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Estimating Public Spending on Health
The use of information on withdrawals by Drawing and Disbursing Officers for improving the estimates of public spending for National Health Accounts in India is illustrated. Using information from Karnataka and Rajasthan, the study highlights the advantages of combining DDO-level information with budgetary data. The significant benefits of using DDO-level information in India have implications for better estimates of public spending and health policy design.
The authors are grateful to the anonymous referee of EPW for their useful comments on this article.
An important determinant of the effectiveness of public spending on health is its distribution across primary, secondary and tertiary healthcare services. In most developing countries, healthcare services are required to be provided through a chain of health facilities structured in the form of a pyramid. The broad base of the pyramid corresponds to health facilities providing primary care, with relatively more specialised care services provided towards the apex of the pyramid. The pyramidal structure of the health system is based on the fact that the volume of healthcare services required by a population reduces as one moves from primary to tertiary levels. The structure is also considered to be important for the cost-effectiveness of health interventions.
Primary healthcare services, which are provided at the base of the pyramid, have lower operational costs and can act as screening centres for referring patients to higher-level facilities, where operational costs are higher. The pyramidal structure also ensures better access to healthcare services to a larger section of the population of the country, as adequate healthcare services at lower levels reduce the requirement of patients to travel long distances to access higher-level health facilities. Broadly, there is a consensus on the effectiveness of a larger volume of health services provided at the lower levels of health facilities (World Bank 1994; WHO 2008; Doherty and Govender 2004).
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