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Dissecting OOP Health Expenditure in India: An Investigation of Trends Since 1999-2000

Despite achieving impressively high growth rates, India’s health sector still seems to be in shams. Health sector in India is characterised by low public spending on health, inadequate public health infrastructure, and poor quality of services in public health care centres coupled with virtually absent social security on health front. The condition of poor and marginalised population can be clearly envisaged in a scenario where treatment in public hospitals lacks quality and in private medical institutions implies high out of the pocket expenses (OOPE) thereby quenching poor’s pockets and rendering them indebted. In light of this, the present paper focuses on trends in OOP expenses on health in India across consumption expenditure quintiles, various religious and caste categories since 1999-2000 till 2011-12, using National Sample Survey unit level data. Also, the paper throws light on recent health initiatives implemented by Indian Government-Centre and State, especially for poor and attempts to analyse the impact of new schemes on OOP spending. The trends reveal that OOP spending has increased sharply between 2009-10 and 2011-12 and the increase has been higher for poorer quintiles vis-a-vis richer expenditure quintiles. Furthermore, the OOP spending was found to be higher among poor in the districts where health insurance schemes (only Rashtriya Swasthya Bima Yojana for poor has been considered) have been running successfully. But it does not necessarily reflect policy failure as the scheme has improved accessibility of health services among poor. The overall analysis, however, points towards the need of an effective health policy and a reform in the healthcare sector in India to ensure achievement of “Universal Healthcare for All” in the country.