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Access and affordability of health

Whether people can reach and pay for health care, and what the surveys and schemes show about it.

Asked before

  1. Mains 2026 GS2: Should education be treated primarily as a welfare obligation of the state or as a strategic investment for building a globally competiti…
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  5. Mains 2024 GS2: In a crucial domain like the public healthcare system the Indian State should play a vital role to contain the adverse impact of marketis…
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  8. Mains 2023 GS2: The crucial aspect of development process has been the inadequate attention paid to Human Resource Development in India. Suggest measures…

See all: Prelims · Mains

Affordability and access to healthcare: out of pocket spending rises again

Copy link to Affordability and access to healthcare: out of pocket spending rises again

StandardPrelims and Mains7 Aug 2026

What it is

  • Out of pocket expenditure is what households pay for health at the point of care, for consultations, medicines, tests and hospital stays, without being reimbursed. Its share of total health expenditure is the standard measure of how far a health system protects people from the cost of illness.
  • The National Health Accounts, prepared by the National Health Systems Resource Centre for the Health Ministry, track it. The estimates for 2022-23, released on 27 May 2026, show the share rising for the first time in a decade; the Ministry calls the 2021-22 dip in out of pocket spending a one time effect of pandemic outlays.
  • Social security schemes paid 9.9 per cent of total health expenditure in 2022-23 and private insurance 9.2 per cent.
Share of total health expenditure (National Health Accounts)2013-142021-222022-23
Out of pocket spending by households64.2 per cent39.4 per cent43.4 per cent
Government health expenditure28.6 per cent48.0 per cent43.7 per cent
Government health expenditure as a share of GDP1.84 per cent1.43 per cent

What happened

  • On 7 August 2026 the Standing Committee on Health and Family Welfare presented its report Affordability and Accessibility of Healthcare Facilities (Report No. 176) in the Rajya Sabha.
  • It found public spending inadequate, private hospital charges unregulated, outpatient care uninsured, specialists scarce in rural areas and medicines the largest out of pocket item.
  • It recommended a time bound roadmap to 2.5 per cent of GDP and then 5 per cent; a capital fund for community health centres, district hospitals and medical colleges; extending Ayushman Bharat to outpatient care, diagnostics and medicines, with the family cover raised to ₹10 lakh; Jan Aushadhi outlets in every hospital; price control of life saving medicines; and a binding framework for private rates under the Clinical Establishments Act.

Why it matters

  • The 2022-23 reversal shows that the fall in out of pocket spending since 2013-14 came from public spending, and that when public spending retreats households pay again; the National Health Policy of 2017 set 2.5 per cent of GDP for 2025, and India is at 1.4.
  • Ayushman Bharat covers hospital stays, but most of what households pay is for outpatient care and medicines, which it does not cover; that is why the committee asks for outpatient and medicine cover and why the share has not fallen further.
  • The Centre's share of government health spending fell from 41.8 to 36.3 per cent in 2022-23, so the States carry nearly two thirds.

Schemes to know

Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (23 September 2018, National Health Authority)

  • Cashless hospital care of ₹5 lakh a family a year for the poorest 40 per cent.
  • Extended on 29 October 2024 to everyone aged 70 and above regardless of income.
  • By July 2026: 44.73 crore cards, 12.69 crore admissions worth ₹1.92 lakh crore, 1,961 packages in 27 specialities.
  • About 1.86 lakh Ayushman Arogya Mandirs are the first point of contact.

Pradhan Mantri Bhartiya Janaushadhi Pariyojana (Department of Pharmaceuticals)

  • Generic medicines at 50 to 90 per cent below branded prices through Jan Aushadhi Kendras.

Exam lens

  • Prelims: National Health Accounts 2022-23: out of pocket spending 43.4 per cent of total health expenditure, government 43.7 per cent, government health spending 1.43 per cent of GDP; the National Health Policy 2017 target of 2.5 per cent of GDP by 2025; PM-JAY's ₹5 lakh cover and the 70 plus extension of October 2024; Report No. 176 of the Standing Committee on Health.
  • Mains: why out of pocket spending rose again, and whether insurance for hospital care or public provision of outpatient care and medicines is the better route to protection.

Asked before: Mains 2024 GS2 · Mains 2021 GS2 · Prelims 2022

Show the questions
  1. Mains 2024 GS2: In a crucial domain like the public healthcare system the Indian State should play a vital role to contain the adverse impact of marketisation of the system. Suggest some measures through which the State can enhance the reach of public healthcare at the grassroots level.
  2. Mains 2021 GS2: "Besides being a moral imperative of a Welfare State, primary health structure is a necessary precondition for sustainable development." Analyze.
  3. Prelims 2022: With reference to Ayushman Bharat Digital Mission, consider the following statements: 1. Private and public hospitals must adopt it. 2. As it aims to achieve universal health coverage, every citizen of India should be part of it ultimately. 3. It has seamless portability across the country. Which of the statements given above is/are correct?

Key reports

  • National Health Accounts Estimates for India 2022-23 (Health Ministry, 27 May 2026).
  • Standing Committee on Health and Family Welfare, Report No. 176, Affordability and Accessibility of Healthcare Facilities (Rajya Sabha, 7 August 2026).

Connects to

Sources
  • ThePrint, May 2026, “As govt cut health spends post Covid, Indians paid more out of pocket in 2022-23”
  • News On AIR, 27 May 2026
  • PRS Legislative Research, August 2026, “Monthly Policy Review”
  • The Pioneer, 28 July 2026
  • PIB, 28 October 2024

Settled facts (dates of Acts, constitutional provisions, standing definitions) are from standard references.

Organ donation: a record year and new initiatives

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BriefPrelims3 Aug 2026

  • Organ donation and transplantation are governed by the Transplantation of Human Organs and Tissues Act, 1994, as amended in 2011, and coordinated by the National Organ and Tissue Transplant Organisation under the Health Ministry, with five regional and 26 State bodies and about 1,200 registered hospitals.
  • On 3 August 2026, the sixteenth Indian Organ Donation Day, which marks India's first deceased donor transplant on 3 August 1994, the Ministry reported 20,138 transplants in 2025, the highest ever, up from 4,990 in 2013; deceased donor transplants rose from 837 to 3,526 over the same years. India is third in the world in total transplants and first in living donor transplants.
  • Over 2.58 lakh people pledged their organs in 2025, and Aadhaar verified pledges on the national portal, opened in 2023, passed five lakh.
  • The Ministry launched Jug Jug Jiyo Abhiyaan, a year long awareness campaign; e-Pratyaropan, a single digital platform for registration, waiting lists, allocation and monitoring; a NOTTO mobile application; and national guidelines on brain stem death certification and on swap transplantation.
  • The Standing Committee on Health, reporting on chronic kidney disease on 7 August, asked for a study of the gender gap in organ donation and more transplant centres.

Exam lens: the 1994 Act and its 2011 amendment, which added tissues and swap donation; brain stem death certification; the National Organ and Tissue Transplant Organisation; 3 August as Indian Organ Donation Day.

Sources
  • DD News, 3 August 2026
  • PRS Legislative Research, August 2026, “Monthly Policy Review”

Settled facts (dates of Acts, constitutional provisions, standing definitions) are from standard references.

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