Health Financing in India Current Challenges and Future Prospects    Presented at Odisha Vikash Conclave Bhubaneswar, Odisha Sakthivel Selvaraj Public Health Foundation of India 20th September, 2016

Health Spending in OECD Countries Health Spending in Developing Economies

Trends in Health Expenditure, 2000-2014 Expenditure Description 2000 2005 2009 2014 Total Health Expenditure (Rs. In Crores) 105,734 133,776 219,776 421,194 Per Capita Health Expenditure (Rs.) 1021 1201 1893 3638 THE as % of GDP 4.63 4.25 3.69 4.02 Govt. Health Exp as % of GDP 1.11 0.94 1.04 1.10 Govt. Health Exp as % of THE 25.97 23.07 28.15 28.6 Govt. Health Exp as % of Total Govt. Exp. 7.4 6.8  6.2 OOP as % of THE 67.97 70.35 61.79 67.7 Source: National Health Accounts, GoI, Respective Years

Union and State government expenditure on health (adjusted for inflation) Note: 2013-14: state figure is RE, Union is actual expenditure; 2014-15: State is BE, Union is RE Source: Authors calculation based on budget data. State Budget: State Finances: a study of budget, RBI, various years; Union Budget: Expenditure Budget of various years; www.indiabudget.nic.in; prices: www.labourbureau.nic.in

Trends in Budgeted Vs Actual Union Government Expenditure, 1997-98 to 2014-15

Trends in Pre and Post-NRHM Health Expenditure in States

Utilisation of NRHM funds: All States Utilisation=Expenditure*100/Allocation NHM, MIS Progress Report,

Hospitalisation Episodes Turning Pro-Poor

Percentage of Population Receiving Free/Partly Free Medicines Accessing Public Health Facilities (OP), 2014

Percentage distribution of insured population by different health insurance scheme in India Note: RSBY-Rashtriya Swasthya Bima Yojana; CMCHIS-Chief Minister Comprehensive Health Insurance Scheme; RGJAY- Rajiv Gandhi Jeevandayee Arogya Yajana; ESIS-Employee State Insurance Schem; CGHS-Central Government Health Scheme Source: Estimated by authors using programmatic data from each scheme

Percentage of Households Facing Catastrophic Expenditure on Health During Pre and Post-Insurance Years Quintile Groups OOP Expenditure Inpatient Expenditure Outpatient Expenditure Drugs Expenditure 2004-05 2011-12 Poorest 7.43 7.66 0.77 1.08 6.85 6.33 5.44 4.52 2nd Poorest 10.97 9.88 1.79 1.98 9.52 7.39 7.62 6.01 Middle 12.89 12.24 2.47 2.77 10.87 8.85 8.88 2nd Richest 17.88 16.20 3.51 4.50 15.11 10.98 12.59 9.59 Richest 23.69 22.46 7.32 7.95 18.29 16.21 16.71 14.85 All 14.57 13.68 3.17 3.66 12.13 9.95 10.25 8.47

Concluding Thoughts Recent Developments Fourteenth FC awards and its implication NRHM funding declining sharply Society to Treasury Route Desirable Policy Direction Scale up public spending Tax funded system with primary care allocation ringfenced Consolidate all health insurance schemes