In pre-Covid India, the Out-Of-Pocket spending on health as percentage of GDP fell
- The total expenditure on health as a percentage of Gross Domestic Product (GDP) declined from 4.2 per cent to 3.2 per cent between 2004-05 and 2018-19. However, the per capita Total Health Expenditure -- the health expenditure per person in the country at current prices -- increased from Rs 3,638 in 2013-14 to Rs 4,470 in 2018-19.
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Government Health Expenditure as a percentage of the GDP too fell from 1.35 per cent in 2017-18 to 1.28 per cent in 2018-19. However, compared to 2013-14, it rose 0.13 percentage points from 1.15 per cent. Government Health Expenditure, including capital expenditure, was Rs 2,42,219 crores in 2018-19, up 5 per cent from Rs 2,31,104 crores in the previous financial year.
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The government's share in Total Health Expenditure increased from 28.6 per cent (2013-14) to 40.6 per cent (2018-19) -- a 12 percentage point rise. The Total Health Expenditure rose from Rs 5,66,644 crores in 2017-18 to Rs 5,96,440 crores in 2018-19 - a 5 per cent rise. The Total Health Expenditure constitutes current and capital expenditures incurred by the government and private sector, including external funds.
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The Centre's share in the Government Health Expenditure fell to 34.3 per cent in 2018-19, from 40.8 per cent in the previous year. On the other hand, the states' share during the same period rose from 59.2 per cent to 65.7 per cent.
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The per capita government spending on healthcare increased by 74 per cent from 2013-14, from Rs 1,042 in 2013-14 to Rs 1,815 in 2018-19.
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The per capita Out-of-Pocket Expenditure (OOPE) as a percentage of Total Health Expenditure declined by 16 percentage points - from 64.2 per cent in 2013-14 to 48.2 per cent in 2018-19. OOPE refers to payments made by an individual to receive medical services, which are often not covered by medical insurance. India's OOPE is considered very high compared to economically-advanced countries with a robust social welfare system.
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While releasing the report, Niti Aayog's Dr VK Paul noted that the guiding principle of government has been to reduce out-of-pocket expenditure (OOPE) on health expenses, which pushes individuals and families into poverty.
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The social security expenditure on health, which includes the social health insurance program, government-financed health insurance schemes, and medical reimbursements made to government employees, increased from 6 per cent in 2013-14 to 9.6 per cent in 2018-19. Moreover, government-financed health insurance expenditure increased by 167 per cent between 2013-14 and 2018-19, rising from Rs 4,757 crores to Rs 12,680.
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The report suggested that government spending on primary healthcare rose from 51.1 per cent in 2013-14 to 55.2 per cent in 2018-19. In India, primary healthcare is the first level of healthcare infrastructure, which includes sub-centres and Primary Health centres. The rise in spending, Union Health Secretary Rajesh Bhushan said, reinforced the Centre's decision to prioritise primary healthcare in the country.
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However, while showing significant improvement in certain indicators, the report reflected the health expenditure of 2018-19, two years before the Covid-19 pandemic. The pandemic-induced focus on public health is expected to catalyse government spending. "The ongoing pandemic has showcased how a healthcare crisis can get transformed into an economic and social crisis," the 2021-22 economic survey noted. It added that health expenditure rose from Rs 2.73 lakh crore in 2019-20 (pre-Covid-19) to Rs 4.72 lakh crore in 2021-22 (Budget Estimate), a 73 per cent rise.
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