Maharashtra Gov Spends Just 29.3% On Healthcare As Households Bear Nearly 39% Of Costs

Mumbai: Despite Maharashtra being one of India's most economically developed states, its government contribution to healthcare spending remains significantly lower than the national average, leaving households to bear a larger financial burden. In 2023–24, households accounted for 38.8% of the state's total health expenditure, compared with just 29.3% contributed by the government.

This contrasts with the national trend, where government spending at 43.5% has overtaken household out-of-pocket expenditure (OOPE) at 42.7%, highlighting Maharashtra's relatively low public investment in healthcare despite its stronger economic position, according to the National Health Accounts (NHA) Estimates for India 2023–24, released by the Union Ministry of Health and Family Welfare.

Maharashtra's total health expenditure stood at Rs 1,15,238 crore in 2023–24. Of this, out-of-pocket expenditure (OOPE), or money paid directly by households while accessing healthcare, accounted for 38.8%. Government health expenditure contributed 29.3% of the total.

The findings come against the backdrop of a significant national improvement in healthcare financing. India's OOPE share declined by 21.5 percentage points, from 64.2% of total health expenditure in 2013–14 to 42.7% in 2023–24. During the same period, the government's share increased from 28.6% to 43.5%.

However, Maharashtra's government spending share remains considerably below the national figure. While government expenditure accounted for 43.5% of total health expenditure nationally, it stood at 29.3% in Maharashtra. The state's OOPE share of 38.8% was lower than the national average of 42.7%.

In per capita terms, Maharashtra's total health expenditure stood at Rs 9,074, including direct household spending of Rs 3,522 per person and government health expenditure of Rs 2,658 per person.

The report also shows that government health expenditure in Maharashtra was equivalent to 0.8% of the state's Gross State Domestic Product (GSDP) and 6.5% of its General Government Expenditure.

A comparison with other states shows that Maharashtra's public share of health spending is lower than that of several states. Gujarat's government health expenditure accounted for 45.8% of its total health expenditure, while Karnataka's share stood at 31.6%. Bihar and Jharkhand reported higher government shares of 48.2% and 37.7%, respectively. Kerala, however, had a lower government share of 25%.

The contrast is notable when viewed against states' economic positions. As per the Ministry of Statistics and Programme Implementation's per-capita Net State Domestic Product figures for 2023–24, Maharashtra's per-capita income was Rs 2.79 lakh. It was higher in Karnataka (Rs 3.39 lakh), Gujarat (Rs 3.01 lakh) and Kerala (Rs 2.81 lakh), while it was considerably lower in Jharkhand (Rs 1.06 lakh), Uttar Pradesh (Rs 97,364) and Bihar (Rs 62,201). The health accounts therefore show that a stronger state economy does not automatically translate into a higher government share of healthcare financing.

Methodology

The NHA report says its OOPE estimates draw on the National Sample Survey Office's 75th-round Health and Morbidity Survey, conducted between July 2017 and June 2018. It means that the government uses the 2017–18 health survey because it is the most detailed national report showing exactly where and how families spend money on healthcare—such as whether they visited a government hospital or a private clinic, and how much went toward medicines versus doctor fees.

While newer general spending surveys exist, they do not capture these specific medical details, and the government has not yet released a newer specialized health survey to replace the 2017–18 one. Instead of copying old numbers, experts take those 2017–18 spending habits and update them for 2023–24 by factoring in population growth, rising medical costs, and current insurance payouts.

Ravi Duggal is an independent healthcare activist, health researcher and activist associated with the Jan Swastha Abhiyan said that healthcare is not priority of state government. "The private healthcare facility is very strong in Maharashtra and widespread. At the same time, state public hospitals are in poor state," said Duggal, adding that per capita expenditure in the state is much lower to states north east, despite Maharashtra is economically developed state. 

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