Kerala still has the highest out-of-pocket-expenditure (OOPE) on health in the country even though in 2018-19, the State spent 7.4% of the General Government Expenditure (GGE) on health, higher than many other States.
Kerala’s per capita total health expenditure was the highest in the country (2018-19) at ₹9,871. Of this, ₹2,479 was the public expenditure, which was also the highest per capita government expenditure on health in the country. Despite the high public spending on health, the State continues to record the highest per capita OOPE on health at ₹6,772.
This is revealed in the key financing indicators for States in the latest National Health Account (NHA) estimates (2018-19) released by the Centre on Monday.
According to the NHA figures, Kerala spent ₹34,548 crore on health in 2018-19, only second to Maharashtra, whose total expenditure on health in the same year was ₹66,703 crore. Yet 68.6% of this expenditure (₹23,702 crore) was from people’s own pockets, the public expenditure on health accounting for just ₹8,676 crore.
In fact, as a percentage of the Gross State Domestic Product, Kerala’s public expenditure on health comes to about 1.1%, which is quite acceptable and is on par with the other States. Yet the OOPE comes to 3% of the GSDP.
In comparison, Tamil Nadu’s total health expenditure for 2018-19 was ₹32,767 crore, of which 46.9% was public funds (Kerala’s public health expenditure was 25.1%). OOPE in Tamil Nadu is 44.3% of the total health expenditure, against Kerala’s whopping 68.6%. The per capita OOPE comes to ₹1,909 in TN, whereas this is ₹6,772 in Kerala.
It was from the early 90s that the State’s OOPE on health began spiraling up, with a huge influx of private health facilities, in the face of languishing public sector investments in health. Though the government woke up to the need for increased investments in health, an aging population and the huge challenge of chronic non-communicable diseases continued to keep the OOPE on health at a high.
The first-ever State Health Accounts for Kerala, for 2013-14, put the State’s average annual expenditure on health at ₹25,000 crore, out of which the government’s share was ₹6,000 crore. In 2013-14 also, Kerala had the highest per capita expenditure on health at ₹7,636, of which the government’s share was about ₹1,765, still one of the highest in the country. Out-of-pocket spending accounted for 76% of the total healthcare expenses.
“Though Kerala still has the highest OOPE on health, one can take heart in the fact that the OOPE on health is showing a downward trend from 2013-14. In the five years since the first State Health Accounts, Kerala has focussed its attention on improving primary healthcare delivery and strengthening public health facilities through Aardram Mission (2016), which has resulted in increased footfall in public sector hospitals. The State is thus moving in the right direction but the results will show up only in the long term,” Arun B. Nair, a health financing expert, says.
