Out-of-pocket expenditure on health shows declining trend, states latest National Health Accounts

The latest National Health Accounts (NHA) estimates for 2022-23 show that out-of-pocket expenditure (OOPE) as a share of total health expenditure has decline...

What Happened

The latest National Health Accounts (NHA) estimates for 2022-23 show that out-of-pocket expenditure (OOPE) as a share of total health expenditure has declined to 43.4%, down from 64.2% in 2013-14 — a reduction of nearly 21 percentage points over a decade.
The share of Government Health Expenditure (GHE) in total health expenditure rose from 28.6% in 2013-14 to 43.7% in 2022-23, indicating a structural shift towards public financing.
A Health Ministry official attributed part of the decline in OOPE to the operationalisation of over 1.8 lakh Ayushman Arogya Mandir (AAM) wellness centres across the country, which deliver free drugs, diagnostics, and comprehensive primary care.
Total Health Expenditure (THE) for India in 2022-23 is estimated at Rs 8,81,359 crore, equivalent to 3.37% of GDP.
Government health expenditure as a share of GDP rose from 1.15% in 2013-14 to 1.43% in 2022-23 (1.48% using the new base-year GDP series).
Absolute government health expenditure nearly tripled from Rs 1.30 lakh crore in 2013-14 to Rs 3.85 lakh crore in 2022-23.
Spending on primary healthcare by the government more than doubled from Rs 0.5 lakh crore to Rs 1.4 lakh crore in the same period.

Static Topic Bridges

Out-of-Pocket Expenditure (OOPE) and Universal Health Coverage (UHC)

Out-of-pocket expenditure refers to direct payments made by households to healthcare providers at the point of service — not covered by insurance or government schemes. High OOPE is a key indicator of financial vulnerability and a barrier to Universal Health Coverage.

The WHO's UHC framework treats OOPE above 45% of total health expenditure as a threshold requiring policy attention; India's 43.4% figure brings it below this benchmark for the first time.
Catastrophic health expenditure — when OOPE exceeds 10% of household consumption — is a primary driver of poverty in India.
The National Health Policy 2017 set a target of reducing OOPE to 30% of total health expenditure by 2025; the 2022-23 figure of 43.4% shows progress but indicates the target remains unmet.
SDG 3.8 specifically calls for financial risk protection and access to quality healthcare for all.

Connection to this news: The 21-percentage-point decline in OOPE over a decade is the single most headline metric in the NHA report, directly reflecting the policy goal of reducing household financial burden from healthcare.

National Health Accounts (NHA) — Framework and Purpose

National Health Accounts is a system of accounts that tracks the flow of financial resources through a country's health system — from financing sources (government, private, donors) through financing agents to providers and functions.

India has adopted the SHA 2011 (System of Health Accounts) framework recommended by the WHO, OECD, and Eurostat.
NHA estimates are produced by the National Health Systems Resource Centre (NHSRC) under the Ministry of Health and Family Welfare.
They are published periodically and used for health financing policy, national planning, and international comparisons.
Key indicators tracked: Total Health Expenditure (THE), Government Health Expenditure (GHE), OOPE, per capita health expenditure.

Connection to this news: The article reports the latest NHA estimates, which are the primary evidence base for claims about India's health financing performance.

Ayushman Arogya Mandir (AAM) — Primary Healthcare Network

Ayushman Arogya Mandir (formerly Ayushman Bharat-Health and Wellness Centres, renamed in November 2023) is India's frontline primary healthcare infrastructure under the Ayushman Bharat programme.

Over 1.8 lakh AAMs have been operationalised across the country as of 2026.
Services span 12 comprehensive primary healthcare packages: reproductive health, child health, communicable diseases (TB, leprosy), non-communicable diseases (hypertension, diabetes, cancer screening), mental health, oral health, ENT, and palliative care.
Each centre provides free essential drugs, free diagnostics, and teleconsultation services.
The tagline of the rebranded centres is "Arogyam Parmam Dhanam."

Connection to this news: AAMs are identified as a contributing factor to the reduction in out-of-pocket expenditure, by providing free primary care services that reduce patients' need to pay out-of-pocket at private facilities.

Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY)

AB-PMJAY is the health insurance component of Ayushman Bharat, providing coverage for secondary and tertiary hospitalisation.

Provides health cover of Rs 5 lakh per family per year for hospitalisation expenses.
Targets the bottom 40% of India's population (approximately 55 crore beneficiaries from 12 crore families).
Covers over 1,900 medical procedures including surgery, medical, and day-care treatments.
Cashless and paperless services at empanelled public and private hospitals.

Connection to this news: Along with AAMs, AB-PMJAY reduces OOPE by covering catastrophic in-patient costs that would otherwise be borne by households entirely.

Key Facts & Data

OOPE as % of Total Health Expenditure: 43.4% (2022-23) vs 64.2% (2013-14)
Government Health Expenditure share of THE: 43.7% (2022-23) vs 28.6% (2013-14)
GHE as % of GDP: 1.43% (2022-23) vs 1.15% (2013-14)
Total Health Expenditure (THE): Rs 8,81,359 crore (3.37% of GDP) in 2022-23
Absolute GHE: Rs 3.85 lakh crore (2022-23) vs Rs 1.30 lakh crore (2013-14)
Per capita GHE: Rs 2,786 (2022-23) vs Rs 1,042 (2013-14)
Primary healthcare spending: Rs 1.4 lakh crore (2022-23) vs Rs 0.5 lakh crore (2013-14)
Ayushman Arogya Mandirs operationalised: over 1.8 lakh
NHA framework: SHA 2011, produced by NHSRC under Ministry of Health and Family Welfare
National Health Policy 2017 OOPE target: 30% of THE by 2025