43.4%
Household out-of-pocket spending as a share of India's Total Health Expenditure in 2022–23, from the Health Ministry's National Health Accounts (not of Current Health Expenditure, where the share is 49.9%). A national spending share, not the percentage of patients or families in hardship or debt.
Healthcare Without Financial Hardship: Patient Rights, Transparent Prices and Accountability
Out-of-pocket payments by households were 43.4% of everything India spent on health in 2022–23. That is down from 64.2% in 2013–14, but up from 39.4% a year earlier, according to the Health Ministry's own National Health Accounts.
That figure is a national share of spending. It does not say how many families borrowed or skipped care, and it leaves out costs such as the travel and lost wages of people who accompany a patient. What it does show is that for a large part of India's health system, the person at the counter is still paying directly.
India already has paper protections for that person: an official Charter of Patients' Rights that includes information on expected costs, displayed rates and an itemised bill, a rule requiring clinical establishments to display their rates, and a Clinical Establishments Act that the Centre says 19 States and Union Territories have adopted, with 17 others using their own laws. What a patient cannot easily find out is which of these apply in their State, what a treatment should cost, or where a complaint will go.
Aarunya's position: make the protections visible and checkable first. Prices on the wall, a written estimate, a complaint with a tracking number, a public record of which State has done what. And cost any promise of free care before we make it.
43.4%
Out-of-pocket payments as a share of Total Health Expenditure, 2022–23. The same series was 64.2% in 2013–14 and 39.4% in 2021–22. It counts spending, not patients, and excludes costs borne by relatives who accompany a patient. Status: verified.
source₹2,767
Average out-of-pocket health spending per person in 2022–23, at current prices, up from ₹2,600 in 2021–22. An average over the whole population, not what a treated patient pays. Status: verified.
source43.7%
Government Health Expenditure as a share of Total Health Expenditure, 2022–23 (₹3,85,332 crore, including capital spending). States account for about 63.7% of it and the Union about 36.3%. A share of spending, not of services delivered. Status: verified.
source1.43% of GDP
Government health spending in 2022–23 on the 2011–12 GDP series (1.48% on the new 2022–23 series), against the National Health Policy 2017 goal of 2.5% by 2025. The two GDP series should not be mixed. Status: verified.
sourceOur position
Patients deserve to know the price, their rights and where to complain before they are in debt. Aarunya asks for visibility and accountability first, and for a costing before any promise of free care. We allege no wrongdoing by any hospital or government.
Why this matters
Why this matters
Aarunya's stand
Aarunya stands with the patient at the counter. No family should be pushed into financial hardship because it could not find out what a treatment would cost, what it was entitled to, or where to complain. Rights and price rules that exist on paper must be visible, checkable and enforced. We will not promise free treatment we have not costed; we promise to publish what already exists, to measure what is not measured, and to hold every authority to account for the part of the system it controls. We allege no wrongdoing by any hospital, State government or official. We ask for the information that lets a patient, and the public, see for themselves.
A national share is not a patient's bill
The 43.4% describes how India's health spending is financed. It does not tell a family what a treatment will cost, how many families went into debt, or how many skipped care. The official report itself says it does not discuss policy implications, and its accounts leave out the transport, food, lodging and lost wages of relatives who accompany a patient. Anyone using this number to say "43.4% of patients are in hardship" is misusing it, and we will not.
The trend moves in both directions
Out-of-pocket share fell from 64.2% (2013–14) to 39.4% (2021–22) and then rose to 43.4% (2022–23). The Ministry presents the decade as a decline and describes the 2021–22 peak in government spending as a one-time COVID-era boost. The report also notes that its household estimates rest mainly on a 2017–18 survey, where earlier years rested on a 2014 one, and that the change between them may reflect several factors, including how people used care. So both the long fall and the latest rise should be read as estimates, and the series is not perfectly like-for-like.
The protections exist on paper
In June 2019 the Health Ministry sent States and Union Territories a Charter of Patients' Rights for adoption, and in August 2021 the National Council for Clinical Establishments approved additional rights. The Charter gives a patient the right to information on expected costs, to information on the rates charged for each service (displayed conspicuously in the local language and in English), and to a copy of records and a detailed, itemised bill. It also says every hospital should have a time-bound grievance mechanism, with the grievance officer's name displayed along with the contact details of the district registering authority. The Charter is guidance for adoption, not a single national law that applies identically everywhere. Which of these rights a patient can actually rely on depends on how their State has adopted and enforces them.
The price rule is waiting for a number
Rule 9 of the Clinical Establishments (Central Government) Rules, 2012 requires establishments to display their rates (9(i)) and to charge within a range the Centre determines in consultation with States (9(ii)). On 27 February 2024 the Supreme Court, hearing a petition that asks it to direct the Centre to determine rates under Rule 9, directed the Union Health Secretary to hold a meeting with State and UT counterparts and come with a concrete proposal, and said it would consider interim CGHS rates if none came. The Union's counsel had told the Court that the 2010 Act had been adopted by 12 State Governments and 7 Union Territories and that rates could not be set without State responses. In August 2026 the Centre told the Court the rule is valid while conceding that the range has not been fixed because States have not agreed on it. A challenge to Rule 9(ii) is pending, so nothing here is a final ruling. We read the 2024 order; the 2026 affidavit is known only from press reports.
What a patient is protected from depends on the State
States finance about 63.7% of government health spending, and the Clinical Establishments Act applies only where adopted. Out-of-pocket share also varies sharply: the report's table for select States puts it at 66.1% of total health spending in Uttar Pradesh and 64.0% in Kerala in 2022–23, against 43.41% nationally. A high share can reflect either low public provision or high private use. We draw no ranking from them.
Money for schemes is not the same as help at the counter
Government-financed insurance schemes accounted for ₹26,266 crore of 2022–23 spending (3.43% of current health expenditure). That is spending, not proof that eligible patients are enrolled, that claims are paid, or that exclusions are understood. We did not find a national, public record of claim rejection or denial of cashless treatment, and we do not allege one. We ask that it be published.
A complaint needs somewhere to go, and a record of where it went
On paper, the Charter gives a patient a route: the hospital's grievance officer, then the district registering authority. In our research we did not find a single public table of which States have adopted this, how quickly complaints are answered, or how many are upheld. That absence is a gap in what we could find, not a finding that no route exists. A complaint is not proof of a violation, and this page makes no claim about any hospital.
What this issue leaves to others
Emergency treatment without paperwork, vacant specialist posts, independent readiness certification and automatic referral are already Aarunya's position in Issue #006 and are not repeated here. Medicines-market questions are treated in Issue #011.
Who decides what
| Lever | Union | States / UTs | Facility |
|---|---|---|---|
| Government health spending (2022–23) | 36.3% of the total | 63.7% of the total | Spends allocations |
| Rate range (Rule 9(ii)) | Determines, in consultation with States | Must agree and enforce | Charges within the range |
| Display of rates (Rule 9(i)) | Rule exists in the 2012 Central Rules | Enforce where the Act or an equivalent law applies | Displays |
| Patient-rights charter | Sent for adoption (2019); additional rights approved (2021) | Adopt and enforce | Display and apply |
| Complaint route | Charter provides for a hospital grievance officer and district authority; Union coordinates | Establish, track and report | Receive and answer |
| Household survey and health accounts | MoSPI and NHSRC | Provide State data | n/a |
Spending shares: National Health Accounts 2022–23, Table 3 (verified). Other cells summarise the Charter (verified) and press reports of Rule 9 and the Clinical Establishments Act (provisional). See Facts & sources.
What is not known
This issue cannot say how many families borrowed or skipped care because of cost, how often hospitals charge more than they display, how many complaints are filed or upheld, how long patients wait, or how many insurance claims are rejected. We did not find national public data on these. The demands ask for it to be measured, not assumed.
The trade-off
Price ranges and mandatory estimates can protect patients but may add administrative cost, may be resisted by providers, and may reduce supply if set unrealistically. The Supreme Court has so far been reported to have directed consultation, not a particular price. Aarunya's demand is for a reasoned, published decision.
What we are asking for
- 1DEMAND 1 · Prices on the wall. Require every clinical establishment where the Act or an equivalent State law applies to display current rates in the local language and in English, as Rule 9(i) and the Charter already describe. Responsible: State and UT clinical-establishment authorities; facilities. Done when: each State publishes the list of establishments covered and the inspection results on rate display, by district.
- 2DEMAND 2 · A decision on the price range. Publish the outcome of the Union–State consultation on Rule 9(ii): either a range of rates or a reasoned statement of what will be done instead, with a timetable. Responsible: the Union Ministry of Health and Family Welfare with State governments. Done when: the consultation record and a notified range, or a published alternative with a date, are available. (A challenge to Rule 9(ii) is pending; this demand does not prejudge it.)
- 3DEMAND 3 · A written estimate and an itemised bill. For planned, non-emergency treatment, give the patient a written estimate beforehand, an itemised bill afterwards, and an explanation if the cost changes. The Charter already recognises the right to expected costs and to an itemised bill. Emergency care must never wait for this. Responsible: State authorities and facilities, through rules or licence conditions where legally available. Done when: covered facilities issue both documents as a matter of record and a billing-dispute route is published.
- 4DEMAND 4 · A public tracker of patient-rights adoption. Publish, State by State, which patient-rights provisions have been adopted, through what instrument, and which authority enforces them. Responsible: the Union Ministry of Health and Family Welfare (to compile); States and UTs (to supply). Done when: a single public table is available and is updated at stated intervals.
- 5DEMAND 5 · One trackable complaint route per State. Every State to publish where a patient complains, issue a tracking reference, state a response time, and report anonymised totals (received, pending, resolved, escalated) each year. The Charter's hospital grievance officer and district registering authority are the natural start. Responsible: State health departments and grievance authorities; the Union Ministry of Health and Family Welfare for coordination. Done when: annual anonymised reports are published with definitions, and a patient can follow a complaint to its outcome.
- 6DEMAND 6 · Entitlements in plain language. At every public facility and on each scheme's website, state in the local language what is free, which scheme covers what, who is eligible, what is excluded, and how to complain. Responsible: State health departments and State scheme agencies; the National Health Authority for national scheme material. Done when: notices are displayed and the same information is published online, and its accuracy is spot-checked and reported.
- 7DEMAND 7 · Measure out-of-pocket burden properly. Collect a fresh national household health survey, publish out-of-pocket share by State every year, and add a defined measure of catastrophic spending and of costs borne by accompanying relatives. Responsible: the Ministry of Statistics and Programme Implementation; the Ministry of Health and Family Welfare (NHSRC). Done when: the next health accounts state which survey year underlies the household estimates, publish State-level figures, and report the new measures with definitions.
- 8DEMAND 8 · A patient-facing facility scorecard, piloted first. Publish for each pilot facility which services are working, typical waiting times by service, and complaints received, with definitions and missing data marked. Responsible: State health departments, with technical standards from national bodies. Done when: a pilot covering named districts publishes dated scorecards, and the method is released before any comparison between facilities is made.
- 9DEMAND 9 · Cost it before promising it. Publish a costed definition of any essential-care package proposed to be free, with the funding source, before it is announced as a commitment. This is separate from, and consistent with, Aarunya's commitment in Issue #006 to raise public health spending toward the 2.5% of GDP goal. Responsible: Union and State finance and health departments. Done when: the package, its cost, funding and eligibility are published with the data used to estimate them.
Facts & sources
Every number here is checkable
We link the source for each claim and record the date we last verified it. If you find something wrong, tell us and we will correct it in public.
Household out-of-pocket expenditure was ₹3,82,629 crore, 43.41% of Total Health Expenditure (₹8,81,359 crore) and ₹2,767 per person, in 2022–23.
National Health Accounts Estimates for India 2022–23, NHSRC, Ministry of Health and Family Welfare (2026) · government document · verified 2026-10-29
Verified
A national share of spending. Not a count of patients, and not a measure of debt or skipped care.
Out-of-pocket share of Total Health Expenditure was 64.2% (2013–14), 48.8% (2017–18), 44.4% (2020–21), 39.4% (2021–22) and 43.4% (2022–23).
National Health Accounts Estimates for India 2022–23, Table 1 · government document · verified 2026-10-29
Verified
The report states no cause for the 2022–23 rise and says it does not discuss policy implications. Estimates before 2017–18 rest on a different survey round (see the survey-source fact).
Out-of-pocket spending was 49.9% of Current Health Expenditure (₹7,66,814 crore) in 2022–23, against 43.4% of Total Health Expenditure. Current excludes capital spending.
National Health Accounts Estimates for India 2022–23, Tables 2 and 4 · government document · verified 2026-10-29
Verified
The same payments measured against different totals. Never quote one as if it were the other.
Government Health Expenditure was ₹3,85,332 crore in 2022–23: 43.72% of Total Health Expenditure, 1.43% of GDP on the 2011–12 series (1.48% on the new series), ₹2,786 per person and 4.89% of general government expenditure. The Union's share was 36.3% and the States' 63.7%.
National Health Accounts Estimates for India 2022–23; Press Information Bureau release of 27 May 2026 · government document · verified 2026-10-29
Verified
A spending share, not services delivered. The release presents the 2021–22 peak as an extra boost during the COVID period.
The main source for out-of-pocket estimates in this report is the National Sample Survey 75th round (July 2017–June 2018); estimates through 2016–17 were extrapolated from the 71st round (2014). The report says the observed change between them may be attributed to several factors, including changes in utilisation. The 2022–23 Household Consumption Expenditure Survey was used for medical equipment and family-planning devices.
National Health Accounts Estimates for India 2022–23, Methodology · government document · verified 2026-10-29
Verified
The fall from 58.7% (2016–17) to 48.8% (2017–18) coincides with the switch of survey round. We do not claim how much of it is real; the report does not quantify this.
A news report states that the 2017–18 household figures are carried forward to 2022–23 by adjusting for inflation and population growth.
ThePrint, 28 May 2026 · media report · verified 2026-10-29
Provisional
Stated by a news report. We did not find it in those words in the report itself; confirm in the full methodology before relying on it.
The accounts exclude expenses of relatives or friends who accompany a patient, such as transport, food, lodging and lost wages.
National Health Accounts Estimates for India 2022–23, activities not included · government document · verified 2026-10-29
Verified
The patient's own transport is included. The omission means the figures understate the full cost to a family.
Government-financed health insurance schemes (including PM-JAY and State schemes) accounted for ₹26,266 crore, 3.43% of current health expenditure, in 2022–23. Social health insurance (CGHS, ESIS, ECHS) was ₹32,090 crore.
National Health Accounts Estimates for India 2022–23, Tables 4 and 10 · government document · verified 2026-10-29
Verified
Expenditure, not enrolment, claims paid or denied, or treatment outcomes.
National Health Policy 2017 sets the goal of raising government health spending from 1.15% to 2.5% of GDP by 2025.
National Health Policy 2017 · government document · verified 2026-10-29
Verified
The goal's year has passed, and 2022–23 data cannot show whether it was met by 2025.
The Charter of Patients' Rights and Responsibilities gives a patient the right to information on expected costs (i); to the rates charged for each type of service, displayed conspicuously in the local language and in English (ii); and to records and a detailed, itemised bill (iii). It also says every hospital shall have a time-bound grievance redressal mechanism, with the grievance officer's name and the district registering authority's contact details displayed (xix). Rights (i)–(xiii) were sent to States and UTs for adoption on 2 June 2019; rights (xiv)–(xx) were approved by the National Council for Clinical Establishments, with minutes issued on 23 August 2021.
Charter of Patients' Rights and Responsibilities, National Council for Clinical Establishments, updated 23 August 2021 · government document · verified 2026-10-29
Verified
Guidance for State adoption and dissemination; its legal force varies by jurisdiction. We read the Charter in full but not the 2019 covering letter.
Rule 9(i) of the Clinical Establishments (Central Government) Rules, 2012 requires clinical establishments to display rates; Rule 9(ii) requires them to charge within a range determined by the Centre in consultation with States. In a counter affidavit reported in August 2026 the Centre defended Rule 9(ii) while conceding that the range has not been fixed because States have not agreed on it.
Bar & Bench, 11 August 2026; The Law Advice, 12 August 2026 · media report · verified 2026-10-29
Provisional
Second-hand reporting of an affidavit, which we have not read. A challenge to Rule 9(ii) by the All India Ophthalmological Society is pending. Neither is a final ruling on the merits.
On 27 February 2024 a Supreme Court bench (Justices B.R. Gavai and Sandeep Mehta), in Veterans Forum for Transparency in Public Life v. Union of India (W.P.(C) 648/2020), which asks the Court to direct the Centre to determine rates under Rule 9 of the 2012 Rules, directed the Secretary, Department of Health, to hold a meeting with State and UT counterparts and come with a concrete proposal by the next hearing. The Court said it would consider issuing directions on interim CGHS rates if no proposal came. The Union's counsel told the Court that 12 State Governments and 7 Union Territories had adopted the 2010 Act and that rates could not be determined without State responses.
Supreme Court record of proceedings, 27 February 2024, W.P.(C) 648/2020 · court record · verified 2026-10-29
Verified
An interim direction to hold a meeting and prepare a proposal, not a finding on prices or a ruling on Rule 9(ii). We did not read the later orders, so we do not know what proposal, if any, was made.
The Centre told the Supreme Court that 19 States and UTs have adopted the Clinical Establishments (Registration and Regulation) Act, 2010, and 17 others have their own laws regulating clinical establishments. It said most of these laws require rate display but do not provide for a government-fixed range.
The Law Advice, 12 August 2026 · media report · verified 2026-10-29
Provisional
As reported from the Centre's own submission. It is consistent with the Union's counsel's statement of 27 February 2024 (12 State Governments and 7 Union Territories). The official portal's current list should be checked; the 19 and 17 may overlap or omit jurisdictions.
The National Health Accounts table of key health financing indicators for select States gives out-of-pocket expenditure as 66.1% of Total Health Expenditure in Uttar Pradesh (₹75,656 crore; ₹3,219 per person) and 64% in Kerala (₹30,197 crore; ₹8,388 per person) in 2022–23, against 43.41% nationally.
National Health Accounts Estimates for India 2022–23, Table A.6 (select States) · government document · verified 2026-10-29
Verified
Table A.6 covers select States only, because the report says some expenditure components are not available for others. A high share can reflect low public provision or heavy private use; it is not a ranking of State governments. State figures are rounded. The South First report of the same figures is secondary and not needed.
Questions
What exactly are you asking for?+
Nine things, each with a named authority: display prices, decide the Rule 9(ii) range, give written estimates and itemised bills, publish where patient rights have been adopted, give every State a trackable complaint route, state entitlements in plain language, measure out-of-pocket burden better, pilot a patient-facing scorecard, and cost any free-care promise before making it.
Is this already public?+
Parts are. The Charter, Rule 9 and the health accounts are published. What we could not find is a single public record of adoption by State, complaint outcomes, or waiting times. That gap is what the demands address.
Does 43.4% mean 43.4% of Indians cannot afford treatment?+
No. It is the share of total health spending paid directly by households in 2022–23. It does not count patients, debt or care skipped.
The Ministry says out-of-pocket spending fell from 64.2% to 43.4%. Why do you stress the rise?+
Both are in the same official table. The long fall is real in the data but partly reflects a change of survey round, and the latest year rose from 39.4%. Presenting only one direction would be selective.
Is Aarunya promising free treatment?+
No. We promise to cost and define any free-care package before announcing it (Demand 9). Aarunya's separate commitment to raise public health spending is in Issue #006.
Will fixing hospital prices reduce the supply of care?+
That is a real risk and a live argument. A price range set too low could push providers out or reduce quality, while no range leaves patients without a benchmark. This is why Demand 2 asks for a published consultation record and a reasoned outcome, not a particular price.
Can the Union do all this?+
Not alone. States finance about 63.7% of government health spending and implement most patient-facing rules. Each demand names the Union, the States or both.
How is this different from Issue #006?+
Issue #006 is about who uses public hospitals and about emergency care and specialists. This issue is about prices, rights, complaints and measuring the burden on patients. We do not repeat #006's demands.
What should I do if I was overcharged or refused information?+
Keep your bill and any estimate, and note the dates. The Charter says a hospital should have a grievance officer whose name is displayed, and the district registering authority's contact details; ask for them. Whether your State has adopted this is not something we have verified State by State, so we do not promise it. We will publish a checked list when the information in Demand 5 exists.
Where this stands
The whole process, in public
We publish each step as it happens — including the steps where nothing happens.
Patient rights (i)–(xiii) sent to States for adoption
2 June 2019The Health Ministry sends States and UTs the first thirteen patient rights, including information on rates and an itemised bill.
Additional patient rights approved
23 August 2021The National Council for Clinical Establishments approves rights (xiv)–(xx), including a time-bound grievance redressal mechanism.
Supreme Court asks the Health Secretary for a proposal on rates
27 February 2024The Court directs the Union Health Secretary to meet State and UT counterparts and come with a concrete proposal under Rule 9, in a petition by Veterans Forum for Transparency in Public Life.
National Health Accounts 2022–23 released
27 May 2026The Health Ministry releases the health accounts showing out-of-pocket spending at 43.4% of total health expenditure.
Source: Press Information Bureau
Centre defends Rule 9(ii) in the Supreme Court
11 August 2026Reported counter affidavit: the rule is valid, but the range has not been fixed because States have not agreed on it.
Source: Bar & Bench
What this issue does not claim
It does not claim that any hospital overcharges, that any complaint is proven, that any State government has failed, that patient rights are unenforceable, or that all treatment should be free. The demands are commitments Aarunya Swaraj Party will advocate for; they are not existing law or legal requirements.
Who is behind this
Aarunya Issues is an initiative of Aarunya Swaraj Party, being built by students who believe that public problems deserve evidence, accountability and action.
Read the founder's noteStay connected
We are building this in public. Watch it happen.
Every issue, every representation, every response — posted as it happens. Follow Aarunya Swaraj Party and be part of the record.
Does this affect you? Report it
If you or people near you face this, tell us. Reports are private: they go to a queue our team reads, and nothing you write here is published.
Report this problem
Prefer a full page? Open the report page.