National Health Accounts Estimates

The National Health Accounts (NHA) is a globally accepted tool to describe the flow of funds in a country’s health system (OECD/WHO/ Eurostat 2011). Its estimates provide a snapshot of the flow of funds in the country’s health system by financing sources, providers of healthcare and healthcare functions. The Ministry of Health and Family Welfare (MoHFW), Government of India (GoI), released the NHA estimates for 2013–14 in August 2016 (GoI 2016a). As per the estimates, the total health expenditure (THE) in India for the year 2013–14 was ₹4,53,106 crore. Households and government (central, state and local governments) are major sources of financing health expenditure in India accounting for 68% and 29% of THE, respectively. The report provides details of these expenditures by health financing schemes, providers and functions. This article comments on some of the major advances and gaps in the latest NHA estimation methodology and in the presentation of results.

The last decade has seen major policy changes due to the implementation of the National Health Mission (NHM), massive uptake of institutional deliveries in public facilities driven by the Janani Suraksha Yojana—a cash incentive scheme—and large-scale implementation of the Rashtriya Swasthya Bima Yojana (RSBY)—publicly funded health insurance scheme. On the other hand the private healthcare system continued to expand. The NHA 2013–14 was expected to provide some clues as to whether these interventions in the health system have brought any transformations in the health financing pattern.