The Economic Survey 2024-25, released earlier this year, showed that the Central government’s health spending had increased from Rs 3.2 lakh crore in 2020-2021 to Rs 6.1 lakh crore in 2024-2025 at an annual growth rate of 18%. The Survey also revealed that India spent a total of Rs 9.04 lakh crore on health in 2022, accounting for 3.8% of the GDP. More importantly, out-of-pocket expenditure for healthcare had dropped from 62.6% in 2014-15 to 39.4% in 2021-22. But Bengal seems to have bucked this national trend. According to the latest data published by the Union health ministry, the per capita OOPE on healthcare in the state stood at more than Rs 4,000 for 2021-22. Bengal ranked only next to Kerala, which has the highest OOPE on healthcare in the country — Rs 7,889. While most states are registering a dip in OOPE, Bengal’s figure has gradually been rising alongside those of Kerala and Andhra Pradesh. According to the National Health Accounts: Estimates for India, Bengal’s OOPE in 2020-21, at Rs 3,648, was higher than most other states. In fact, Bengal figures among the five states where the OOPE as a percentage of the total health expenditure was more than 50%. This is in spite of the fact that Bengal’s healthcare budget went up from Rs 4,000 crore in 2011 to Rs 21,500 crore in the last budget.
What then explains the jump in OOPE? The lack of access to quality government healthcare is perhaps the biggest factor driving up OOPE. While Bengal’s public healthcare infrastructure received a boost during the pandemic years — the number of ventilators in state-run healthcare facilities went up from 1,000 to 2,500 in that period — it still falls short while responding to individual health emergencies. A poor referral system, which came to light in the course of the horror at the R.G. Kar Medical College and Hospital, has contributed to the crisis. Health insurance can do its bit in making healthcare affordable and accessible. But household coverage under Rashtriya Swasthya Bima Yojana was 8.6% in the state, according to a 2019 study by the Institute for Studies in Industrial Development. Further, the Bengal government’s own health scheme, Swasthya Sathi, which provides cashless treatment for over 4.45 lakh beneficiaries, has been plagued by non-implementation in private facilities. The hurdles are many but not insurmountable. What is required, first and foremost, is the political will to reduce Bengal’s OOPE burden.