Health Economy

Detailed chapter description

Chapter 123 treats health as an economy without reducing it to a market. Illness and care redistribute time, money and labour across households, public facilities, private clinics, pharmacies, diagnostic centres, transport providers, insurers, medical colleges and governments. A district hospital is simultaneously a welfare institution, a large workplace, a purchaser of goods and services, and a node in a wider referral geography. A village pharmacy may be the quickest point of access but also a source of unrecorded expenditure and treatment without full diagnosis. A medical college can retain skilled employment in a regional city, while a household facing a serious illness may sell assets, borrow, postpone schooling or send a patient to Patna, Delhi or Kathmandu. The health economy of Mithila, Vajji and Anga therefore has to be reconstructed from care pathways, finance, workforce, transport and household-risk evidence together. The evidence is dated and uneven. Bihar's NFHS-5 fieldwork was conducted in 2019–20 and recorded 76.2 per cent institutional births, with 56.9 per cent of births in public facilities; it also reported average out-of-pocket expenditure of Rs 2,848 per delivery in a public facility. These indicators are useful historical baselines, not 2026 point estimates. At the national level, India's National Health Accounts for 2021–22 estimated household out-of-pocket expenditure at 39.4 per cent of total health expenditure, down from earlier levels as government expenditure increased. Nepal's National Health Accounts for 2019/20 still recorded household out-of-pocket payment at 54.2 per cent of current health expenditure. The figures cannot be directly mapped onto Mithila, Vajji, Anga or Madhesh without subregional data, but they show why financial protection remains central to any history of the contemporary health economy.