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High per capita health spend needed, but that alone isn’t enough: Data | India News


How effective states are on health indicators do not appear to be directly correlated with how much they spend per capita on health care. For example, J&K has indicators that are almost as good as those of KeralaHimachal or Maharashtra for less than half the cost and Tamil Nadu too achieve the same results with much lower spending.
The states with the lowest levels of per capita spending – Bihar, MP and Assam in that order – have very poor health indicators, which underline that spending is necessary, but Bihar performs better. in most indicators compared to many states with higher spending levels, suggesting that spending on its own is inadequate. This data has been removed from the recent release National Health Account for 2018-19.
It shows that often in places where total spending on health is high, most of it is out-of-pocket, such as in Kerala and Maharashtra. However, in Himachal and J&K, the government accounts for more than half of total spending on health and 47% in Tamil Nadu.
The government’s share of total health spending is highest in Uttarakhand at 61% and Assam at more than 55%. It is lowest in UP and Kerala at about 25%. In 2004-05, the government accounted for only 9.7% of spending in Kerala and 13% in UP. While rates have increased significantly, people in these states, as well as in West Bengal, continue to shoulder the bulk of the health care burden. This has been the case since 2004-05, the earliest year that the National Health Account (DENTAL) available.
Maharashtra, the third largest spender on health after Kerala and Himachal Pradesh per capita, also has the government accounting for only 27% of this spending. Interestingly, Tamil Nadu, which has a similar health index to Maharashtra, spends much less per capita. Furthermore, the government’s share of total spending on health has increased from just 18% in 2004-05 to nearly 47% in 2018-19, thus easing the burden on the population.
Virtually all states have increased public spending on health from dire levels in 2004-05, with a significant jump between NHA 2014-15 and 2018-19. Assam had the highest increase in the share of public spending in total health spending from 2004-05 to 2018. J&K had the lowest increase during this period. Jharkhand and Karnataka also showed increases of 2.5 percentage points and six percentage points, respectively.
Total health spending has three components – government spending, out-of-pocket spending, and a third, a combination of private health insurance, business spending, non-profit organizations or non-governmental organizations and external sources or funds from outside India.
In Karnataka and Maharashtra, the third component is nearly as large as the government’s share of total health spending. “This is because most of the major companies/NGOs have their headquarters in these states although their subsidiaries may be spread across India. Since budgeting, payments, and insurance are always passed through headquarters, reporting of medical-related expenses is centralized there. These are our findings from surveys we have conducted of businesses and NGOs. Insurance data even from IRDAI shows the same picture,” explains Dr Rahul Reddy Kadarpetacountry coordinator at the Health System Transformation Platform.





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