Why in News?
The Ministry of Health and Family Welfare recently released the National Health Accounts (NHA) Estimates for India 2022–23, highlighting a steady rise in public healthcare expenditure and a decline in out-of-pocket spending by households.
National Health Accounts (NHA)
The National Health Accounts (NHA) provide a comprehensive and systematic assessment of health expenditure in India. Released annually, the estimates track actual spending incurred by the government, private sector, households, and external agencies across various healthcare services and programmes.
The 2022–23 report marks the tenth edition of the NHA series, which began in 2013–14. The estimates are prepared by the National Health Accounts Technical Secretariat (NHATS) under the National Health Systems Resource Centre (NHSRC), functioning under the Ministry of Health and Family Welfare.
India follows the internationally accepted System of Health Accounts (SHA) 2011 framework, developed by organisations such as the World Health Organization (WHO), OECD, and Eurostat. This framework ensures standardisation and enables international comparison of healthcare expenditure.
Key Highlights of the NHA Estimates 2022–23
Rise in Government Health Expenditure
The report indicates a substantial increase in government spending on healthcare over the last decade. Government Health Expenditure (GHE) increased from ₹1.30 lakh crore in 2013–14 to ₹3.85 lakh crore in 2022–23, reflecting the growing policy emphasis on strengthening public healthcare infrastructure and services.
The share of government health expenditure in GDP also increased from 1.15 percent in 2013–14 to 1.43 percent in 2022–23. According to the revised GDP base year series (2022–23), the figure stands at 1.48 percent.
Similarly, the share of health expenditure within total government expenditure rose from 3.78 percent to 4.89 percent during the same period.
In per capita terms, government health expenditure increased nearly 2.7 times, rising from ₹1,042 in 2013–14 to ₹2,786 in 2022–23.
Decline in Out-of-Pocket Expenditure
One of the most significant achievements highlighted in the report is the sharp reduction in Out-of-Pocket Expenditure (OOPE) incurred by households on healthcare.
OOPE as a share of total health expenditure declined from 64.2 percent in 2013–14 to 43.4 percent in 2022–23.
This decline is particularly important because high out-of-pocket expenditure often pushes vulnerable households into poverty and financial distress. The reduction reflects improved public provisioning of healthcare services, expansion of insurance coverage, and greater government intervention in healthcare financing.
Lower OOPE is also considered a major indicator of progress toward Universal Health Coverage (UHC).
Growth in Social Security and Health Insurance
The report notes a substantial increase in the share of Social Security Expenditure (SSE) in total health expenditure. SSE includes government-funded health insurance schemes such as Ayushman Bharat–Pradhan Mantri Jan Arogya Yojana (AB PM-JAY), social health insurance programmes, and medical reimbursements for government employees.
The share of SSE increased from 6 percent in 2013–14 to 9.9 percent in 2022–23.
Private health insurance expenditure also witnessed a significant rise, increasing from 3.4 percent to 9.2 percent during the same period. This reflects growing insurance penetration and increasing awareness regarding financial protection against medical expenses.
Increased Focus on Primary Healthcare
The report highlights a major rise in expenditure on primary healthcare services. Government expenditure on primary healthcare more than doubled from ₹0.5 lakh crore in 2013–14 to ₹1.4 lakh crore in 2022–23.
This shift indicates increasing emphasis on preventive healthcare, early diagnosis, maternal and child health services, immunisation, and strengthening grassroots healthcare delivery systems through Health and Wellness Centres.
Strengthening primary healthcare is considered essential for reducing disease burden, improving accessibility, and lowering healthcare costs in the long term.
Significance of the Report
The NHA estimates serve as an important policy tool for assessing India’s progress toward affordable and equitable healthcare access. The data reflects the gradual transition from a predominantly out-of-pocket healthcare financing model toward greater public financing and insurance-based coverage.
The increase in government health expenditure aligns with India’s broader objective of achieving Universal Health Coverage and improving healthcare resilience after the COVID-19 pandemic.
The report also demonstrates the growing role of flagship programmes such as Ayushman Bharat, PM-JAY, and the National Health Mission in improving healthcare accessibility and reducing financial hardship.
Challenges
Despite progress, India’s public health expenditure as a share of GDP remains lower than many developed and emerging economies. Regional disparities in healthcare infrastructure, shortage of medical personnel, rising non-communicable diseases, and uneven quality of healthcare services continue to pose major challenges.
Ensuring affordable healthcare access in rural and underserved areas remains a critical policy priority.
Conclusion
The National Health Accounts Estimates 2022–23 reflect significant improvements in India’s healthcare financing landscape, particularly through rising public expenditure and declining out-of-pocket spending. While the trends indicate progress toward a more inclusive healthcare system, sustained investment, stronger primary healthcare infrastructure, and equitable access will remain essential for achieving long-term health security and universal healthcare coverage.