Nagaland, Manipur cut health spending in 2023-24; Sikkim's jumps 50%

Three of the eight North East states spent less public money on health in 2023-24 than a year earlier, according to the National Health Accounts (NHA) Estimates for India 2023-24 released by the Union Health Ministry on November 15. Nagaland's government health spending fell 29.1%, Manipur's 21.8% and Mizoram's 4.9%, while Sikkim's rose by about half.

The NHA counts health spending by every arm of government, not just a state health department's budget. NEInsider compared the state table in the new report (Table A.7) with the same table in the 2022-23 report.

Year on year, state by state

Government health expenditure (GHE), 2022-23 to 2023-24:

• Nagaland: Rs 1,294 crore to Rs 917 crore (down 29.1%); per person Rs 6,470 to Rs 4,585
• Manipur: Rs 2,112 crore to Rs 1,652 crore (down 21.8%); per person Rs 7,040 to Rs 5,507
• Mizoram: Rs 980 crore to Rs 932 crore (down 4.9%); per person Rs 9,800 to Rs 9,320
• Assam: Rs 8,012 crore to Rs 8,214 crore (up 2.5%); per person Rs 2,226 to Rs 2,282
• Arunachal Pradesh: Rs 1,675 crore to Rs 1,777 crore (up 6.1%); per person Rs 8,375 to Rs 8,885
• Tripura: Rs 1,247 crore to Rs 1,344 crore (up 7.8%); per person Rs 3,118 to Rs 3,360
• Meghalaya: Rs 2,053 crore to Rs 2,260 crore (up 10.1%); per person Rs 6,843 to Rs 7,533
• Sikkim: Rs 740 crore to Rs 1,109 crore (up 49.9%); per person Rs 7,400 to Rs 16,026

Together, the eight states' government health spending barely moved, from Rs 18,113 crore to Rs 18,205 crore (about 0.5%): gains in Sikkim, Meghalaya and Tripura were largely cancelled out by the falls in Nagaland and Manipur.

Nagaland: bigger budget, smaller health share

Nagaland's fall stands out because its budget grew: total government expenditure rose from Rs 16,115 crore to Rs 17,942 crore and GSDP from Rs 35,629 crore to Rs 39,809 crore. Health's share of that spending dropped from 8% to 5.1%, and its share of GSDP from 3.6% to 2.3%.

At 5.1%, Nagaland ties with Punjab for the lowest share among all states in the table. The Morung Express, tracing the series back to 2017-18, reported spending had climbed steadily from Rs 615 crore that year to the 2022-23 peak; Rs 917 crore is still above every year up to 2020-21. As the Eastern Mirror put it, of every Rs 100 the state government spent, barely Rs 5 went to health.

The report does not explain why any state's spending changed.

Manipur and Mizoram also slipped

Manipur's drop covers the year the ethnic conflict broke out in May 2023. Even so, it still put 10% of its government spending into health, down from 12%, the third-highest share in the region after Meghalaya (10.7%) and Sikkim (10.2%).

Mizoram's dip was small; at Rs 9,320 per person it still outspends every NE state except Sikkim. Its first Asian Development Bank tranche for its universal healthcare scheme, Rs 205 crore, arrived this month (NEInsider, November 8).

Assam: lowest per person, but data on families exists

Assam has the region's biggest health budget but the smallest per-person figure, Rs 2,282, below the national Rs 2,959. It is the only NE state with full estimates (Table A.6): total health spending of Rs 13,795 crore, 59.5% paid by government and 34.8% (Rs 4,795 crore, Rs 1,332 per person) paid by households out of pocket, against 33.9% in 2022-23 and a national share of 42.7%.

For the other seven states, the report gives only government figures, saying survey samples in the North-Eastern and small states are too small for reliable household estimates. So the data cannot show whether families in Kohima or Imphal paid more themselves when government spending fell.

What it means for patients

State insurance schemes are one visible slice: the NHA lists Megha Health Insurance at Rs 173 crore in 2023-24, Mizoram's state scheme at Rs 100 crore and the Manipur Health Protection Scheme at Rs 40 crore. In Nagaland, the employees' health scheme dropped nine Fortis hospitals and Dispur Hospital from its list this month (NEInsider, November 8).

Nationally, government health spending more than tripled in ten years to Rs 4.14 lakh crore, and households' out-of-pocket share fell from 64.2% in 2013-14 to 42.7%, the ministry said in its PIB release.

What to watch

The figures describe 2023-24; the 2024-25 picture will come in the next NHA round, for which no date has been announced. Until then, state budget documents and the RBI's annual study of state finances are the best guide to whether health's share in Nagaland and Manipur has recovered.