The Ministry of Health and Family Welfare recently released the 7th National Health Accounts (NHA) Estimates for India (2019-20), which was compiled by the National Health Systems Resource Centre. The creation of the NHA estimates is made possible using an accounting framework that abides to the System of Health Accounts 2011, provided by the World Health Organization (WHO).
National Health Systems Resource Centre (NHSRC)
The NHSRC was inaugurated in 2006-07 under the National Rural Health Mission (NRHM) of the Government of India. Its primary function is to provide technical assistance at the top level. It helps in the development of policy and strategies, provides technical assistance to states and facilitates capacity building for the Ministry of Health and Family Welfare (MoHFW).
Understanding the Key Report Highlights
An understanding of the key report highlights can be gained by investigating health indicators, definitions, and data of growth trends.
Out of Pocket Expenditure (OOPE)
OOPE is the direct payment made by households when receiving health care services. This payment is made when services aren’t provided free of cost through a government health facility or when the individual isn’t covered under any public or private insurance scheme. According to the NHA Estimates, OOPE’s share in total health expenditure has seen a decrease from 62.6% in 2014-15 to 47.1% in 2019-20.
Government Health Expenditure (GHE)
The GHE includes spending across all schemes funded and managed by Union, State, Local Governments and quasi-Governmental organizations. Additionally, it includes donor funding if channeled through Government organizations. The proportion of GHE in India’s total GDP increased from 1.13% (2014-15) to 1.35% (2019-20).
General Government Expenditure (GGE)
The GGE is the share of Government expenditures dedicated to healthcare in General Government Expenditures. This ratio indicates the Government’s priority towards healthcare. The proportion of health sector spending in the GGE rose from 3.94% to 5.02% between 2014-15 and 2019-20.
Total Health Expenditure (THE)
THE covers all current and capital expenditures incurred by both Government and Private Sources, including External funds. THE’s share of GHE rose from 29% in 2014-15 to 41.4% in 2019-20.
Social Security Expenditure (SSE)
This includes government-funded health insurance, medical reimbursement to government employees, and social health insurance programs. SSE’s share on health elevated from 5.7% in 2014-15 to 9.3% in 2019-20.
Private Health Insurance Expenditures (PHIE)
PHIE is funding through health insurance companies, where households or employers pay a premium to be under a specific health plan. PHIE grew from 3.4 % in 2013-14 to 7 % in 2019-20 from the total Health Expenditure.
External/Donor Funding for health
This includes all aid available to the country from donors. It expanded from 0.3 % in 2013-14 to 0.5 % in 2019-20 out of the total health expenditure.
Recommended Next Steps
The recommended next steps include state governments increasing their healthcare spending as a percentage of their total budget to about 8%, which currently falls between 4-5% for many states. Furthermore, it’s suggested that there be increased commitment towards primary healthcare expenditure to focus on promotive and preventive health. The Fifteenth Finance Commission recommends that the Union and States’ public health expenditure should reach 2.5% of GDP (Growth Domestic Product) by 2025.
Health Insurance Coverage
Currently, 20% of the population has social and private health insurance, while the remaining 30%, known as the “missing middle,” have no health insurance.
Healthcare Related Initiatives
These include National Health Mission, Ayushman Bharat, Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), National Medical Commission, PM National Dialysis Programme, Janani Shishu Suraksha Karyakram (JSSK) and Rashtriya Bal Swasthya Karyakram (RBSK).
