Fiscal Transfers from the Union to States and Healthcare in India

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.