Prioritization of government expenditure on health in India: A fiscal space perspective

Unequal distribution of fiscal resources and lower prioritization of budget towards healthcare are the most important challenges in achieving universal health coverage in India. This study has examined relationships between government health expenditure and fiscal space (i.e. tax revenue, non-tax revenue, fiscal transfer, and borrowings) in twenty-one states of India for the period of 1980–2014. Our panel regression results imply that mobilization of tax revenue has a positive impact, while borrowings have a negative impact on the allocation of government expenditure on healthcare in the long-run. The panel quantile regression results show that states associated with the low and middle level of revenue growth have been mobilizing finance through central government transfer and borrowings in short-run. Further, the panel vector error correction models show that sum of the lagged coefficients of borrowings have a greater impact on health financing process as compared to other sources of fiscal space at short-run, and the speed of adjustment towards long-run equilibrium is relatively slower. The overall analysis concludes that less domestic revenue mobilization and higher dependency of borrowings for healthcare financing may create fiscal stress on state finances in the long-run, and thereby it could possibly reduce the prioritization of spending. Therefore, improvement in revenue growth and proper utilization of fiscal transfer would be appropriate policy implications from this study.