- Current health expenditure as a share of GDP in India has remained stable at around 3.84% since 2000, with private expenditure making up around three times the share of government expenditure. - Government spending on health as a share of total government spending averages 3%, while out-of-pocket expenditures make up around 69% of current health expenditures on average. - In 2011, high out-of-pocket payments contributed to 17% of the population spending over 10% of their budget on health, equivalent to 216 million people, and pushed 52.5 million people below the poverty line.

1. Health financing profile 2017
India
Context: Macroeconomic situation
Population (million) 2016 1 324.2
General financing
GDP (trillion current US$) 2016 2.264
GDP per capita (current US$) 2016 1 709.4
GDP annual growth (%) 2016 7.1
Total government revenue* as % of GDP 2013 12.6
Population living below poverty line at $1.90
a day (2011 PPP) (% of population)
2011 21.23
Health financing
CHE as % of GDP 2015 3.93
CHE per capita (current US$) 2015 63.94
GGHE-D as % of GDP 2015 0.92
GGHE-D per capita (current US$) 2015 14.91
Out-of-pocket payment as % of CHE 2015 67.78
CHE: current expenditure on health; GDP: gross domestic product;
GGHE-D: domestic general government health expenditure
* Total taxes and other revenues received by the national government
(excluding grants)
Since 2000, how has health financing changed?
Overall spending on health
Fig. 1: Current expenditure on health as a % of GDP,
2000–2015
4.18 4.28 4.25 4.01 3.96 3.79 3.63 3.52 3.51 3.49 3.27 3.25 3.33
3.75 3.63 3.89
0
2
4
6
8
10
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
%
of
GDP
GGHE-D + External resources PVT-D CHE
CHE: current expenditure on health; GDP: gross domestic product;
GGHE-D: domestic general government health expenditure; PVT-D:
domestic private health expenditure
* PVT-D refers to spending on health including voluntary health insurance
schemes, enterprise financing schemes and household out-of-pocket payment
Sources of health revenue
Fig. 2: Share of revenues for health as a % of current
expenditure on health, 2000–2015
0
10
20
30
40
50
60
70
80
90
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
%
of
CHE
GGHE-D PVT-D EXT
CHE: current expenditure on health; GGHE-D: domestic general
government health expenditure; PVT-D: domestic private health
expenditure; EXT: external health expenditure
Government spending on health
Fig. 3: Domestic general government expenditure on health
(GGHE-D) as a % of general government expenditure
(GGE), 2002–2015
0
2
4
6
8
10
12
14
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
%
of
GGE
Spending per person on health ($),by source
Fig. 4: Current expenditure on health (CHE), domestic
general government health expenditure (GGHE-D), out-of-
pocket (OOP) payment, per capita US$, 2000–2015
0
50
100
150
200
250
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Per
capita
in
US$
CHE GGHE-D OOP
Share of OOP expenditure (%)
Fig. 5: OOP payment as a % of current expenditure on
health (CHE), 2000–2015
0
10
20
30
40
50
60
70
80
90
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
%
of
CHE
OOP

2. Funding for health by donors
Fig. 6: External expenditure on health (EXT) as a % of
current expenditure on health (CHE), 2000–2015
EXT as % of CHE
0
5
10
15
20
25
30
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
%
of
CHE
How many households experience financial
hardship from health-care expenditure?
Table 1: Catastrophic health expenditure and impoverishment
due to health spending, 2011
Population
Catastrophic
expenditure
Impoverishment
due to OOP
Threshold
= 10%
Threshold
= 25%
Poverty
line =
PPP$ 1.90
Poverty
line =
PPP$ 3.10
% 17.33 3.89 4.21 4.56
Headcount 216.11 48.51 52.50 56.86
Source: India: National Sample Survey, sixty-eighth round. Household
Consumer Expenditure, 2011. Calculations by staff of the WHO Regional
Office for South-East Asia.
Key messages
~
~ Current expenditure on health (CHE) as a share of gross
domestic product (GDP) has been stable since 2000, averaging
3.84%. Private expenditure as a share of CHE is three times
more than government’s.
~
~ Government spending on health as a share of total
government spending averages 3% of general spending.
~
~ Out-of-pocket (OOP) expenditure has decreased from the
highest around 74% of CHE to 65% in 2015, but is still fairly
high, averaging 69.3% of CHE.
~
~ High OOP payments contribute to a serious lack of
financial protection. In 2011, 17% spent more than 10% of
their total budget on health, translating to 216 million people;
in addition, 52.5 million of the population were pushed below
the poverty line of PPP$ 1.90 per capita per day.
Sources
1. World development indicators. In: The World Bank [website];
2017 (https://data.worldbank.org/indicator/, accessed 23
November 2017).
2. Indicators and data: In: WHO Global Health Expenditure
database [online database] updated 20 November 2017 (http://
apps.who.int/nha/database/Select/Indicators/en, accessed 23
November 2017).
3. National Health Systems Resource Centre. National Health
Accounts: Estimates for India (2013-2014). New Delhi: Ministry
of Health and Family Welfare, Government of India, 2016
Health financing flows
Fig. 7: Health financing flow
Industry/enterprises
Households
Central
Government
(MoF)
State
Government
NGOs (NPISHs) and external
donors can provide finances
for any of the above level
Private Health insurance
State department forhealth (DoHFW)/
AYUSH/Medical Education
Ministry of Health and Family Welfare
(MoHFW)
Central
Taxes
State government
health facilities
Premium Out-of-Pocket payments
Other ministries/
PSUs for health
purposes
Local Gov’t
funds
(Urban/ Rural)
State health society
(National Health Mission)
Private health
centres
District health society
State
/
Local
Taxes
Fund Flows from GoI (MoF)
Fund flow from ministries / state to intermediates
Fund flow from people (taxes, OOPs)/ enterprises
Line item budgets
Payment to healthcare providers
Central
government health
facilities
Employees’ State Insurance
Schemes (ESIS)(Social security )
State Health Insurance Schemes
Contribution
Municipal bodies
Village health, Nutrition
and Sanitation Committee
Central Government Health
Schemes (CGHS)for central government
employees, pensioners, their dependents
Rashtiya Swasthiya Bima Yojana
(RSBY)for BPL families
ESIS Hospital &
Clinics
Municipal gov’t
hospital, clinics, etc.
Public health
services
Source: WHO SEARO, adapted from National Health Accounts: Estimates for India (2013-2014)