts are moving in the right direction-towards a more affordable, equitable, and accessible healthcare system for all," the ministry said.

In per capita terms, government health expenditure rose nearly 2.7 times over the decade, increasing from Rs 1,042 in 2013-14 to Rs 2,786 in 2022-23.

The report also recorded a rise in spending aimed at financial risk protection. Social Security Expenditure (SSE) on healthcare- which includes schemes such as Ayushman Bharat Pradhan Mantri Jan Arogya Yojana, medical reimbursements for government employees and social health insurance programmes-increased from 6 per cent of total health expenditure in 2013-14 to 9.9 per cent in 2022-23.

Private health insurance expenditure also rose sharply during the period, from 3.4 per cent to 9.2 per cent of total health expenditure. The ministry attributed this to "improved health-seeking behaviour due to awareness, and the population's purchasing power".

Government spending on primary healthcare more than doubled during the decade, rising from Rs 0.5 lakh crore in 2013-14 to Rs 1.4 lakh crore in 2022-23, according to the estimates.

The report is the tenth edition of India's National Health Accounts estimates and has been prepared using the globally recognised System of Health Accounts (SHA) 2011 framework. Experts from institutions including NITI Aayog, National Institute of Public Finance and Policy, National Council of Applied Economic Research and Institute of Economic Growth were part of the expert group involved in the exercise.