Despite pandemic and growing health scares, India’s budget share for healthcare continues to decline

India's government healthcare spending appears to be on the rise, but a closer look reveals a concerning trend. While the headline figures might suggest an increase, the reality is a steady decline in health expenditure as a proportion of both the budget and GDP over the past five years (2018-19 to 2023-24).

This decline is even starker when adjusted for inflation. In real terms, spending has barely kept pace since 2019-20. As a percentage of the total budget, health spending has shrunk from 2.4% in 2018-19 to just 1.9% in 2023-24. Similarly, the share of GDP allocated to health has fallen from 0.30% to 0.28%, as per a report from the Times of India.

Growing expectations ahead of Budget 2024

As the Finance Minister Nirmala Sitharaman prepares to present the full budget for the current fiscal on July 23, the expectations from the health sector has only been growing.

“The Union Budget 2024-25 is a pivotal moment for India's healthcare sector. Building on the ₹64,180 crores allocated in 2023-24 under the Pradhan Mantri Atmanirbhar Swasth Bharat Yojana, we need enhanced tax incentives and financial support for healthcare startups to catalyze innovation. Significant investments in digital health infrastructure, particularly AI, will improve patient outcomes and operational efficiency,” says Dr Sravani Reddy G, Founder & CEO, Soprav Healthcare Consulting.

“Strengthening public-private partnerships will improve healthcare accessibility and quality, leveraging private sector efficiency. Additionally, focused efforts on affordability and access, such as reducing out-of-pocket expenses and improving insurance coverage, are vital for a more equitable healthcare system.”

“The healthcare sector in India is on the brink of excellence. There is an increased focus on treating unique patient cases, robotic surgeries, and increasing prominence of AI for accurate diagnosis. To reach the next phase, emphasis must be laid on innovation, research & development, and infrastructure development. These are the foundations for India’s health sector to achieve an international standard of treatment for all,” hopes Joseph Pasangha, Group COO, SPARSH Hospital, Bengaluru.

Health tax not helping enough

This situation is further complicated by the introduction of the health cess in 2018. This tax levy was intended to boost government spending on healthcare, particularly for the underprivileged. However, the collected funds seem to be merely filling the gap created by cuts to regular budgetary allocations for health.

In 2022-23, over Rs 18,300 crore of the central government's health spending came from the health cess. Excluding this amount, the actual budgetary allocation for health stands at a concerning Rs 59,840 crore. This is lower than the pre-pandemic level of Rs 66,042 crore allocated in 2019-20, even without adjusting for inflation.

Where's the money going?

The intended purpose of the health cess seems to be falling short. In 2018, health spending accounted for 2.4% of the government's total expenditure. If this ratio had remained constant in 2023-24, the health budget should have been over Rs 1.07 lakh crore. Instead, the revised expenditure, including the health cess, stands at just Rs 83,400 crore.

Even the additional allocations for the COVID-19 pandemic (Rs 10,655 crore and Rs 15,955 crore in 2020-21 and 2021-22 respectively) cannot mask the overall decline. When combined with the regular health budget (excluding health cess), the total spending in these years still falls short of what it would have been if the 2.4% share of 2018-19 had been maintained.

More for alternative medicine

While the share allocated to Ayush (Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homeopathy) has seen a significant increase, spending on crucial areas like health research has seen only marginal growth. Additionally, a major portion of research funding goes to the Indian Council of Medical Research, with only a temporary increase during the peak of the pandemic response.

The most concerning decrease is in the allocation for health and family welfare, encompassing national programs, the National Health Mission, and health system strengthening. This critical area has seen a substantial decline in its share of both GDP and total budget expenditure, falling from a peak of over 2% in 2017-18 to a mere 1.7% in 2023-24. Excluding the health cess, this figure drops even further to 1.5%.

What this means

This decline in government health spending raises serious concerns about India's commitment to public healthcare, particularly for its most vulnerable populations. Increased investment in health is crucial for a growing nation like India, and a reversal of this downward trend is essential to ensure accessible and quality healthcare for all.

The 2024 Interim Health Budget saw a boost in total healthcare expenditure from Rs. 79,221 crore to Rs. 90,171 crore. Experts have opined that The healthcare budget should encompass at least 2.5% of the total budget. But it remains to be seen how the exact picture will turn out to be on July 23.

“The 2024-25 budget presents an opportunity to build on past successes while addressing shortcomings, ensuring that India's healthcare system remains resilient, innovative, and patient-centric. This budget can pave the way for a healthier, more equitable future for all," concludes Dr Reddy.

(With inputs from TOI)