The puzzle of public health expenditure and healthcare infrastructure in India : an empirical investigation

This study examines the temporal pattern of healthcare infrastructure and manpower indicators across Indian states and regions between 2006-2020 using a composite index and data from various published sources. The study also investigates the monetary factors determining the quality and provision of healthcare infrastructure and manpower for India as a whole as well as for rural and tribal areas discretely, using a panel regression model and the generalized method of moments. The results show that economically advanced states, like Haryana and Maharashtra, do not rank highly on the index based on the healthcare infrastructure and manpower indicators; rural states with smaller populations enjoy better healthcare services. Inadequate public health expenditure results in a low ranking on the composite index and is reflected in the high infant mortality rates in Bihar, Uttar Pradesh, and Madhya Pradesh, though the situation is reversed in Kerala. The panel regression model reveals that increased per capita public health expenditure has not translated into improved healthcare infrastructure and manpower in Indian states or tribal regions within those states. The public health expenditure to gross state domestic product ratio is a positively significant predictor of healthcare infrastructure and manpower in rural areas. The panel generalized method of moments results confirm that developing targeted healthcare infrastructure and manpower in India as a whole, as well as for rural and tribal areas in the short term, has been poorly realized.