National Health Accounts

How well states do on health indices does not seem to be directly correlated to how much they spend per capita on healthcare. This fact was highlighted by the recently-released National Health Accounts for 2018-19 for 20 large states.

Details –

The recently-released National Health Accounts for 2018-19 has revealed the fact that high per capita health spend is needed, but that alone is not enough.

What is ‘National Health Accounts’?

• National Health Accounts (NHA) provide financing information on health system which is very important for evidenced based policy making.
• It is a tool to describe health expenditures and the flow of funds in both Government and private sector in the country.
• It is published by the National Health Systems Resource Centre under the Ministry of Health and Family Welfare.
• NHA 2018-19 is the 6th round of estimates in the series of annual Health Accounts for India.

Key highlights of the data –

• Decline in out-of-pocket expenditure —
  • • The NHA 2018-19 estimates show a continuous decline in out-of-pocket expenditure as a share of Total Health Expenditure (THE) from 64.2% to 48.2% between 2013-14 to 2018-19.
    • The report highlights that the Social Security Expenditure on health has also increased as a share of THE from 6% to 9.6% during this period
    • Government Health Expenditure as a share of THE has also increased from 28.6% to 40.6% between this period.
• Health outcomes are not directly co-related to per capita spending by state —
  • • The report showed that J&K had indicators nearly as good as those of Kerala, Himachal or Maharashtra with less than half the spending.
    • Tamil Nadu too achieved similar outcomes with much lower expenditure.
    • It shows that often where total health expenditure is high, the bulk is borne by people out of their own pockets, as in Kerala and Maharashtra.
    • However, in Himachal and J&K, the government accounts for more than half the total spending on health and 47% in Tamil Nadu too.
• Spending is necessary, but spending alone is not sufficient —
  • • States with the least per capita spend — Bihar, MP and Assam in that order — have very poor health indices, which underlines that spending is necessary.
    • However, Bihar does better on most indices than many states with higher levels of spending, showing that spending alone is not sufficient.
• Government’s share in total health spending — It was highest in Uttarakhand at 61% and Assam at over 55%, while lowest in UP and Kerala at about 25%.
• Per capita spending — Per capita health spending is highest in Kerala, while lowest in Bihar.
• Increased public spending on health —
  • • Almost all states have increased public spending on health from abysmal levels in 2004-05.
    • Assam had the highest jump in share of public spending in the total health expenditure between 2004-05 and 2018.
    • J&K saw the lowest increase in this period.