Financing for Health Coverage in India : Issues and Concerns

The paper explores the trends, composition, and incidence of out-of-pocket health expenditure (OOPHE) in India, which has been the predominant means of financing its health care needs. Unit-level data from the National Sample Survey on Household Consumer Expenditure for the years 1993-94, 2004-05, and 2011-12 are used. Results show that the burden of OOPHE has increased steadily over time, but more for the lower economic quintiles. Drugs remain the major component of OOPHE, but their share has declined over the years. Expenditure on diagnostics and non-medical items increased sharply, especially for in-patient care. The latter period, i.e., 2004-05 to 2011-12, has been relatively more regressive. Higher growth of diagnostics and other expenditures, especially at institutions, points toward the possibility of supplier-induced demand. The income effect may also have had some role in the increase in the share of OOPS in the total expenditure of households. Any design of a universal health coverage scheme must take these results into consideration - not only in the specifics of a package, but also around regulation and quality of health services