National Health Accounts FY2022-23: Government Health Expenditure Triples, OOPE Declines to 39.4%

29 May 2026·5 arguments·5 dimensions

Summary

The Union Ministry of Health and Family Welfare released the 10th edition of National Health Accounts (NHA) Estimates for FY 2022-23, prepared by the National Health Accounts Technical Secretariat (NHATS) under the NHSRC. Government Health Expenditure (GHE) has tripled from ₹1.30 lakh crore in 2013-14 to ₹3.85 lakh crore in 2022-23, with GHE as a share of GDP rising from 1.15% to 1.43%. Out-of-Pocket Expenditure (OOPE) as a share of Total Health Expenditure (THE) declined from 64.2% in 2013-14 to 39.4% in 2022-23.

●Despite progress, India remains below the National Health Policy 2017 target of 2.5% of GDP in government health spending.

⬡gs2-health-social ⬡gs2-welfare-vulnerable

Core Arguments

1
India's OOPE declining from 64.2% to 39.4% represents genuine progress in financial protection, but the absolute number of households pushed into poverty by health spending has not decreased proportionally — because population growth and rising treatment costs mean more people are exposed to medical bills even as the percentage metric improves, making the headline figure politically misleading.
2
The 1.43% of GDP government health expenditure in FY23 — compared to a 2.5% NHP 2017 target — reveals that India has consistently under-invested in public health not due to resource constraints but due to revealed budgetary priorities, since India's defence expenditure exceeds 2% of GDP and total government expenditure grew substantially in the same period.
3
The 11x differential in per capita state health expenditure (Bihar ₹937 versus Arunachal Pradesh ₹10,148) is the most structurally damaging finding in the NHA series — it means that universal health coverage, as a policy ambition, is operationally impossible within the current fiscal federalism framework without significant equalisation transfers earmarked specifically for health.
4
Ayushman Bharat – PM-JAY's contribution to the OOPE decline is real but asymmetric: it covers hospitalisation for BPL families but leaves out the 40–70% middle population above the BPL threshold, and it does not cover outpatient care, medicines, or diagnostics — which constitute 50–60% of household health spending, the main driver of financial hardship.
5
India's trajectory from 64.2% to 39.4% OOPE over a decade, while impressive in relative terms, still leaves 39.4 cents of every health rupee spent directly by households — compared to 12% in the UK, 11% in Germany, and 18% in Thailand. The structural gap is not a funding gap but a system design gap: India does not have a universal prepayment mechanism (social health insurance or tax-funded NHS model) that pools risk across the entire population.

Dimensional Angles

Governance

NHA FY23 is the 10th edition — a decade-long time series now exists. This is a governance achievement in itself, since consistent health accounts data is a prerequisite for evidence-based health budgeting. The challenge is that NHA data informs the next budget cycle with a 2-year lag (FY23 data released in 2026), reducing its real-time policy utility.

Economic

High OOPE is not merely a welfare issue — it is a macroeconomic drag. The Economic Survey 2021-22 estimated that catastrophic health spending pushes 5.5–7 crore Indians into poverty annually. Reducing OOPE to the NHP target levels would generate significant secondary economic gains through consumption smoothing and reduced distress asset sales.

Social

The OOPE burden falls disproportionately on women, who are typically the household care-givers and often the last to seek care due to cost. The decline in OOPE, to the extent it reflects improved maternal and child health facility coverage (Ayushman Bharat Health and Wellness Centres), has a gendered dimension that aggregate statistics do not capture.

Legal

Article 21 of the Constitution, as interpreted in Paschim Banga Khet Mazdoor Samity v. State of West Bengal (1996), imposes a positive obligation on the State to provide emergency healthcare. The NHA data on per capita expenditure disparity between States is directly relevant to any Article 21 challenge to healthcare access in low-spending States.

International Relations

India's Sustainable Development Goal (SDG) 3.8 commitment is to achieve Universal Health Coverage (UHC) by 2030. With OOPE at 39.4% and GHE at 1.43% of GDP, India's UHC Index score (tracked by WHO) will remain well below the South-East Asia regional average, affecting India's multilateral standing on health commitments at WHA and G20.

Value-Adds for Answers

◆
Data: NHA FY23 (10th edition) headline numbers — GHE: ₹3.85 lakh crore (1.43% of GDP); per capita GHE: ₹2,786; OOPE as % of THE: 39.4% (down from 64.2% in 2013-14); primary healthcare expenditure: ₹1.4 lakh crore (Ministry of Health and Family Welfare / NHSRC, May 2026).
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Data: State-level per capita health expenditure disparity FY22-23 — Bihar: ₹937; Arunachal Pradesh: ₹10,148 — an approximately 11x differential, representing the widest recorded gap in the NHA series (NHA FY23, NHSRC).
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Comparison: Thailand reduced OOPE from approximately 60% in 1990 to under 18% by 2010 through the Universal Coverage Scheme (2002) — a tax-funded model covering all citizens not enrolled in formal employment insurance. India's PM-JAY covers only BPL households for hospitalisation, leaving the structural middle out of risk pooling.
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Quote: National Health Policy 2017 — the government committed to increasing public health expenditure to 2.5% of GDP by 2025. At 1.43% in FY23, over eight years after the policy was notified, the gap between commitment and execution is 1.07 percentage points of GDP — approximately ₹3 lakh crore in annual public health investment.