Fiscal Policy for Equity:Analysing the Public Expenditure Benefit Incidence of Health Sector in India

The public expenditure benefit incidence analysis captures how well public services are targeted to certain groups in the population, across gender, ethnicity, income quintiles and geographical units. The BIA involves allocating unit cost according to individual utilization rates of public services. Using the latest International Classification of Diseases (ICD) produced by World Health Organisation (WHO) in 2024, we examine the disease-wise utilisation of publicly subsidised healthcare in India using benefit incidence analysis. Quite contrary to the earlier studies on benefit incidence analysis based on "aggregate" public health spending, our study attempts the benefit capture at the disaggregate level by meticulously mapping the WHO_ICD disease-specific codes to the data extracted from the unit records of the latest National Sample Survey health 75th rounds. Our broad findings based on the WHO_ICD disease-specific benefit incidence analysis revealed that the public health subsidy appears to be pro-poor or progressive in distribution for WHO_ICD categories, however with evident gender differentials. The disaggregated benefit incidence analysis based on ICD codes also showed that there is no "elite capture" in the public health financing in India. This inference has policy implications for strengthening the role of fiscal policy in tackling inequalities in the access and utilisation of health care in India.