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.



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.