Public health spending in India hovers below 2 percent of GDP against the National Health Policy 2017 target of 2.5 percent. Examine the consequences for equity and out-of-pocket expenditure.
Subtopic: Social Justice · Health
How to structure your answer
Introduction: India's public health expenditure remains around 1.84 percent of GDP (NHA 2021-22), short of the 2.5 percent target set in the National Health Policy 2017 and the High Level Expert Group on UHC (2011) benchmark of 3 percent.
Body: Three dimensions — (i) Out-of-pocket expenditure has fallen from about 64.2 percent (FY15) to 39.4 percent (FY22) but still drives an estimated 6 crore Indians into poverty annually; (ii) State variation — Tamil Nadu and Kerala spend more than 1 percent of GSDP on health while Uttar Pradesh and Bihar spend less than 0.5 percent; (iii) Federal design — health is a State Subject (List II Entry 6); 15th Finance Commission's Health Sector Grant of Rs 70,051 crore (2021-26) routed via local bodies.
Way forward / Conclusion: Earmark a cess-funded Health Equity Fund, expand PM-ABHIM critical-care blocks and condition central transfers on primary-care strengthening.
Written within the word limit
138 words · target 150 words · 9 min
Introduction: India's public health expenditure stands at about 1.84 percent of GDP (NHA 2021-22) against the National Health Policy 2017 target of 2.5 percent and the HLEG on UHC (2011) benchmark of 3 percent.
Body: Three dimensions trace the consequences. First, out-of-pocket expenditure — falling from 64.2 percent (FY15) to 39.4 percent (FY22), it still drives an estimated 6 crore Indians into poverty annually, despite PM-JAY's secondary-tertiary cover. Second, State variation — Tamil Nadu and Kerala spend over 1 percent of GSDP on health, while Uttar Pradesh and Bihar spend under 0.5 percent, reproducing regional inequity under List II Entry 6 (State Subject). Third, federal design — the 15th Finance Commission's Health Sector Grant of Rs 70,051 crore (2021-26) is routed through local bodies, but absorption remains uneven and conditional grants under PM-ABHIM are slow-moving.
Conclusion: Earmark a cess-funded Health Equity Fund, expand PM-ABHIM critical-care blocks and condition central transfers on primary-care strengthening.
What an examiner expects to see
- Public health expenditure about 1.84 percent of GDP (NHA 2021-22) against 2.5 percent NHP 2017 target
- Out-of-pocket expenditure 39.4 percent of total health spend (NHA 2021-22), down from 64.2 percent in FY15
- About 6 crore Indians pushed into poverty annually by health spending (WHO-NCAER 2021)
- 15th Finance Commission Health Sector Grant Rs 70,051 crore (2021-26) routed via PRIs and ULBs
- PM-ABHIM Pradhan Mantri Ayushman Bharat Health Infrastructure Mission (October 2021) — Rs 64,180 crore
- Ayushman Arogya Mandirs (renamed HWCs) as primary-care backbone
- Health a State Subject under List II Entry 6; insurance and ESI on Concurrent List
Concrete cases, schemes and judgments
- National Health Policy 2017
- PM-ABHIM (October 2021)
- 15th Finance Commission Health Sector Grant
- Ayushman Arogya Mandirs (formerly Health and Wellness Centres)
- WHO Global Health Expenditure Database