Methods and Measurement of Primary, Secondary and Tertiary Healthcare Expenditures in India During 2013–2014 to 2016–2017

Improving investments in primary health care has become a mounting priority in the context of Universal Health Coverage and India’s National Health Policy 2017 goal to provide cost-effective care. The paper uses the India National Health Accounts, health care providers and health care functions classifications, to allocate current health expenditures (CHE) to primary, secondary and tertiary (PST) care and analyse the trends and composition of PST expenditures between 2013–2014 and 2016–2017. Findings reveal that 45.2% of CHE was spent on primary care in 2016–2017. The government spends 52% of its CHE for primary care. Private spending on primary care has declined from 44% to 41% during the study period. Disaggregate analysis shows that 41% of primary care expenditures were on medicines, 29% on curative care and 15% on preventive care services. About 32% of primary care expenditures were spent at government facilities/providers as compared to 10% at private facilities/doctors. Private sector share of secondary care (38%) and tertiary care (75%) reinforces the role of private sector in providing secondary and tertiary care services. In cognisance of national and international goals, an additional investment of 0.7% of gross domestic product or additional US$11 (₹754) per capita would be required in primary care.