Fiscal Transfers from the Union to States and Healthcare in India
DOI:
https://doi.org/10.55763/ippr.2024.05.05.002Abstract
The key focus of the study is to assess the role of fiscal transfers from the Union government compared to States’ own revenue in explaining their healthcare spending. The study found that both States’ own revenue and unconditional transfers impact their health spending. However, own revenue was more significant than unconditional fiscal transfers in explaining health spending by economically well-off states. In contrast, unconditional fiscal transfers were the sole factor for health spending by economically weaker states. Generally, States were substituting their non-National Health Mission (NHM) health spending with NHM health spending. However, this substitution was much less pronounced in economically well-off states compared to economically weaker states. Post-NHM, there was a slight increase in horizontal inequalities. The intricate interplay between fiscal transfers and health spending by Indian states underlines the need for nuanced policy changes. A differentiated strategy is essential for economically well-off and economically weaker states to improve healthcare spending in the country.
Keywords:
National Health Mission, Fiscal Transfers, India Healthcare, Healthcare expenditureDownloads
References
Allin, S., Marchildon, G.P., and Peckham, A. (2020). International Health Care System
Profiles- Canada. Retrieved from The Commonwealth fund:
https://www.commonwealthfund.org/international-health-policy-center/countries/canada
Ardanaz, M., Leiras, M., & Tommasi, M. (2012). The politics of federalism in Argentina: Implications for governance and accountability. IDB working paper series; 327. Retrieved from https://publications.iadb.org/en/publication/11042/politics-federalism-argentina-implications-governance-and-accountability.
Bhat, R., and Jain, N. (2004). Analysis of public expenditure on health using state level data. No. WP2004-06-08 Indian Institute of Management Ahmedabad, Research and Publication.
Biggs, A. (2013, November 6). Health in Australia. Retrieved from Parliament of Australia:
Blümel M, Spranger A, Achstetter K, Maresso A, Busse R. (2020). Germany: Health system review. Health system in transition, 22(6), i- 273.
Boadway, R., and Flatters, F. (1982). Efficiency and equalization payments in a federal system of government: A synthesis and extension of recent results. Canadian Journal of Economics, 613-633.
Boadway, R. W., and Shah, A. (2007). Intergovernmental fiscal transfers: Principles and Practices. World Bank Publications. http://hdl.handle.net/10986/7171
Bowser, D. M., Jha, R., Bhawalkar, M., and Berman, P. (2019). The challenge of additionality: the impact of central grants for primary healthcare on state-level spending on primary healthcare in India. International Journal of Health Policy and Management, 8(6), 329.
Brown, M. C. (1987). Caring for Profit: Economic Dimension of Canada’s Health Industry. Fraser Institute, Vancouver.
Buchanan, J. M. (1950). Federalism and fiscal equity. The American Economic Review, 40(4), 583-599.
Byaro, M., Kinyondo, A., Michello, C., and Musonda, P. (2018). Determinants of Public Health Expenditure Growth in Tanzania: An Application of Bayesian Model. African Journal of Economic Review, 6(1).
Chakraborty, P., and Gupta, M. (2016). Evolving Centre–State Financial Relations. Role of the New Framework for Grants. Economic and Political Weekly, 51(16).
Clemente, J., Marcuello, C., Montañés, A., and Pueyo, F. (2004). On the international stability of health care expenditure functions: are government and private functions similar? Journal of health economics, 23(3), 589-613.
Coady, D., Clements, B.J. and Gupta, S. (2012). The economics of public health care reform in advanced and emerging economies. Washington: International Monetary Fund.
Commission on Centre-State Relations. (2010). Centre-State Financial Relations and Planning (Volume 3).
Costa‐Font, J., and Pons‐Novell, J. (2007). Public health expenditure and spatial interactions in a decentralized national health system. Health economics, 16(3), 291-306.
Demand for Grants 2022-23 Analysis: Health and Family Welfare.
Di Matteo, L., and Di Matteo, R. (1998). Evidence on the determinants of Canadian provincial government health expenditures: 1965–1991. Journal of health economics, 17(2), 211-228.
Duggal, R., Acharya, N., & Garg, A. (2014). Budget transparency and participation: Recommendations to the fourteenth finance commission. Economic and Political Weekly, 19-22.
Economic Survey, 2020-21. Volume 1, Chapter 9, “JAY Ho: Ayushman Bharat's Jan Arogya Yojana (JAY) and Health Outcomes”.
Farag, M., Nandakumar, A. K., Wallack, S. S., Gaumer, G., and Hodgkin, D. (2009). Does funding from donors displace government spending for health in developing countries? Health Affairs, 28(4), 1045-1055.
Feld, L. P., & Hagen, J. (2007). Federal Republic of Germany. In A. Shah, & J. Kincaid, The practice of fiscal federalism: Comparative perspectives (pp. 125-150). Montreal, Canada: McGill-Queen’s University Press.
Garg, C. C., & Karan, A. K. (2009). Reducing out-of-pocket expenditures to reduce poverty: a disaggregated analysis at rural-urban and state level in India. Health policy and planning, 24(2), 116-128.
Giannoni, M., and Hitiris, T. (2002). The regional impact of health care expenditure: the case of Italy. Applied Economics, 34(14), 1829-1836.
GS1 India (2022). rep. Building Resilience in Post Covid Supply Chains. Available at: https://www.gs1india.org/wp-content/uploads/2022/10/Building-resilience-in-post-covid-supply-chain-2.pdf.
Healy, J., Sharman, E., Lokuge, B., & World Health Organization. (2006). Australia: Health system review. World Health Organization.
Hooda, S. K. (2016). Determinants of public expenditure on health in India: A panel data analysis at sub-national level. Journal of Quantitative Economics, 14(2), 257-282.
Kapoor, A., Mukhopadhyay, I., Raj, J. and Venkateshwaran, S. (2023). “Federal Financing of Health: Implications for Health System Capacity and Priority”. CSEP Working Paper (Mimeo).
Karatzas, G. (2000). On the determination of the US aggregate health care expenditure. Applied Economics, 32(9), 1085-1099.
Kotasthane, P., Kher, D., Srinath, P., and Chajjer, A. (2018). The Regressive Nature of Central Transfers for Health.
Leu, R. (1986). The public-private mix and international health care costs. The public and private health services, 41-63.
Lu, C., Schneider, M. T., Gubbins, P., Leach-Kemon, K., Jamison, D., and Murray, C. J. (2010). Public financing of health in developing countries: a cross-national systematic analysis. The Lancet, 375(9723), 1375-1387.
Ma, J. (1997). Intergovernmental fiscal transfers in nine countries: Lessons for developing countries.
Ministry of Finance. (2017). Economic Survey, Fiscal Rules: Lessons from the States (Chapter 6). Government of India.
Mukherjee, S. (2022). Revenue Assessment of Goods and Services Tax (GST) in India (No. 22/385).
Nambiar, S. (2007). Malaysia. In A. Shah, & J. Kincaid, The practice of fiscal federalism: Comparative perspectives (pp. 178-203). Montreal, Canada: McGill-Queen’s University Press.
Newhouse, J. P. (1977). Medical-care expenditure: a cross-national survey. The journal of human resources, 12(1), 115-125.
Parkin, D., McGuire, A., and Yule, B. (1987). Aggregate health care expenditures and national income: is health care a luxury good? Journal of health economics, 6(2), 109-127.
Press Information Bureau. (2018, August 10). Health Programmes/Schemes. [Press release]. https://pib.gov.in/newsite/PrintRelease.aspx?relid=181817
Press Information Bureau. (2019, March 28). Speech of Shri N.K. Singh, Chairman, XVFC at the launch of the book ‘Indian Fiscal Federalism’. [Press release]. https://pib.gov.in/newsite/PrintRelease.aspx?relid=189589
Rahman, T. (2008). Determinants of public health expenditure: some evidence from Indian states. Applied Economics Letters, 15(11), 853-857.
Raj, Janak and Shauryavir Dalal (2023). Evolution of the Healthcare Policy Framework in India. (Mimeo).
Rao, M. G. (2018). Central transfers to states in India: rewarding performance while ensuring equity. Final report submitted to NITI Aayog.
Rao, M. G., and Singh, N. (2006). Political Economy of Federalism in India. Oxford University Press.
Rao, M. G. (2017). Central transfers to states in India: rewarding performance while ensuring equity. Final report submitted to NITI Aayog.
Rao, M. G., and Choudhury, M. (2012). Health care financing reforms in India. National Institute of Public Finance and Policy, working paper no 2012-100.
Rao, M. G., & Singh, N. (2006). The political economy of federalism in India. Oxford University Press.
Reddy, Y. V. (2019). New approaches to fiscal federalism in India. Review of Development and Change, 24(2), 163-186.
Reserve Bank of India. (2022). RBI Annual Report.
Rezende, F. (2007). Federal Republic of Brazil. In A. Shah, & J. Kincaid, The practice of fiscal federalism: Comparative Perspective (pp. 73-97). Montreal, Canada: McGill-Queen’s University Press.
Rice T, Rosenau P, Unruh LY, Barnes AJ, van Ginneken E (2020). United States of America: Health system review. Health Systems in Transition, 22(4), i–44.
Ritwika, S., Gupta, M., and James, K. (2021, July). Why Article 282 needs a rethink as Centre and states battle for money. The Print.
Rotulo, A., Epstein, M., and Kondilis, E. (2020). Fiscal federalism vs fiscal decentralization in healthcare: a conceptual framework. Hippokratia, 24(3), 107.
Safurah, J., Kamaliah, M. N., Khairiyah, A. M., Hanah Othman, N., & Healy, J. (2013). Malaysia Health System Review, Health Systems in Transition. World Health Organization.
Schapiro, R. A. (2020). States of Inequality: Fiscal Federalism, Unequal States, and Unequal People. California Law Review, 108(5).
Schapiro, R. A. (2020). States of inequality: Fiscal federalism, unequal states, and unequal people. Calif. L. Rev., 108, 1531.
Selvaraj, S., & Karan, A. K. (2009). Deepening health insecurity in India: evidence from national sample surveys since 1980s. Economic and political weekly, 55-60.
Stephan, A. (1999). Federalism and democracy: Beyond the US model. Journal of Democracy,10(4),19–34.
Tarr, G. A. (2011). Federalism and Health Care. Revista d'estudis autonòmics i federals, (14), 10-35
Yu, Y., Zhang, L., Li, F., and Zheng, X. (2013). Strategic interaction and the determinants of public health expenditures in China: a spatial panel perspective. The Annals of Regional Science, 50, 203-221.