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, but Bihar does better on most indices than many states with higher levels of spending, showing that spending alone is not sufficient. This data was culled out of the recently-releasedNational Health Accountsfor 2018-19.
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.
The governments share in total health spending was highest in Uttarakhand at 61% and Assam at over 55%. It was lowest in UP and Kerala at about 25%. In 2004-05, the government accounted for just 9.7% of the spending in Kerala and 13% in UP. While those shares have risen significantly, people in these states, as also in West Bengal, continue to shoulder most of the burden of healthcare. This has been the case since 2004-05, the earliest year for which the National Health Accounts (NHA) are available.
Maharashtra, the third biggest spender on health after Kerala and Himachal Pradesh in per capita terms, also had the government accounting for barely 27% of this expenditure. Interestingly, Tamil Nadu, which has health indices similar to Maharashtra, spends much less per capita. Moreover, the government share of the total health spend expanded from just 18% in 2004-05 to almost 47% in 2018-19, thus reducing the burden on the people.
Almost all states have increased public spending on health from abysmal levels in 2004-05, with a significant jump between NHA of 2014-15 and 2018-19. 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. Jharkhand and Karnataka too showed increases of 2.5 percentage points and six percentage points, respectively.
The total health expenditure has three componentsgovernment spending, people spending out of pocket and the third is a combination of private health insurance, expenditures by enterprises, not-for-profit institutions or NGOs and external sources or funds from outside India.