The central government has nearly tripled its per capita health spending over the last decade, and the share of medical bills paid directly by ordinary citizens out of their own pockets has fallen sharply—from
64% in 2013-14 to 43% in 2022-23, according to the findings of the National Health Accounts 2022-23 report released by the Union Health Ministry.
The report, the tenth in a series tracking India’s health finances, shows government health spending rising from 1.15% of GDP in 2013-14 to 1.43% in 2022-23. In rupee terms, per capita government spending has grown from Rs. 1,042 to Rs. 2,786—nearly 2.7 times in a decade.
But experts told News18 that the numbers, while directionally positive, do not fully capture what patients actually experience when they walk into a hospital.
What does the data show?
Think about the last time someone in your family was hospitalised. The bills, the medicines, the diagnostics—most of it likely came straight from your savings. That drain on personal finances is what economists call “out-of-pocket expenditure”, and for years it has been one of India’s biggest healthcare problems.
The Union Health Ministry this week released the National Health Accounts (NHA) 2022-23—the tenth such annual report tracking where India’s health money comes from and where it goes.
The simplest way to understand the report: the government is putting in more, and ordinary people are paying a smaller share.
In 2013-14, for every Rs 100 spent on healthcare in India, the government contributed about Rs 29 and ordinary people paid Rs 64 directly from their pockets. By 2022-23, the government’s share had risen to Rs 44 out of every Rs 100.
That shift—from 64.2% to 43.4%—is what the report describes as a drop of “nearly 21 percentage points”. To be clear, this does not mean out-of-pocket spending fell by 21%. It means the share of the total pie that patients personally pay has shrunk by that margin over ten years.
In absolute numbers, per capita government spending on health has grown nearly 2.7 times—from Rs 1,042 per person in 2013-14 to Rs 2,786 in 2022-23. Government health spending as a share of GDP has also risen, from 1.15% to 1.43%.
Schemes like Ayushman Bharat (PM-JAY) and government employee health insurance have contributed to this shift. The share of such social security spending in total health expenditure has grown from 6% to 9.9% over the decade. Private health insurance has also expanded, from 3.4% to 9.2% of total spending.
The Covid years briefly pushed government spending even higher—to 1.84% of GDP in 2021-22—due to emergency programmes and the world’s largest vaccination drive.
What Experts Are Saying
Experts told News18 that the percentage story hides a more uncomfortable truth about what patients actually experience on the ground. However, reviews are mixed.
Dr Dilip Bhanushali, national immediate past president of the Indian Medical Association (IMA), said, “The NHA 2022-23 shows progress in public spending, but 43.4% OOPE, rising hospital costs, collapse of small affordable hospitals, and exclusion of OPD/chronic care mean patients still face financial stress. From IMA’s perspective, financial protection will be real only when affordable first-contact care is preserved and insurance reforms cover the actual disease burden of Indians.”
He added a point that cuts to the heart of the percentage debate: “Total health expenditure has grown significantly over 10 years. Therefore, even with a lower percentage share, the absolute OOPE burden on patients is much higher today. A patient today pays far more in rupees for admission, surgery, diagnostics and medicines than in 2013-14.”
Another IMA’s past national president, Dr RV Asokan, went further, questioning the numbers themselves: “The government reduces a substantial percentage of out-of-pocket expenditure from calculation just from PMJAY coverage. This is misleading.”
Asokan calculated, saying, “Roughly the total health care expenditure of the country is Rs 14 lakh crore. Governments together spend Rs 5 lakh crore (Centre Rs 1 lakh crore and states spend Rs 4 lakh crore). This includes Ayushman Bharat, and the rest is private expenditure. Private health insurance is Rs 1.3 lakh crore. Hence, out-of-pocket is Rs 8 lakh crore. This stays there like an elephant in the room. The government has to explain how this disappeared with PMJAY outlay of Rs 12,000 crore. Whatever the government spends doesn’t even cover inflation. Perhaps the government has to come out with a white paper for more clarity.”
Dr Rajiv Kumar Jain, senior advisor at the Foundation of People Centric Health Systems, wrote his measured view, largely in agreement with the report’s direction, on LinkedIn. “This shift underscores the important role of public financing in the health system and signals that policy efforts are moving in the right direction—towards a more affordable, equitable, and accessible healthcare system for all.”
Jain believes that reducing the burden of OOPE on households has been a key priority for the government, pursued through various health schemes and a sustained commitment to universal health coverage.
