Is State-Wise Healthcare Budget Allocation Consistent With the Disease Burden in India? A Quinquennial Account (2015–2019)

INTRODUCTION: Evidence-based resource allocation may help to achieve immense health gains in resource-limited settings like India. Understanding healthcare expenditure and the corresponding disease burden could provide insights to plan optimal allocation of limited resources. Hence, we aimed to investigate the status and trends of state-wise healthcare budget allocation and the corresponding disease burden. METHODS: We retrieved state-wise healthcare budget allocation information in India for the years 2015 to 2019. Corresponding state-wise disability-adjusted-life-year (DALY) estimates from the Global Burden of Disease, injuries, and Risk Factors Study (GBD) was used to measure disease burden. The allocated budget (in rupees) per DALY was calculated for overall, communicable, and non-communicable diseases (NCDs). Descriptive statistics, correlation and graphical representations were used to identify and evaluate the trends and relationships between state-wise health budget allocation and disease burden. RESULTS: The allocated budget per DALY in 2019 was highest for Goa ([Image: see text] 34,260 or US$ 486.66) and lowest for Bihar ([Image: see text] 2,408 or US $ 34.20). Smaller, less populous states had higher budget allocations per DALY than larger states. Health budget allocation had an inverse relationship with infectious diseases and an identical linear relationship with NCDs. Most state-wise health budget allocations, as well as total disease burden, increased over the years except for Assam, Karnataka, and Himachal Pradesh. Also, such trends are not similar for the injuries and NCD disease burden. DISCUSSION: The health budget allocation is variable across states as well as between infectious and NCDs. The current increase in the allocated budget is incongruent with the increasing disease burden. There is a need for rapid expansion of healthcare resource allocation guided by evidence in India.