1. 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

2. Health Spending in OECD Countries
Health Spending in Developing Economies

3. 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

4. Union and State government expenditure on health (adjusted for inflation)
Note: : state figure is RE, Union is actual expenditure; : 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; prices:

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

6. Trends in Pre and Post-NRHM Health Expenditure in States

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

10. Hospitalisation Episodes Turning Pro-Poor

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

12. 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

14. Percentage of Households Facing Catastrophic Expenditure on Health During Pre and Post-Insurance Years
Quintile Groups
OOP Expenditure
Inpatient Expenditure
Outpatient Expenditure
Drugs Expenditure
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

15. 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