National Health Accounts Estimates

Table of Contents

Context: The National Health Accounts Estimates report for India (2019-20) has been released recently.

About the National Health Accounts Estimates report for India (2019-20)

This report presents National Health Accounts (NHA) Estimates for India for Financial Year 2019-20.
National Health Accounts is a tool to describe health expenditures and the flow of funds in both Government and Private sector in the country.
These estimates are derived within the framework of National Health Accounts Guidelines for India, 2016 and adhere to System of Health Accounts 2011 (SHA 2011), a global standard framework for producing health accounts.
- SHA 2011 is a framework developed by the World Health Organization (WHO), the Organisation for Economic Co-operation and Development (OECD), and the European Union (EU) to provide a standardized method for measuring health spending across countries.
NHA estimates 2019-20 is the seventh round of estimates for India.

Major findings of the National Health Accounts Estimates report for India (2019-20)

For the year 2019-20, Total Health Expenditure (THE) for India is estimated to be Rs. 6.5 lakh crores (3.27% of GDP and Rs. 4,863 per capita).
Components of THE:
- THE constitutes current and capital expenditures incurred by Government and Private Sources including External/Donor funds.
- Current Health Expenditure (CHE) accounts for 90.52% of THE and capital expenditures make up 9.48% of THE.
- Government Health Expenditure (GHE) accounts for 41.41% of THE or 1.35% GDP.
- Household’s Out of Pocket Expenditure on health (OOPE) account for 47.07% of THE or 1.54% of GDP.
- Private Health Insurance expenditure accounts for 6.99% of THE.

Who contributes to Current Health Expenditure (CHE)?

Of the total Current Health Expenditure (CHE), 17.28% is attributed to Government Hospitals and 28.50% is attributed to Private Hospitals.
Rest of the CHE is attributed to other Government Providers (incl. PHC, Dispensaries), and Other Private Providers (incl. private clinics) etc.

What Services are Consumed?

In terms of percentage of Current Health Expenditure (CHE), 33.94% is attributed to Inpatient Curative Care, 19.29% to Outpatient Curative Care, 0.49% to Day Curative Care, 3.52% to Patient Transportation, 4.04% to Laboratory and Imaging Services, 18.50% to Prescribed Medicines, and 3.47% to Over-the-Counter (OTC) Medicines.
In addition, the percentage of CHE attributed to Therapeutic Appliances and Medical Goods is 0.12%, to Preventive Care is 10.16%, and to Other expenditures is 2.17%. Furthermore, 4.30% of CHE is attributed to Governance, Health System, and Financing Administration.
Total Pharmaceutical Expenditure is 35.11% of CHE (includes prescribed medicines, over-the-counter drugs, etc.)
Expenditure on Traditional, Complementary, and Alternative Medicine (TCAM) is 4.36% of CHE.
Current Health Expenditure attributed to Primary Care is of around 48.0%, Secondary Care of 32.5%, Tertiary care of 13.5% and governance and supervision of 4.3%.
When disaggregated; government’s expenditure on Primary Care is 55.9%, Secondary Care is 29.6% and Tertiary Care is 6.4%.
Private expenditure on Primary Care is 37.2%, Secondary Care is 36.5% and Tertiary Care is 23.3%.

Comparison with 2014-15 National Health Accounts:

OOPE: Share of Out-of-Pocket Expenditure (OOPE) in Total Health Expenditure declines from 62.6% in 2014-15 to 47.1% in 2019-20.
Government expenditure on health: Government Health Expenditure’s share in country’s total GDP increases from 1.13% (2014-15) to 1.35% (2019-20).
- Additionally, in General Government Expenditure (GGE), the share of health sector spending has steadily increased from 3.94% to 5.02% between 2014-15 and 2019-20.
Per capita health expenditure: In per capita terms, Government health expenditure has doubled from Rs. 1,108 to Rs. 2,014 between 2014-15 to 2019-20.
Primary healthcare: The share of primary healthcare in Current Government Health Expenditure (CGHE) has increased from 51.3% in 2014-15 to 55.9% in 2019-20.
SSE: The share of Social Security Expenditure (SSE) on health, which includes government-funded health insurance, medical reimbursement to government employees, and social health insurance programs, in THE (Total Health Expenditure) has increased from 5.7% in 2014-15 to 9.3% in 2019-20.
Private health insurance: Private health insurance share is also going up which is a sign of maturity for a country in terms of the insurance arena. It complements the government system of primary, secondary and tertiary care.

Related Terms

Out-of-Pocket Expenditure (OOPE) in health:
- Out-of-pocket expenditure is the money paid directly by households, at the point of receiving health care. ‘
- This occurs when services are neither provided free of cost through a government health facility, nor is the individual covered under any public or private insurance or social protection scheme.
General Government Expenditure (GGE):
- GGE involves all types of expenditure, current and capital. It includes all types of revenue. GGE includes funds that are provided by donors and channeled through the government.
- It is not the same as the General Government Final Consumption, which comprises only current spending.