The report entitled National Health Accounts: Estimates for India 2014-15 (released in October, 2017) provides healthcare expenditures in India based on National Health Accounts Guidelines for India, 2016 (with refinements where required) that adhere to System of Health Accounts 2011 (SHA 2011), a global standard framework for producing health accounts. The NHA estimates for India is a result of an institutionalised process wherein, the boundaries, data sources, classification codes and estimation methodology have all been standardised in consultation with national and international experts under the guidance of NHA Expert Group for India.
The NHA provides key indicators to understand financing of health system in the country and allows for comparison with other countries. The National Health Policy 2017 sets out several goals related to healthcare financing and emphasizes the need to track expenditures on health through a robust system of National Health Accounts. The production of annual NHA estimates builds a database for tracking trends in allocations for health by union/state governments and estimate the burden of out-of-pocket payments.
• The Total Health Expenditure (THE) for India is estimated at Rs. 4,83,259 crores (3.89 percent of GDP and Rs. 3,826 per capita) for the year 2014-15. THE constitutes current and capital expenditures incurred by Government and Private Sources including External/Donor funds. Current Health Expenditure (CHE) is Rs. 4,51,286 crores (93.4 percent of THE) and capital expenditures is Rs. 31,973 crores (6.6 percent of THE).
• The Government Health Expenditure (GHE) including capital expenditure is Rs. 1,39,949 crores (29 percent of THE, 1.13 percent GDP and Rs. 1,108 per capita) for the year 2014-15. This amounts to about 3.94 percent of General Government Expenditure in 2014-15. Of the GHE, Union Government share is 37 percent and State Government share is 63 percent. Union Government Expenditure on National Health Mission is Rs. 20,199 crores, Defence Medical Services Rs. 6,695 crores, Railway Health Services is Rs. 2,111 crores, Central Government Health Scheme (CGHS) is Rs. 2,300 crores and Ex Servicemen Contributory Health Scheme (ECHS) is Rs. 2,243 crores.
• The Out-of-Pocket Expenditure (OOPE) on health by households is Rs. 3,02,425 crores (62.6 percent of THE, 2.4 percent of GDP, Rs. 2,394 per capita) for the year 2014-15. Private Health Insurance expenditure is Rs. 17,755 crores (3.7 percent of THE) for the year 2014-15.
• Of the Current Health Expenditure, Union Government share is Rs. 37,221 crores (8.2 percent) and the State Government’s share Rs. 59,978 crores (13.3 percent). Local bodies’ share is Rs. 2,960 crores (0.7 percent), Households share (including insurance contributions) about Rs. 3,20,262 crores (71 percent, OOPE being 67 percent). Contribution by enterprises (including insurance contributions) is Rs. 20,069 crores (4.4 percent) and NGOs is Rs. 7,422 crores (1.6 percent). External/donor funding contributes to about Rs. 3,374 crores (0.7 percent).
• The Current Health Expenditure attributed to Government Hospitals is Rs. 64,685 crores (14.3 percent) and Private Hospitals Rs. 1, 16,943 (25.9 percent). Expenditures incurred on other Government Providers (including PHC, Dispensaries and Family Planning Centres) is Rs. 27,782 crores (6.2 percent), Other Private Providers (incl. private clinics) is Rs. 23,795 crores (5.3 percent), Providers of Patient Transport and Emergency Rescue is Rs. 20,627 crores (4.6 percent), Medical and Diagnostic laboratories is Rs. 21,058 crores (4.7 percent), Pharmacies is Rs. 1,30,451 crores (28.9 percent), Other Retailers is Rs. 559 crores (0.1 percent), Providers of Preventive care is Rs. 23,817 crores (5.3 percent), and Other Providers is Rs. 9,985 crores (2.2 percent). About Rs. 11,584 crores (2.6 percent) is attributed to Providers of Health System Administration and Financing.
• Current health expenditure attributed to Inpatient Curative Care is Rs. 1,58,334 crores (35.1 percent), Outpatient curative care is Rs. 73,059 crores (16.2 percent), Patient Transportation is Rs. 20,627 crores (4.6 percent), Laboratory and Imaging services is Rs. 21,058 crores (4.7 percent), Prescribed Medicines is Rs. 1,28,887 crores (28.6 percent), Over The Counter (OTC) Medicines is Rs. 1564 crores (0.3 percent), Therapeutic Appliances and Medical Goods is Rs. 559 crores (0.1 percent), Preventive Care is Rs. 30,420 crores (6.7 percent), and others is Rs. 5,194 crores (1.2 percent). About Rs. 11,584 crores (2.6 percent) is attributed to Governance and Health System Administration.
• Total Pharmaceutical Expenditure is 37.9 percent of CHE (includes prescribed medicines, over the counter drugs and those provided during an inpatient, outpatient or any other event involving a contact with health care provider). The Expenditure on Traditional, Complementary and Alternative Medicine (TCAM) is 16 percent of CHE.
• The Current Health Expenditure attributed to Primary Care is 45.1 percent, Secondary Care is 35.6 percent, Tertiary care is 15.6 percent and governance and supervision is 2.6 percent. When this is disaggregated; Government expenditure on Primary Care is 51.3 percent, Secondary Care is 21.9 percent and Tertiary Care is 14 percent. Private expenditure on Primary Care is 43.1 percent, Secondary Care is 39.9 percent and Tertiary Care is 16.1 percent.