However, the report points to a major long-term improvement within India. Out-of-pocket expenditure as a share of total health expenditure declined sharply from 64.2% in 2013-14 to 43.4% in 2022-23. Government officials attributed the decline to rising public health expenditure, expansion of Ayushman Bharat PM-JAY, free medicine schemes, wider access to primary health services through Jan Aushadhi shops and Ayushman Arogya Mandirs.Government health expenditure has almost tripled in the last decade, from Rs 1.3 lakh crore in 2013-14 to Rs 3.8 lakh crore in 2022-23, the report showed. Health economists say that despite recent reforms, India’s health care financing system remains largely dependent on domestic spending.According to the report, drugs and pharmaceutical purchases remain the largest driver of personal health care spending in India. International comparisons also showed huge contradictions at the global level. Switzerland reported the highest per capita out-of-pocket spending in the world at 2,302 international dollars, followed by Malta at 1,729 and Singapore at 1,647.Among major developed economies, the US reported an OOPE of 1,380 international dollars, while the UK stood at 857 and Canada at 1,038.At the low end of the global ranking, Kiribati recorded the world’s lowest OOPE at just 2 international dollars, followed by Tuvalu and Solomon Islands at 4 international dollars each.Public health experts say low out-of-pocket spending is considered a leading indicator of strong public health care systems because it reduces the risk of families falling into poverty due to medical expenses.