Cost determinants and financing of health expenditure: Evidence from India

Authors

  • Sakshi IIS (Deemed to be University), Jaipur, 302020, India
  • J. N. Sharma IIS (Deemed to be University), Jaipur, 302020, India

Keywords:

Health Expenditure, Per Capita Public & Private, Per capita out-of-Pocket spending, Demographic and Socioeconomic

Abstract

Despite achieving sustained economic growth, India continues to face challenges in public health financing and outcomes. India’s public health spending, at just 2–3% of GDP, lags global norms and contributes to persistent gaps in healthcare infrastructure and access. This study analyses annual data from 1991–2022 to examine the determinants of per capita public and private health expenditures. Using the autoregressive distributed lag (ARDL) model with FMOLS & DOLS for robustness, results confirm stable long-run relationships. Per capita public expenditure is strongly influenced by out-of-pocket spending, urbanization, and population, while per capita private expenditure responds more to life expectancy and demographic change. The findings shed light on India’s dual health financing structure.

References

Ahmad and Hasan. (2016). Public Health Expenditure, Governance and Health Outcomes in Malaysia. Jurnal Ekonomi Malaysia, 50(1). https://doi.org/10.17576/JEM-2016-5001-03

Arrow, K. J. (1978). UNCERTAINTY AND THE WELFARE ECONOMICS OF MEDICAL CARE. In Uncertainty in Economics (pp. 345–375). Elsevier. https://doi.org/10.1016/B978-0-12-214850-7.50028-0

Asteriou, D., Pilbeam, K., & Pratiwi, C. E. (2021). Public debt and economic growth: Panel data evidence for Asian countries. Journal of Economics and Finance, 45(2), 270–287. https://doi.org/10.1007/s12197-020-09515-7

Baltagi, B. H., & Moscone, F. (2010a). Health care expenditure and income in the OECD reconsidered: Evidence from panel data. Economic Modelling, 27(4), 804–811. https://doi.org/10.1016/j.econmod.2009.12.001

Baltagi, B. H., & Moscone, F. (2010b). Health care expenditure and income in the OECD reconsidered: Evidence from panel data. Economic Modelling, 27(4), 804–811. https://doi.org/10.1016/j.econmod.2009.12.001

Behera, D. K., Rahut, D. B., & Dash, U. (2024). Fiscal Policy Determinants of Health Spending in India: State Versus Center. Asian Development Review, 41(02), 325–347. https://doi.org/10.1142/S0116110524500100

Bein, M., & Coker-Farrell, E. Y. (2020). The association between medical spending and health status: A study of selected African countries. Malawi Medical Journal: The Journal of Medical Association of Malawi, 32(1), 37–44. https://doi.org/10.4314/mmj.v32i1.8

Breyer, F., & Felder, S. (2006). Life expectancy and health care expenditures: A new calculation for Germany using the costs of dying. Health Policy, 75(2), 178–186. https://doi.org/10.1016/j.healthpol.2005.03.011

Chandra, A., & Skinner, J. (2012). Technology Growth and Expenditure Growth in Health Care. Journal of Economic Literature, 50(3), 645–680. https://doi.org/10.1257/jel.50.3.645

Erdil, E., & Yetkiner, I. H. (2009). The Granger-causality between health care expenditure and output: A panel data approach. Applied Economics, 41(4), 511–518. https://doi.org/10.1080/00036840601019083

Filmer, D., & Pritchett, L. (1999). The impact of public spending on health: Does money matter? Social Science & Medicine (1982), 49(10), 1309–1323. https://doi.org/10.1016/s0277-9536(99)00150-1

Grossman, M. (1972). On the Concept of Health Capital and the Demand for Health. Journal of Political Economy, 80(2), 223–255.

Jakovljevic, M. B., & Milovanovic, O. (2015). Growing Burden of Non-Communicable Diseases in the Emerging Health Markets: The Case of BRICS. Frontiers in Public Health, 3. https://doi.org/10.3389/fpubh.2015.00065

Kazemi Karyani, A., Kazemi, Z., Shaahmadi, F., Arefi, Z., & Meshkani, Z. (2015). The Main Determinants of Under 5 Mortality Rate (U5MR) in OECD Countries: A Cross-Sectional Study. Journal of Pediatric Perspectives, 3(1.2), 421–427. https://doi.org/10.22038/ijp.2015.3838

Khan, H. N., Razali, R. B., & Shafie, A. B. (2016). Modeling Determinants of Health Expenditures in Malaysia: Evidence from Time Series Analysis. Frontiers in Pharmacology, 7. https://doi.org/10.3389/fphar.2016.00069

Khandelwal, V. (2015). Impact of Energy Consumption, GDP & Fiscal Deficit on Public Health Expenditure in India: An ARDL Bounds Testing Approach. Energy Procedia, 75, 2658–2664. https://doi.org/10.1016/j.egypro.2015.07.652

Kofi Boachie, M., Ramu, K., & Põlajeva, T. (2018). Public Health Expenditures and Health Outcomes: New Evidence from Ghana. Economies, 6(4), 58. https://doi.org/10.3390/economies6040058

Lin, F. L., & Wang, M.-C. (2020). Longevity and Economic Growth in China and India Using a Newly Developed Bootstrap ARDL Model. Frontiers in Public Health, 8. https://doi.org/10.3389/fpubh.2020.00291

Logarajan et al., 2022. (n.d.). The Impact of Public, Private, and Out-of-Pocket Health Expenditures on Under-Five Mortality in Malaysia. Retrieved October 6, 2025, from https://www.mdpi.com/2227-9032/10/3/589

Mohanty, R. K., & Behera, D. K. (2020). How Effective is Public Health Care Expenditure in Improving Health Outcome? An Empirical Evidence from the Indian States. Working Papers, Article 20/300. https://ideas.repec.org//p/npf/wpaper/20-300.html

Mohapatra, G., Arora, R., & Giri, A. K. (2022). Establishing the relationship between population aging and health care expenditure in India. Journal of Economic and Administrative Sciences, 40(3), 684–701.

Mohd Nasir, N. B., Nasir, Z. A., Abdullah Fahami, N., Ahmad Kusairee, M. A. Z., & Ramli, K. (2021). Malaysia’s Healthcare Expenditure: ARDL Bound Test. ADVANCES IN BUSINESS RESEARCH INTERNATIONAL JOURNAL, 7(2), 267. https://doi.org/10.24191/abrij.v7i2.13340

Murthy, V. N. R., & Okunade, A. A. (2016). Determinants of U.S. health expenditure: Evidence from autoregressive distributed lag (ARDL) approach to cointegration. Economic Modelling, 59, 67–73. https://doi.org/10.1016/j.econmod.2016.07.001

Pandey, A. (2024). The role of public health expenditure in reducing infant mortality rate in India: Insights from cointegration analysis. International Journal of Health Governance, 29, 397–411. https://doi.org/10.1108/IJHG-06-2024-0074

Pesaran, M. H., Shin, Y., & Smith, R. J. (2001). Bounds Testing Approaches to the Analysis of Level Relationships. Journal of Applied Econometrics, 16(3), 289–326.

Ray, D., & Linden, M. (2020). Health expenditure, longevity, and child mortality: Dynamic panel data approach with global data. International Journal of Health Economics and Management, 20(1), 99–119. https://doi.org/10.1007/s10754-019-09272-z

Ruzima, M., & Veerachamy, P. (2023). The impact of public spending in education and health on human development in India. Journal of the Asia Pacific Economy, 28(2), 390–403. https://doi.org/10.1080/13547860.2021.1952920

Sachs, J. (2002). Report of the WHO Commission on Macroeconomics and Health (FIFTY-FIFTH WORLD HEALTH ASSEMBLY No. A55/5).

Saleh, M. H., Alkhawaldeh, R. S., & Jaber, J. J. (2023). A predictive modeling for health expenditure using neural networks strategies. Journal of Open Innovation: Technology, Market, and Complexity, 9(3), 100132. https://doi.org/10.1016/j.joitmc.2023.100132

Sofi, S. A., & Yasmin, E. (2024). Out-of-Pocket Health Expenditure and Associated Factors: Insights From National Health Accounts (NHA) Using Panel Data Analysis. INQUIRY: The Journal of Health Care Organization, Provision, and Financing, 61, 00469580241309903. https://doi.org/10.1177/00469580241309903

Ssozi, J., & Amlani, S. (2015). The Effectiveness of Health Expenditure on the Proximate and Ultimate Goals of Healthcare in Sub-Saharan Africa. World Development, 76, 165–179. https://doi.org/10.1016/j.worlddev.2015.07.010

Vyas, V., Mehta, K., & Sharma, R. (2023). The nexus between toxic-air pollution, health expenditure, and economic growth: An empirical study using ARDL. International Review of Economics & Finance, 84, 154–166. https://doi.org/10.1016/j.iref.2022.11.017

Younsi, M., Bechtini, M., & Lassoued, M. (2024). The relationship between insurance development, population, economic growth, and health expenditures in OECD countries: A panel causality analysis. Future Business Journal, 10(1), 113. https://doi.org/10.1186/s43093-024-00404-7

Published

2025-10-20

How to Cite

Sakshi, S., & Sharma, J. N. (2025). Cost determinants and financing of health expenditure: Evidence from India. International Journal of Economic Perspectives, 19(10), 164–177. Retrieved from http://ijeponline.org/index.php/journal/article/view/1189

Issue

Vol. 19 No. 10 (2025)

Section

Peer Review Articles
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Copyright (c) 2025 Sakshi, J. N. Sharma

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