Health Economy

Research record

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.

Section index

1. 123.1 Health as welfare, market and productive infrastructure
2. 123.2 The household as the first health institution
3. 123.3 Public primary care and Ayushman Arogya Mandirs
4. 123.4 ASHA, ANM and the community health workforce
5. 123.5 PHCs, CHCs and the economics of first referral
6. 123.6 District hospitals as regional economic anchors
7. 123.7 Medical colleges and tertiary-care hubs
8. 123.8 Private clinics, nursing homes and hospital markets
9. 123.9 Pharmacies and medicine retail
10. 123.10 Diagnostics, imaging and laboratory economies
11. 123.11 Maternal care and childbirth expenditure
12. 123.12 Child health, immunisation and nutrition services
13. 123.13 Tuberculosis, infectious disease and programme economies
14. 123.14 Floods, vector-borne disease and seasonal demand
15. 123.15 Snakebite, emergency medicine and time-critical access
16. 123.16 Non-communicable disease and chronic-care markets
17. 123.17 Ageing, disability and long-term care
18. 123.18 Mental health and the hidden care economy
19. 123.19 Health shocks, debt and asset erosion
20. 123.20 Insurance, PM-JAY and public purchasing
21. 123.21 Transport, referral and medical travel
22. 123.22 Cross-border care between north Bihar and Madhesh
23. 123.23 Medical education as a regional labour market
24. 123.24 Nurses, technicians and the migration of health workers
25. 123.25 Procurement, medicines and supply-chain infrastructure
26. 123.26 Telemedicine, eSanjeevani and digital health
27. 123.27 Informal providers, trust and regulatory gaps
28. 123.28 Gender, caste, class and unequal access
29. 123.29 Measuring quality, cost and financial protection
30. 123.30 From treatment economy to health security

Cite this record

Gajendra Thakur. “Health Economy.” Videha Digital Research Archive: Mithila–Vajji–Anga. Videha — https://www.videha.co.in/ · ISSN 2229-547X · GitHub mirror: https://videha-ejournal.github.io/videha/ · Digital Research Archives on GitHub: https://github.com/videha-ejournal. https://videha-ejournal.github.io/mithila-vajji-anga/records/history/social-123/