National Health Accounts (NHA) estimates for India (2019-20) released
“Through NHA Estimates report we can see that indicators like Out-of-pocket expenditure (OOPE) reduction are going hand in hand with increased public spending in healthcare. Thus, showcasing the right trajectory country is taking towards achieving milestones of Universal Health Coverage”, this was stated by Dr Vinod K. Paul, Member (Health) of NITI Aayog as he launched NHA Estimates for India for 2019-20 in the presence of Rajesh Bhushan, Secretary, Union Ministry of Health & Family Welfare.
Highlighting the efforts of the government towards public investments in the health sector, findings from NHA show that various indicators have demonstrated an encouraging trend on a sustained basis.
While congratulating everyone on NHA Estimates report launch, Dr Paul stated that “Government is ensuring that healthcare services that are required, be made readily available and accessible to the citizens without financial hardships.”
Highlighting investments in strengthening primary healthcare, Dr Paul said that the “report highlights the increased public spending in primary healthcare, which is in line with National Health policy 2017 where it states that two-thirds of public health spending must be in Primary Health systems. This is also a result of great developments/initiatives taken at grassroot level such as the opening of over 1.6 lakh Ayushman Bharat Health and Wellness Centres (AB-HWCs) which are providing a plethora of health services to the people.” He further said that primary healthcare must be prioritized as it is the fundamental base on which secondary and tertiary services can be supported efficiently.
Dr Paul expressed his heartfelt appreciation to the teams working behind this report and noted the significance of an accurate record of data collected for evidence-based decision making. He said that “these estimates are crucial for policymaking and comparing various indicators further aids in reflecting the progress made by the health system of the country.”
Dr Paul also threw light on the fact that private health insurance share is also going up. He said that “this shows a sign of maturity for a country in terms of insurance arena as those who can afford, will afford it from private players too. This complements the government system of primary, secondary and tertiary care.”
The NHA estimates for 2019-20 which is the seventh in the series of reports released annually, clearly show that government expenditure for healthcare continues to be the priority.
The share of OOPE in Total Health Expenditure (THE) declined from 62.6 per cent to 47.1 per cent. The continuous decline in the OOPE in overall health spending shows progress toward ensuring financial protection and Universal Health Coverage for citizens.
During this period, the share of Government Health Expenditure (GHE) in the overall GDP of the country has increased from 1.13 per cent in 2014-15 to 1.35 per cent in 2019-20.
In per capita terms, GHE has doubled from Rs 1,108 to Rs. 2,014 between 2014-15 to 2019-20. The government spending on health between 2018-19 and 2019-20 increased by 12 per cent, more than double the growth rate between 2017-18 and 2018-19 which was at 5 per cent.
Additionally, in General Government Expenditure (GGE), the share of health sector spending has steadily increased from 3.94 per cent to 5.02 per cent between 2014-15 and 2019-20. This clearly indicates that healthcare has been the priority for public investment in the country.
The increase in government spending on health has an important implication for the reduction of financial hardship endured by households. In the THE of the country between 2014-15 and 2019-20, the share of GHE has increased from 29 per cent to 41.4 per cent.
The share of primary healthcare in Current Government Health Expenditure (CGHE) has increased from 51.3 per cent in 2014-15 to 55.9 per cent in 2019-20. The increased focus on primary healthcare reinforces the government’s decisions to prioritise primary healthcare in the country.
Another positive trend in the country’s health financing space is the increase in Social Security Expenditure (SSE) on healthcare. This increase in social security has a direct impact on reducing out-of-pocket payments. A robust social security mechanism ensures that individuals will not face financial hardship and the risk of poverty as a consequence of accessing essential healthcare services.
The share of SSE on health, which includes government-funded health insurance, medical reimbursement to government employees, and social health insurance programs, in THE, has increased from 5.7% in 2014-15 to 9.3% in 2019-20.
While thanking the huge participation of state officials and other stakeholders, Dr Paul also highlighted the persistent efforts in increasing total public spending on health at the state level. He thus urged the state governments to move ahead in healthcare spending as a percentage of their total budget to about 8 per cent which is currently 4-5 per cent for many states. He further added that “this spending must be in line with the bigger picture of benefiting the citizens”.
Bhushan highlighted four important indicators i.e. reduced out of pocket expenditure due to which people are now spending less from their pockets.” “This is also a consequence of the increased government health spending over the years, he further stated. Bhushan informed everyone about government spending through services at AB-HWCs, insurance claims etc. While highlighting the significance of promotive and preventive health, Bhushan said that “we need to persist with this trend of expenditure on primary healthcare so that promotive and preventive health, which mostly take place at primary level, can be focused upon.”
Bhushan also pointed out about social security expenditure, which includes the social health insurance program, government-financed health insurance schemes, and medical reimbursements made to government employees, has drastically increased from 5 per cent to 9.3 per cent. “This along with other indicators taken together highlight that the burden on an individual or family due to health issues have reduced”, he added. This is a significant increase which shows that the common people of India are better equipped and better provided in terms of healthcare at their doorstep and making health more accessible.
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