Patients' out-of-pocket medical bill spend declined in 2018-19, shows data

Out of every Rs 100 spent on health in India, around Rs 48.2 is borne by households directly. This is lower than what it was 15 years ago, but is still significantly higher than the global figure.

The burden is twice as high in some states compared to others, shows an analysis of data from the National Health Accounts Estimates for India (2018-19) released on Monday. Indians are estimated to have spent Rs 5.9 trillion on health in 2018-19. This total health expenditure includes current and capital health expenditure.

Current health expenditure covers hospital stays and cost of medicines. Capital health expenditure covers activities, including construction of new hospitals, purchase of equipment and expenditure on medical education. More than 90 per cent of the total health expenditure is current health expenditure.

Households pay out of pocket for 48.2 per cent of the total health expenditure. The proportion has been declining over time. It was 69.4 per cent in 2004-05 and 64.2 per cent 2013-14. Households paid out of pocket for 53.2 per cent of their current health expenditure. 

The global figure for out-of-pocket expenditure as a percentage of current health expenditure was 18.01 per cent in 2019, according to World Bank data.

India’s figure has declined over time. It was 55.1 per cent in 2017-18. The government accounted for 34.5 per cent of current health expenditure. Private health insurance expenditure as a percentage of current health expenditure was 7.3 per cent.   

There are significant differences state-wise. Uttar Pradesh (71.3 per cent), West Bengal (68.7 per cent) and Kerala (68.6 per cent) had people spending the most out of pocket as a percentage of total health expenditure. Some states had less than half this figure.

It was 36.7 per cent in Assam, 35.5 per cent in Uttarakhand and 33.3 per cent in Karnataka. In other words, the proportion of out-of-pocket spending in the top three states was around twice that of the bottom three states. However, total health expenditure as a percentage of the gross domestic product (GDP) has also declined to 4.2 per cent in 2018-19 from 3.2 per cent in 2004-05. 

At the same time, total health expenditure per capita has increased from Rs 2,066 in 2004-05 to Rs 3,314 in 2018-19, after adjusting for inflation.

Government-financed health insurance expenditure increased by 167 per cent since 2013-14 from Rs 4,757 crore in 2013-14 to Rs 12,680 crore in 2018-19.

This is primarily led by spending on Ayushman Bharat- Pradhan Mantri Jan Arogya Yojana.

In March this year, Minister of State for Health Bharati Pravin Pawar stated that hospital admissions worth Rs 37,185 crore were authorised under the AB-PMJAY scheme till March 2022. The inception of the scheme was in September 2018.

The beneficiaries of the scheme would have borne out-of-pocket expenditure to the tune of 1.5-2 times of what they incurred under the scheme, the minister had said. The NHA 2018-19 highlighted that the Centre’s expenditure on the National Health Mission was Rs 30,578 crore.

About Rs 4,060 crore was spent on the Central Government Health Scheme (CGHS), while defence medical services got Rs 12,852 crore. Railway health services was given Rs 4,606 crore.