National Health Accounts 2022-23

Syllabus: GS2/Governance

Context

• The Union Health Ministry released the National Health Accounts (NHA) estimates for India 2022-23.

About

• The National Health Account (NHA) is a tool to describe health expenditures and the flow of funds in both the Government and Private sectors of the country.
• Preparation of NHA estimates was institutionalised at National Health Systems Resource Centre (NHSRC) in 2014.
• Published by: NHSRC, Ministry of Health and Family Welfare.
• As of now, 9 NHA estimates (2013-14 to 2021-22) have been prepared.
• Methodology followed: System of Health Accounts, 2011 (SHA 2011), a global standard framework for producing health accounts.

Major Highlights of NHA 2022-23

• Total Health Expenditure: The Total Health Expenditure (THE) for India is estimated at 3.37% of GDP and Rs 6,373 per capita.
  • This constitutes current and capital expenditures incurred by Government and Private Sources, including External/Donor funds. 
• Increase in Government Expenditure: The share of Government Health Expenditure (GHE) in the country’s Gross Domestic Product (GDP) has risen from 1.15% in 2013–14 to 1.43% in 2022–23.
  • As per the new GDP series with base year 2022-23, Government Health Expenditure is 1.48 per cent of GDP.
• GHE’s share in General Government Expenditure (GGE) has increased from 3.78% to 4.89% over the same period. 
• In per capita terms, GHE has increased nearly 2.7 times, from Rs. 1,042 to Rs. 2,786 between 2013-14 and 2022-23.
• Out-of-pocket expenditure (OOPE): The report’s international comparison of out-of-pocket expenditure (OOPE) showed India’s per capita spending from personal pockets stood at 121 international dollars (PPP) in 2022, placing the country at rank 64 globally.
  • The figures highlight that despite the expansion of public healthcare schemes and insurance coverage, households in India continue to bear a substantial share of treatment costs themselves. 
  • Among neighbouring countries, the OOPE burden stood at 85 international dollars in Pakistan, 180 in Nepal, 130 in Bangladesh and 246 in Sri Lanka. 
• Private hospitals take the largest share of all current health expenditure at 30.83%, followed by government hospitals at 16.73%. 
• Relatively Low Spending on Preventive Care: Preventive care forms only 8.88% of the Current Health Expenditure (CHE) spending, while inpatient and outpatient curative care together claim over 56% as the biggest spending head, and pharmaceutical expenditure is also high.

Concerns with Low Public Expenditure on Healthcare

• This has resulted in inadequate health infrastructure including human resources, and slow improvement in key health indicators.  
• Limited Access to Healthcare Services: Low public spending hampers accessibility to healthcare services, particularly in rural and remote areas where infrastructure is already lacking. This exacerbates health disparities between urban and rural populations.
• Neglected Preventive and Primary Care: A large portion of healthcare spending in India is directed towards tertiary care, neglecting preventive and primary healthcare services. 
• Higher Disease Burden: Low public spending on healthcare contributes to a higher burden of preventable diseases such as communicable diseases, malnutrition, and maternal and child health issues. 
• Increased Out-of-Pocket Expenditure: The lack of public healthcare infrastructure has led people to use private health services more, and that has increased the financial burden on citizens.  

Recent steps Taken by the Government for Strengthening Healthcare Sector

• National Health Policy 2017: It outlines the government’s vision to achieve the highest possible level of health and well-being for all and emphasizes preventive and promotive healthcare.
  • Equal treatment for modern medicine and traditional systems (Ayurveda, Yoga, Unani, Siddha, Homeopathy).
  • All India Institute of Medical Research was now promoting research on traditional medical systems and a comprehensive approach.
• Ayushman Arogya Mandirs: 1.75 lakh health centers functioning with 369 crore visits.
  • Focus on screening hypertension, blood pressure, and diabetes for people over 30 years.
• National Digital Health Mission (NDHM): Launched in 2020, NDHM aims to create a digital health ecosystem, including health IDs for citizens and the establishment of a national digital health infrastructure.
• Health and Wellness Centers (HWCs): The government is working towards transforming primary health centers into HWCs to provide comprehensive primary healthcare services, including preventive and promotive care.
• Pradhan Mantri Swasthya Suraksha Yojana (PMSSY): PMSSY aims to enhance tertiary care capacities and strengthen medical education in the country by setting up new AIIMS institutions and upgrading existing government medical colleges.
• Research and Development Initiatives: The government has been encouraging research and development in healthcare, including support for the development of vaccines, drugs, and medical technologies.
• National Medical Commission (NMC) Act: The NMC Act, passed in 2019, aims to bring reforms in medical education and practice by replacing the Medical Council of India (MCI) and promoting transparency and accountability.
• Jan Aushadhi Scheme: The Pradhan Mantri Bhartiya Janaushadhi Pariyojana (PMBJP) aims to provide quality generic medicines at affordable prices through Jan Aushadhi Kendras.

Way Ahead

• The COVID-19 pandemic had shown the cracks in India’s health system and highlighted the need for increased public investment in healthcare. 
• Effective primary health care can prevent the occurrence of more serious health issues, meaning that overall health outcomes can be improved significantly through investing in primary healthcare. 

Source: PIB