Out-of-pocket expenditure (OOPE) as a share of total health expenditure and foreign aid for health has both come down as per the findings of the National Health Accounts (NHA) estimates for India for 2017-18.

What is National Health Accounts (NHA)?

• The NHA estimates are prepared by using an accounting framework based on internationally accepted System of Health Accounts 2011, provided by the World Health Organization (WHO).
• It is released by Ministry of Health & Family Welfare.
• It describes health expenditures and flow of funds in the country’s health system over a financial year of India.
• It answers important policy questions such as what are the sources of healthcare expenditures, who manages these, who provides health care services, and which services are utilized.
• It is a practice to describe the health expenditure estimates according to a global standard framework, System of Health Accounts 2011 (SHA 2011), to facilitate comparison of estimates across countries.

Objective of the NHA

• To describe the Current Health Expenditures (CHE).

The details of CHE are presented according to

• Revenues of healthcare financing schemes: – entities that provide resources to spend for health goods and services in the health system;
• Healthcare financing schemes: entities receiving and managing funds from financing sources to pay for or to purchase health goods and services;
• Healthcare providers: entities receiving finances to produce/ provide health goods and services;
• Healthcare functions: It describes the use of funds across various health care services.

About NHA (2017-2018)

• The 2017-18 NHA estimates shows government expenditure on health exhibiting an increasing trend and growing trust in public health care system.
• With the present estimate of NHA 2017-18, India has a continuous Time Series on NHA estimates for both government and private sources for five years since 2013-14.
• These estimates are not only comparable internationally, but also enable the policy makers to monitor progress towards universal health coverage as envisaged in the National Health Policy, 2017.

Key Highlights

Increase in GDP share: The NHA estimates for 2017-18 clearly show that there has been an increase in the share of government health expenditure in the total GDP from 1.15% in 2013-14 to 1.35% in 2017-18.

Increase in govt share in expenditures: In 2017-18, the share of government expenditure was 40.8%, which is much higher than 28.6% in 2013-14.

Per-Capita increase in expenditure: In per capita terms, the government health expenditure has increased from Rs 1042 to Rs.1753 between 2013-14 to 2017-18.

Focus on total healthcare: The primary and secondary care accounts for more than 80% of the current Government health expenditure.

Social security expenditure: The share of social security expenditure on health, which includes the social health insurance program, Government financed health insurance schemes, and medical reimbursements made to Government employees, has increased.

Decline in foreign aid: The findings also depict that the foreign aid for health has come down to 0.5%, showcasing India’s economic self-reliance.

Decline in OOPE: The government’s efforts to improve public health care are evident with out-of-pocket expenditure (OOPE) as a share of total health expenditure coming down to 48.8% in 2017-18 from 64.2% in 2013-14.

Way forward

• After 18 months of Covid-19, financial year 2017-18 appears to be from another era.
• However, learnings from that year’s NHA help us to plan for health system strengthening in the post-Covid years.
• The special financing packages for Covid emergency response, announced by the central government in 2020 and 2021, represent an extraordinary situation.
• The resolve to increase public financing for health must remain strong even after Covid.

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