India’s 2019-20 economic survey has underscored a decline in out-of-pocket healthcare spending by households over a three-year period, but experts say the fall is likely linked to expanding private health insurance than to extra government spending.

The survey, citing figures from the National Health Accounts (NHA), has pointed out that the out-of-pocket expenditure as a percentage of total health expenditure has declined from 64.2 per cent in 2013-14 to 58.7 per cent in 2016-17.

Health experts have for long advocated a substantial increase in government spending on healthcare to help reduce the country’s high out-of-pocket — either households’ savings or money borrowed from friends of relatives — expenditure on healthcare.

The survey has also listed multiple government initiatives, including the Pradhan Mantri Jan Aarogya Yojana (PMJAY), a nationwide health insurance cover for up to Rs 5 lakh per year per household for hospital expenses, and free drugs and diagnostics initiatives. The PMJAY scheme covers over 50 crore people from poor and vulnerable households across the country.

But experts say there is little evidence to suggest that any of these initiatives have impacted the fall in out-of-pocket expenditure cited by the survey. They point out that the PMJAY scheme, for instance, was launched in September 2018.

“The decline in out-of-pocket expenditure between 2013-14 and 2016-17 is largely the result of a growth in private health insurance,” said Sakhtivel Selvaraj, a senior health economist at the Public Health Foundation of India, New Delhi.

The NHA’s data sets show that the share of private health insurance expenditure as a percentage of the country’s total health expenditure increased from 3.4 per cent in 2013-14 to 3.7 per cent in 2014-15 and 4.2 per cent in 2015-16.

The survey said all states and Union territories (UTs) have notified policies to provide essential drugs free at government clinics and hospitals and free diagnostic services have been implemented in 33 states or UTs — through public-private-partnerships in 11 states/UTs and inhouse in 22 states/UTs.

The survey also said computerised tomography scans are available in 23 states.

“This is misleading — there are gaps in many states, all patients who approach public hospitals do not get free drugs or diagnostic services,” said Nitin Jadhav, a coordinator with the Pune-based non-government Support for Advocacy and Training for Health Initiatives.

“There are drug shortages in many public facilities.

The public-private-partnership model is not working well in many places, including Maharashtra,” he said.

“The private sector might increase fees and deny patients services. There is little monitoring or regulation of the private sector.”