Public Expenditure and Sustainable Health Care in India: Achieving 2030 Agenda

Abstract

To achieve the Sustainable Development Goals: Agenda 2030, the government of India has taken several steps to improve healthcare services. Public expenditure plays a crucial role in achieving the agenda of good health and well-being. While the public expenditure on healthcare in India has been quite low around 2.1% of GDP, various financial reforms have been made to improve the fiscal capacity of the states. However, the healthcare expenditure in India has neither been sufficient nor sustainable. The paper highlights that the centralized fiscal federal design in the Indian Constitution poses challenges to revenue generation and mobilization by the States. There has been a huge decline in the revenue-generating ability of the states from 1998-99 to 2020-21 which has reduced the fiscal autonomy of the states by making them dependent for 47% of their resources on the Centre. This declining fiscal autonomy of the states and increasing dependence on the centre for resources affect the public expenditure on healthcare which primarily is the subject matter of the state list. Thus, the paper suggests the need and ways for sustainable healthcare financing in India.