Preprint / Version 1

Exploring methods for improving out-of-pocket expenditure (OOPE) estimates for India


  • Indranil Mukhopadhyay Jindal School of Government and Public Policy
  • Montu Bose Tata Institute of Social Sciences
  • Rahul S Reddy Kadarpeta Health Systems Transformation Platform



Oout-of-pocket expenditure, Global Health Expenditure Database, Health expenditure


Health Accounts presents an overview of sources of financing healthcare, how these finances are paid to the providers, for which services and for whom (population characteristics) within the health system at national or sub-national level for a financial year (FY). This information is presented in the Global Health Expenditure Database (GHED) for almost all countries based on health accounts. Out of Pocket expenditure (OOPE) is a major source of financing healthcare in most Low-and Middle-Income Countries (LMICs). OOPE is defined as any payment made by the household directly at the point of receiving a health service. OOPE is a significant indicator to measure financial risk protection offered by the health system and to monitor progress towards universal health coverage (SDG 3.8). When OOPE is a major source of financing, households tend to face financial hardship when seeking health services. Households that cannot afford to pay at point of service, may also forego care. OOPE estimates for India are presented in the National Health Accounts (NHA). These are available for FY 2001-02, FY 2004-05 & consecutively for FY 2013-14 to FY 2018-19. OOPE for NHA India is estimated from household health or consumption surveys conducted by the National Sample Survey Office, Ministry of Statistics and Program Implementation, Government of India (NSSO-MoSPI) and market data available on sale of medical goods. Routine health related administrative data captured by government, insurers, regulators, and providers which is commonly used in OECD countries is not the usual source in India due to limited data availability.


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