1. Health System Financing in Odisha
Date: 20th September 2016
Dr Sarit Kumar Rout
Kirti Sundar Sahu
IIPH-B

2. State Health Accounts Odisha 2013-14

3. Introduction Creation of health account (HA) is important to :
understand financial flows related to the consumption of health care goods and services
Monitor pattern of health expenditure  for improving health system performance
The state health system has undergone rapid changes after the introduction of NHM in 2005
With additional resources from the union government the states are introducing new innovative programs to address the healthcare challenges.
There is hardly any robust mechanism to capture the resource flow, spending pattern, what type of goods an services are produced and who benefits from it.

4. Why SHA?
To improve health system financing in the state by producing evidence on resource allocation, spending and distribution of resources on health care goods and services.
To create and strengthen data base on various components of health expenditure – Government, NGOs, private firms and autonomous bodies.
To provide inputs for designing effective and efficient health financing systems in the context of changing disease-profile in the state

5. Methodology
The health accounts for Odisha have been estimated using the System of Health Accounts (SHA) 2011, a framework developed by the OECD, European Union(EU) and the World Health Organisation (WHO).
According to SHA 2011 health expenditure is defined as resources used for “current consumption” excluding
Expenditure incurred for capital formation which are futuristic in nature
Medical education, training and research ( the consumption of which does not accrue to the current year)

6. Data sources for health financing in Odisha
Public
Private
Department of health and family welfare (treasury)
Including OSTF
Medical reimbursement from all departments of GoO
(Detail demand for grants-DDG)
MAMATA- WCD dept. (Detail demand for grants-DDG)
National health mission
Urban local bodies (ULBs)
Insurance:
RSBY
BKKY (Detail demand for grants-DDG)
CGHS
ESIC
Railways ( Detailed demands for grants (DDGs) volume-2 and the health directorate of Indian Railway)
AIIMS Bhubaneswar
OOP
National Sample Survey (Morbidity and Health Care Survey: NSS 71st round, January-June 2014;
Consumer Expenditure Survey ( ) for medical devices and family planning
Firms/Enterprises
NGO/NPISH

7. Methodology
After collection of data the health expenditure was classified as
Health care financing schemes (HF),
financing arrangements through which health services are paid for and obtained by people.( eg. state govt. fin scheme)
Revenues of health care financing schemes (FS),
Refers to how resource are raised for health financing schemes
Health care functions (HC)
Type of health care the expenditure is used for– curative, preventive, administrative
Health care Providers (HP)
Who provides the services- Hospitals, pharmacies, providers of preventive care.
Factors of provision (FP)
How the health care resources are distributed across salary, medical goods, non medical goods

8. Results SHA 2013-14 Indicators INR in crores As share of GSDP
*Population 4.31(2013)
# GSDP Odisha- CSO,MOSPI
Results
SHA
Indicators
INR in crores
As share of GSDP
Per capita*
(INR )
Current Public Expenditure (I) (% share)
2635
0.95
613
Private Expenditure (II) (% share)
9580
3.46
2228
Current expenditure on health (A=I+II)
12215
4.41
2841
Total Public Expenditure (Current + Capital)
3099
1.12
721
Total Health Expenditure (Current+ Capital)
12679
4.58
2949

10. India NHA 2013-14 Indicators INR in crores As share of GDP
Current Public Expenditure (I)
97866
0.86
Private Expenditure (II)
307917
2.73
Current expenditure on health (A=I+II)
421194
3.74
Total Public Expenditure (Current + Capital)
129778
1.15
Total Health Expenditure (Current+ Capital)
453106
4.02
The share of Private expenditure in the total health expenditure of India was 71.3%, compared to 76 % in Odisha.

11. Who pays for the health care financing schemes?
Total Expenditure
(In crore INR)
 Share
Per capita
(In INR)
Government scheme
Central Government
937
7.7
218
State Government
1542
12.6
359
Local bodies 6
0.0 1
Tax Financed Insurance Scheme (RSBY) 32
0.3 7
Social health insurance (ESIC+CGHS)
119
1.0 28
Private  scheme
VHI 33 8
Firms
128 30
NGO/NPISH 96
0.8 22
Households
9322
76.3
2168
12215
100.0
2841

12. Who pays for the health care financing schemes?

13. Where money is spent?

14. Who provides health care?

15. Public health expenditure in Odisha trend, pattern and classification

16. Public spending on health as share of GSDP

17. Health Exp. as a Share of Total government Exp.

18. Where money is spent?
Total curative=61.2%, preventive =

19. Factors of Provision for State Department of Health

20. Major Highlights of Out of Pocket Expenditure in Odisha

21. Out-of-pocket Expenditure in Odisha

22. Average per episode cost (Rs
Average per episode cost (Rs.) of Outpatient treatment (15 days recall) in public and private sector in Odisha

23. Average per hospitalization case medical expenditure (Rs
Average per hospitalization case medical expenditure (Rs.) and non-medical expenditure (Rs.) for public and private facilities in Odisha and India
Total-INR 14470

24. Composition of OOP for hospitalization(%of total spending)

25. SC/PHC/CHC Public hospital Private hospital
Average total expenditure (Rs.) per childbirth in Odisha and all India
TOTAL INR 6091 PER CHILDBIRTH
SC/PHC/CHC Public hospital Private hospital

26. Composition of OOP for institutional delivery(%of total spending)

27. Conclusion
Stepping up Public investment on Health Care is essential (around 24% of the total health expenditure)
Within public expenditure, medicine and patient transport are two major areas that need attention
The share of expenditure on drugs in total OOP currently stands at 58%.
Other Specific areas which need attention are diagnostics, immunizations services and preventive care
Currently 1% of the total public health expenditure is incurred on diagnostics,
3% on immunization and 8% on preventive.

28. Conclusion
Expenditure on child birth in public hospital is also high (Rs 5024) of which 38% is on medicine and 14% on transportation
Designing Innovative Financial Protection Scheme for the Poor is essential only 21% are covered under any health insurance schemes.
Steps should be taken to Institutionalize health accounts in Odisha for evidence based policy making.