Out-of-pocket-expenses remained dangerously high till 2019-2020
Government expenditure on health, both state and central, was 2.1 per cent of the Gross Domestic Product (GDP) last year, as per the Economic Survey 2022-2023, tabled by Union Minister of Finance and Corporate Affairs Nirmala Sitharaman January 31, 2023.
This is a slight dip from 2.2 per cent of the GDP in financial year 2021-2022 and an increase from 1.3 per cent of the GDP in 2015-2016. This “highlights the rising importance of public healthcare and social security in ensuring universal health coverage,” the report noted.
In absolute figures, the increase translated into Rs 1,75,272 crore in 2015-2016 to Rs 5,48,855 crore in 2022-2023. These figures are straying away from the target of increasing the total public expenditure on health to 2.5 per cent of GDP by 2025 as mandated by the National Health Policy (NHP) of 2017.
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The government’s share in the country’s total health expenditure has increased from 28.6 per cent in 2014-2015 to 40.6 per cent in 2014-2015. While out-of-pocket health expenditure (OOPE) has recorded a necessary decline in the same duration — from 64.2 per cent in 2014-2015 to 48.2 per cent in 2019-2020 — it remains dangerously high.
More than 17 per cent of Indian households incur catastrophic levels of health expenditures every year, a March 2022 report by the World Health Organization found. High OOPE on health impoverishes some 55 million Indians annually, the report added.
“The larger figures for India, however, point to one reality — health is not a priority for the government,” Pratheeba J, health financing specialist with the Health Systems Transformation Platform, had earlier told Down To Earth (DTE).
India risks a future of widening inequities, hindered progress towards universal health coverage as well as increased morbidities and associated mortalities, as it is highly likely that the poor and vulnerable may forgo treatment due to higher cost of care, she had further said.
The government has increased its expenditure on primary healthcare from 51.1 per cent in 2014-2015 to 55.2 per cent in 2019-2020, according to the National Health Policy 2017.
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“This not only ensures quality services at the grassroots level but also reduces the chances of ailments requiring secondary or tertiary healthcare services,” the Economic Survey 2022-2023 noted.
In the same vein, social health insurance programmes, government-financed health insurance schemes and medical reimbursements to government employees have increased from 6 per cent in 2014-2015 to 9.6 per cent in 2019-2020.
Under the Ayushman Bharat Pradhan Mantri – Jan Arogya Yojana, India’s health insurance scheme, some 21.9 crore beneficiaries have been verified as of January 4, 2023. The scheme was cited as the reason behind the decrease in OOPE on health over the past few years by Chief Economic Adviser V Anantha Nageswaran.
“Augmenting rural public healthcare system, the number of sub-centres, primary health centres (PHCs) and community health centres (CHCs) have improved substantially, along with a rise in doctors, nurses, and other medical personnel in the past eight years,” the government report noted.
It noted improvement on several indicators, including institutional births, immunisation, coverage of health insurance, infant mortality, stunting, wasting and total fertility rate, citing the National Family Health Survey from 2015-2016 and 2019-2021.
The maternal mortality ratio has recorded a similar trend, down from 167 per lakh live births in 2016 to 97 in 2020, data from the Sample Registration System revealed.
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Health-related indicators that have worsened during the same period are the prevalence of obesity and overweight in children, men and women — up from 2.1 per cent in 2015-2016 to 3.4 per cent for children, 20.6 per cent to 24 per cent for women and 18.9 per cent to 22.9 per cent for men.
Progress on the health infrastructure front has improved, barring the reduction in Auxiliary Nurse Midwives at sub-centres and PHCs from 213,400 in 2014 to 207,600 in 2022. The total number of PHCs has also come down from 25,000 in 2014 to 24,900 in 2022.
Other indicators — sub-centres, CHC, doctors at PHCs, specialists at CHCs and nursing staff, lab technicians and pharmacists at CHCs and PHCs have recorded an improvement in the same duration as well.
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