Lok Sabha Question No. 587 (UNSTARRED), answered on 2022-12-09
Subject: Health Expenditure
Ministry: HEALTH AND FAMILY WELFARE
Asked by: Sanjeev Kumar Singari, S. Jagathrakshakan

## GOVERNMENT OF INDIA MINISTRY OF HEALTH & FAMILY WELFARE DEPARTMENT OF HEALTH & FAMILY WELFARE

## LOK SABHA UNSTARRED ADMITTED QUESTION NO. 587 TO BE ANSWERED ON 09 th  DECEMBER, 2022

## HEALTH EXPENDITURE

## 587. DR. SANJEEV KUMAR SINGARI: SHRI S. JAGATHRAKSHAKAN:

Will the Minister of HEALTH AND FAMILY WELFARE be pleased to state:

- a) the per capita Out-of-Pocket Expenditure (OoPE), for the years 2018-19, 2019-20, 2020-21, 202122, State/UT-wise;
- b) the  Total  Health  Expenditure  (THE),  Current  Health  Expenditure  (CHE),  Government  Health Expenditure  (GHE),  Out-of-Pocket  Expenditure  (OoPE),  Private  Health  Insurance  Expenditure during the last four years;
- c) the  distribution  of  Total  Health  Expenditure  (THE)  and  Government  Health  Expenditure  (GHE) across different levels of care - primary, secondary and tertiary during last four years;
- d) the details regarding the distribution of Government health expenditure across Central, State and local Governments; and
- e) whether  the  health  expenditure  in  India  accounts  for  less  than  five  percent  of  Gross  Domestic Product  (GDP)  and  the  level  of  Out-of-Pocket  (OoP)  spending  is  69.5  percent  of  total  health expenditures  and  if  so,  the  necessary  steps  taken/proposed  to  be  taken  to  increase  health expenditure as a percentage of GDP?

## ANSWER THE MINISTER OF STATE IN THE MINISTRY OF HEALTH AND FAMILY WELFARE

(DR. BHARATI PRAVIN PAWAR)

- (a) As  per  the  latest  available  estimates  from  National  Health  Accounts  Estimates  (NHA)  Report 2018-19, the State-wise per capita Out-of-Pocket Expenditure (OOPE) is given below:

## State-wise per-capita OOPE

|   S. No. | State             | Per Capita in Rs.   |
|----------|-------------------|---------------------|
|        1 | Assam             | 949                 |
|        2 | Andhra Pradesh    | 3,140               |
|        3 | Bihar             | 811                 |
|        4 | Chhattisgarh      | 1,175               |
|        5 | Gujarat           | 1,606               |
|        6 | Haryana           | 2,193               |
|        7 | Jammu and Kashmir | 1,363               |
|        8 | Jharkhand         | 1,915               |

|   9 | Karnataka        | 1,625   |
|-----|------------------|---------|
|  10 | Kerala           | 6,772   |
|  11 | Madhya Pradesh   | 1,409   |
|  12 | Maharashtra      | 2,644   |
|  13 | Odisha           | 1,750   |
|  14 | Punjab           | 3,065   |
|  15 | Rajasthan        | 1,745   |
|  16 | Tamil Nadu       | 1,909   |
|  17 | Uttar Pradesh    | 2,481   |
|  18 | Uttarakhand      | 1,216   |
|  19 | West Bengal      | 3,208   |
|  20 | Telangana        | 1,982   |
|  21 | Himachal Pradesh | 3,180   |

Source: NHA 2018-19

- (b) As per the available data from NHA reports, the data on the health indicators is as under:

(In Rs. Crore)

| Indicators                           | 2015-16   | 2016-17   | 2017-18   | 2018-19   |
|--------------------------------------|-----------|-----------|-----------|-----------|
| Total Health Expenditure             | 5,28,484  | 5,81,023  | 5,66,644  | 5,96,440  |
| Current Health Expenditure           | 4,95,190  | 5,39,371  | 5,01,760  | 5,40,246  |
| Government Health Expenditure        | 1,61,863  | 1,88,010  | 2,31,104  | 2,42,219  |
| Out-of-Pocket Expenditure            | 3,20,211  | 3,40,196  | 2,76,532  | 2,87,573  |
| Private Health Insurance Expenditure | 22,013    | 27,339    | 33,048    | 39,201    |

Source: National Health Accounts Estimates for India

- (c) The  NHA  2018-19  report  provides  the  distribution  of  Current  Health  Expenditure  for  different levels of care  - primary, secondary and tertiary for Government and Combined (Govt. and Private)

## Current Health Expenditure by primary, secondary and tertiary care (%)

| Category                 | Govt.    | Govt.    | Govt.    | Govt.    | Combined   | Combined   | Combined   | Combined   |
|--------------------------|----------|----------|----------|----------|------------|------------|------------|------------|
| Category                 | 2015- 16 | 2016- 17 | 2017- 18 | 2018- 19 | 2015- 16   | 2016- 17   | 2017- 18   | 2018- 19   |
| Primary                  | 51.5     | 52.1     | 54.7     | 55.2     | 45.1       | 45.2       | 47.0       | 47.4       |
| Secondary                | 22       | 23.1     | 31.5     | 30.5     | 35.2       | 36.1       | 34.0       | 31.7       |
| Tertiary                 | 13       | 10.8     | 6.4      | 5.9      | 15.2       | 13.9       | 13.7       | 14.9       |
| Governance &supervision  | 10.7     | 10.4     | 5.8      | 5.6      | 3.1        | 3.3        | 4.0        | 4.0        |
| Not Classified elsewhere | 2.8      | 3.6      | 1.6      | 2.8      | 1.5        | 1.5        | 1.3        | 2.1        |

Source: National Health Accounts Estimates for India

- (d) As  per  National  Health  Accounts  Estimate  2018-19,  in  Current  Health  Expenditure  the  Union Government contributes Rs 63,256 crores, State Government contributes Rs 1,06,056 crores and Local Government contributes Rs 5451 crores.
- (e) As  per  National  Health  Accounts  Estimate  2018-19,  the  Out-of-pocket  expenditure  (OOPE)  as percentage of Total Health Expenditure (THE) is 48.2%. OOPE on health as percentage of THE in

the  country  for  the  year  2015-16,  2016-17,  2017-18  and  2018-19  are  60.6%,  58.7%,  48.8%  and 48.2% respectively and therefore there is declining trend in OOPE as percentage of THE.

The Central Govt. has taken several initiatives for supplementing the efforts of the State for  providing  quality  and  affordable  healthcare  services  to  the  people.  Under  National  Health Mission, financial and technical support is provided to States/UTs to provide accessible, affordable and  quality  healthcare,  especially  to  the  poor  and  vulnerable  sections  of  the  population,  in  both urban and rural areas.

The 'India COVID-19 Emergency Response and Health System Preparedness Package-I' (ECRP-I)  of  Rs.15,000  Crores  has  been  approved  by  the  Cabinet  on  22nd  April  2020  with  an objective to prevent, detect and respond to the threat posed by COVID-19.

The  Cabinet  has  also  approved  the  scheme,  'India  Covid-19  Emergency  Response  and Health  Systems  Preparedness  Package-II'  (ECRP-II)  on  08th  July  2021  for  an  amount  of Rs.23,123 Crores.

Under National Health Mission, the Government has taken many steps towards universal health  coverage,  by  supporting  the  State  Government  in  providing  accessible  &  affordable healthcare to people. It encompasses the National Rural Health Mission (NRHM) and the National Urban  Health  Mission  (NUHM)  as  its  two  Sub-Missions.  Under  the  National  Health  Mission, financial  and  technical  support  is  provided  to  States/UTs  to  provide  accessible,  affordable  and quality healthcare, especially to the poor and vulnerable sections of the population, in both urban and  rural  areas.  The  National  Health  Mission  provides  support  for  improvement  in  health infrastructure,  availability  of  adequate  human  resources  to  man  health  facilities,  to  improve availability and accessibility to quality health care especially for the underserved and marginalized groups in rural areas.

The Government has launched four mission mode projects, namely PM-Ayushman Bharat Health  Infrastructure  Mission  (PM-ABHIM),  Ayushman  Bharat  Health  &  Wellness  Centres (ABHWCs), Pradhan Mantri Jan Arogya Yojana (PMJAY) and Ayushman Bharat Digital Mission (ABDM)

PM-ABHIM was launched as a mission to develop the capacities of primary, secondary, and  tertiary health care  systems, strengthen existing national institutions,  and  create  new institutions,  to  cater  to  detection  and  cure  of  new  and  emerging  diseases.  PM-ABHIM  is  a Centrally  Sponsored  Scheme  with  some  Central  Sector  Components,  for  implementation  of  the Atmanirbhar Bharat Package for health sector with an outlay of Rs 64,180 crore.

Under  Ayushman  Bharat  Health  &  Wellness  Centres(HWCs),  Comprehensive  Primary healthcare by strengthening Sub Health Centres (SHCs) and Primary Health Centres (PHCs) are facilitated. The HWCs are to provide preventive, promotive, rehabilitative and curative care for an expanded  range  of  services  encompassing  Reproductive  and  child  care  services,  Communicable diseases, Non-communicable diseases and all health issues.

Pradhan  Mantri  Jan  ArogyaYojana  (PMJAY),    Scheme  provides  health  coverage  of Rs.5.00 lakh per family per year to around 10.74 crore poor and vulnerable families for secondary and tertiary care as per Socio Economic Caste Census data 2011.

Ayushman Bharat Digital Mission (ABDM) has been announced on 27th September, 2021 with aim to develop the backbone necessary to support the integrated digital health infrastructure of the country.