National Health Accounts figures indicate high burden of health care costs on people

The National Health Accounts (NHA) Estimates for India 2022-23, released by the Union Health Ministry, reveal that out-of-pocket expenditure (OOPE) constitut...

What Happened

The National Health Accounts (NHA) Estimates for India 2022-23, released by the Union Health Ministry, reveal that out-of-pocket expenditure (OOPE) constitutes nearly half (43.4%) of the country's current health expenditure.
While this marks a significant improvement from 64.2% in 2013-14 — a reduction of nearly 21 percentage points over a decade — experts caution that the absolute burden on households remains high.
Government health expenditure rose to Rs 3.85 lakh crore in 2022-23, up from Rs 1.30 lakh crore in 2013-14 — nearly tripling in nominal terms.
The share of government health expenditure in total health expenditure increased from 28.6% (2013-14) to 43.7% (2022-23).
Health sector experts flag that continued high levels of unregulated private sector growth are creating major inequities in healthcare access, particularly for lower-income groups.

Static Topic Bridges

National Health Accounts (NHA) Framework

National Health Accounts are a systematic framework for tracking financial flows in the health sector of a country. In India, NHA estimates are prepared by the National Health Systems Resource Centre (NHSRC) under the Ministry of Health and Family Welfare, following the System of Health Accounts (SHA 2011) methodology developed by the WHO, OECD, and Eurostat.

NHA estimates capture expenditure across financing sources (government, private, external), financing agents (insurance funds, employer schemes, households), and providers (hospitals, clinics, pharmacies).
Total Health Expenditure (THE) = Government Health Expenditure (GHE) + Private Health Expenditure (PHE) + External Aid.
Current Health Expenditure excludes capital investment in health infrastructure.
India's GHE as a percentage of GDP rose from 1.15% (2013-14) to 1.43% (2022-23) — still well below the 2.5% target set in the National Health Policy 2017.

Connection to this news: The NHA 2022-23 data provides the official benchmark for tracking India's progress toward reducing OOPE and increasing public financing of health, making it a key reference for UPSC questions on health policy outcomes.

Out-of-Pocket Expenditure (OOPE) and Healthcare Inequity

Out-of-pocket expenditure refers to direct payments made by households to healthcare providers at the time of service use — including consultation fees, medicines, diagnostics, and hospitalisation costs not covered by any insurance or government scheme.

High OOPE is associated with catastrophic health expenditure — defined as spending more than 10% of total household consumption on health in a single episode.
The WHO estimates that high OOPE is a primary driver of poverty, with around 55 million Indians pushed into poverty annually due to healthcare costs (pre-reform estimates).
OOPE disproportionately affects rural households, the elderly, and households in states with weak public health infrastructure.
Universal Health Coverage (UHC) — SDG Target 3.8 — specifically aims to ensure all people have access to quality health services without financial hardship.
Countries with strong public health systems (like Sri Lanka, Thailand) have OOPE shares below 30% of total health expenditure.

Connection to this news: At 43.4%, India's OOPE remains above the level considered acceptable for universal health coverage, indicating that despite policy progress, a significant share of healthcare financing still falls directly on households.

Ayushman Bharat and Public Health Financing Architecture

Ayushman Bharat is India's flagship health programme launched in 2018, comprising two components: Health and Wellness Centres (HWCs) for primary care and PM-JAY (Pradhan Mantri Jan Arogya Yojana) for secondary and tertiary hospitalisation coverage.

PM-JAY provides health cover of up to Rs 5 lakh per family per year for secondary and tertiary hospitalisation across public and empanelled private hospitals.
Coverage extended to approximately 12 crore economically vulnerable families (later expanded with Vay Vandana Card for senior citizens from October 2024).
As of October 2025, over 32,000 hospitals were empanelled under PM-JAY.
By July 2025, approximately 1.78 lakh Ayushman Bharat HWCs were operational.
National Health Policy 2017 set a target of raising government health spending to 2.5% of GDP.

Connection to this news: The reduction in OOPE share from 64.2% to 43.4% between 2013-14 and 2022-23 coincides with the rollout of PM-JAY and the expansion of public health infrastructure, suggesting a correlation — though experts note that unregulated private sector growth continues to create access barriers that schemes alone cannot fully address.

Private Sector Regulation and Inequity in Healthcare

India's healthcare delivery is dominated by the private sector, which accounts for approximately 60–70% of outpatient care and 40–50% of inpatient care nationally. The Clinical Establishments (Registration and Regulation) Act, 2010, provides a framework for regulating private clinical establishments, but implementation varies significantly across states.

Many states, including Maharashtra, Tamil Nadu, and Delhi, have not fully adopted or implemented the 2010 Act.
Lack of price regulation in private hospitals leads to significant variation in treatment costs for the same procedure.
The Consumer Protection Act, 2019, includes medical services within its ambit following Supreme Court rulings, providing a recourse mechanism for patients.
The National Medical Commission (NMC) Act, 2020, replaced the Medical Council of India, introducing an ethics and medical registration board to improve accountability.

Connection to this news: Expert commentary in the NHA 2022-23 report specifically points to unregulated privatisation as a structural driver of persistent OOPE and healthcare inequity, framing regulatory reform as a necessary complement to public spending increases.

Key Facts & Data

OOPE as % of current health expenditure (2022-23): 43.4%
OOPE as % of current health expenditure (2013-14): 64.2%
Reduction over decade: ~21 percentage points
Government health expenditure (2022-23): Rs 3.85 lakh crore
Government health expenditure (2013-14): Rs 1.30 lakh crore
GHE as % of GDP (2022-23): 1.43%
GHE as % of GDP (2013-14): 1.15%
National Health Policy 2017 target: 2.5% of GDP
GHE share in total health expenditure (2022-23): 43.7%
GHE share in total health expenditure (2013-14): 28.6%
PM-JAY coverage: up to Rs 5 lakh per family per year
PM-JAY empanelled hospitals (Oct 2025): 32,000+
SDG Target related: SDG 3.8 (Universal Health Coverage)
NHA prepared by: National Health Systems Resource Centre (NHSRC), MoHFW