Several Rajya Sabha seats go to elections this year. The President and the Vice-President are also due to be elected by August. We analyse the impact of the recent State Assembly elections on the composition of the Rajya Sabha and the outcome of the Presidential polls. Rajya Sabha - How will its composition change? Since Rajya Sabha members are elected by the elected members of State Legislative Assemblies, a change in the composition of State Assemblies can affect the composition of Rajya Sabha. A total of 61 Rajya Sabha seats are up for election in April and July. This includes 10 seats from Uttar Pradesh and 1 seat from Uttarakhand. In light of the recent Assembly elections, we work out two scenarios to estimate the composition of Rajya Sabha in 2012. Members of Rajya Sabha are elected through the system of proportional representation by means of the Single Transferable Vote (STV). In an STV election, a candidate is required to achieve a certain minimum number of votes (called the 'quota') to be elected. (For more details on the STV system, click here) For instance, in the case of Uttar Pradesh (UP) 10 Rajya Sabha seats go to election this year. Candidates will be elected to these 10 seats by the 403 elected MLAs of the Uttar Pradesh State Assembly. Each MLA will rank the candidates based on his/ her preference. After successive rounds of elimination, candidates who are able to secure at least 37 {or 403/(10+1) } votes will be declared elected. In the new UP Assembly, Samajwadi Party (SP) has a total strength of 224 members. As a result, SP can elect at least 6 (or 224/37) Rajya Sabha MPs of its choice. BSP's strength of 80 will allow it to elect 2 (or 80/37) MPs to Rajya Sabha. Similarily, the BJP with a strength of 47 MLAs can have one candidate of its choice elected to the Rajya Sabha. This leaves 1 seat. The fate of this seat depends on the alliances that may be formed since no other party in UP has 37 or more seats in the Assembly. If the Congress (28 seats) and RLD (9 seats) join hands, they may be able to elect a candidate of their choice. We build two scenarios which give the likely range of seats for the major coalitions and parties. The actual result will likely fall between these scenarios, depending on alliances for each election. Of the two scenarios, Scenario II is better for the UPA. It is based on the assumption that the UPA is able to put together the necessary support/ alliances to get its candidates elected to seats with indeterminate status. Scenario I is based on the assumption that the UPA is not able to put together the required support. As a result, the seats in question get allocated to candidates from other parties/ coalitions. (See Notes for the composition of the coalitions) Composition of Rajya Sabha
| Party/ Coalition | Current composition | Scenario I | Scenario II |
| Total seats |
245 |
245 |
245 |
| UPA |
93 |
95 |
98 |
| NDA |
66 |
67 |
65 |
| Left |
19 |
14 |
14 |
| BSP |
18 |
15 |
15 |
| SP |
5 |
9 |
9 |
| BJD |
6 |
8 |
7 |
| AIADMK |
5 |
5 |
5 |
| Nominated |
7 |
12 |
12 |
| Others |
21 |
20 |
20 |
| Vacant |
5 |
0 |
0 |
It appears that there would not be a major change in the composition of the Rajya Sabha. Which party's candidate is likely to become the next President? The next Presidential election will be held in June or July. The electoral college for the Presidential election consists of the elected members of Lok Sabha, Rajya Sabha and all Legislative Assemblies. Each MP/ MLA’s vote has a pre-determined value based on the population they represent. For instance, an MP's vote has a value of 708, an MLA from UP has a vote value of 208 and an MLA from Sikkim has a vote value of 7. (Note that all MPs, irrespective of the constituency or State they represent, have equal vote value) As is evident, changes in the composition of Assemblies in larger States such as UP can have a major impact on the outcome of the Presidential election. The elections to the office of the President are held through the system of proportional representation by means of STV (same as in the case of Rajya Sabha). The winning candidate must secure at least 50% of the total value of votes polled. (For details, refer to this Election Commission document). By this calculation, a candidate will need at least 5,48,507 votes to be elected as the President. If the UPA were to vote as a consolidated block, its vote tally would reach 4,50,555 votes under Scenario II (the one that is favourable for the UPA). Therefore, the UPA will have to seek alliances if it wants a candidate of its choice to be elected to the office of the President. Scenarios for Presidential elections (figures represent the value of votes available with each party/ coalition)
| Party/ Coalition | Scenario I | Scenario II |
| UPA |
4,48,431 |
4,50,555 |
| NDA |
3,05,328 |
3,03,912 |
| Left |
51,574 |
51,574 |
| BSP |
43,723 |
43,723 |
| SP |
69,651 |
69,651 |
| BJD |
30,923 |
30,215 |
| AIADMK |
36,216 |
36,216 |
| Others |
1,11,166 |
1,11,166 |
| Total |
10,97,012 |
10,97,012 |
| Minimum required to be elected |
5,48,507 |
5,48,507 |
What about the Vice-President? Elections to the office of the Vice-President (VP) will be held in July or August. The electoral college will consist of all members of Lok Sabha and Rajya Sabha (i.e. both elected and nominated). Unlike the Presidential elections, all votes will have an equal value of one. Like the President, the VP is also elected through the system of proportional representation by means of STV. The winning candidate must secure at least 50% of the total value of votes polled. Presently, two seats are vacant in the Lok Sabha. If we exclude these from our analysis, we find that a candidate will need at least 395 votes to be elected as the VP. Under our best case scenario, the UPA holds 363 votes in the forthcoming VP elections. As is the case with Presidential elections, the UPA will have to seek alliances to get a candidate of its choice elected to the office of the Vice-President. Scenarios for VP elections (figures represent the value of votes available with each party/ coalition)
| Party/ Coalition |
Scenario I |
Scenario II |
| UPA |
360 |
363 |
| NDA |
216 |
214 |
| Left |
38 |
38 |
| BSP |
36 |
36 |
| SP |
31 |
31 |
| BJD |
22 |
21 |
| AIADMK |
14 |
14 |
| Nominated |
14 |
14 |
| Others |
57 |
57 |
| Total |
788 |
788 |
| Minimum required to be elected |
395 |
395 |
Notes: [1] UPA: Congress, Trinamool, DMK, NCP,Rashtriya Lok Dal, J&K National Conference, Muslim League Kerala State Committee, Kerala Congress (M), All India Majlis-e-Ittehadul Muslimeen, Sikkim Democratic Front, Praja Rajyam Party, Viduthalai Chiruthaigal Katchi [2] NDA: BJP, JD(U), Shiv Sena, Shiromani Akali Dal [3] Left: CPI(M), CPI, Revolutionary Socialist Party,All India Forward Bloc
The Union Cabinet recently approved the launch of the National Health Protection Mission which was announced during Budget 2018-19. The Mission aims to provide a cover of five lakh rupees per family per year to about 10.7 crore families belonging to poor and vulnerable population. The insurance coverage is targeted for hospitalisation at the secondary and tertiary health care levels. This post explains the healthcare financing scenario in India, which is distributed across the centre, states, and individuals.
How much does India spend on health care financing vis-à-vis other countries?
The public health expenditure in India (total of centre and state governments) has remained constant at approximately 1.3% of the GDP between 2008 and 2015, and increased marginally to 1.4% in 2016-17. This is less than the world average of 6%. Note that the National Health Policy, 2017 proposes to increase this to 2.5% of GDP by 2025.
Including the private sector, the total health expenditure as a percentage of GDP is estimated at 3.9%. Out of the total expenditure, effectively about one-third (30%) is contributed by the public sector. This contribution is low as compared to other developing and developed countries. Examples include Brazil (46%), China (56%), Indonesia (39%), USA (48%), and UK (83%) (see Figure 1).
Who pays for healthcare in India? Mostly, it is the consumer out of his own pocket.
Given the public-private split of health care expenditure, it is quite clear that it is the private expenditure which dominates i.e. the individual consumer who bears the cost of her own healthcare. Let’s look at a further disaggregation of public spending and private spending to understand this.
In 2018-19, the Ministry of Health and Family Welfare received an allocation of Rs 54,600 crore(an increase of 2% over 2017-18). The National Health Mission (NHM) received the highest allocation at Rs 30,130 crore and constitutes 55% of the total Ministry allocation (see Table 1). Despite a higher allocation, NHM has seen a decline in the allocation vis-à-vis 2017-18.
Interestingly, in 2017-18, expenditure on NHM is expected to be Rs 4,000 crore more than what had been estimated earlier. This may indicate a greater capacity to spend than what was earlier allocated. A similar trend is exhibited at the overall Ministry level where the utilisation of the allocated funds has been over 100% in the last three years.
State level spending
A NITI Aayog report (2017) noted that low income states with low revenue capacity spend significant lower on social services like health. Further, differences in the cost of delivering health services have contributed to health disparities among and within states.
Following the 14th Finance Commission recommendations, there has been an increase in the states’ share in central pool of taxes and they were given greater autonomy and flexibility to spend according to their priorities. Despite the enhanced share of states in central taxes, the increase in health budgets by some states has been marginal (see Figure 2).
Consumer level spending
If cumulatively 30% of the total health expenditure is incurred by the public sector, the rest of the health expenditure, i.e. approximately 70% is borne by consumers. Household health expenditures include out of pocket expenditures (95%) and insurance (5%). Out of pocket expenditure dominate and these are the payments made directly by individuals at the point of services which are not covered under any financial protection scheme. The highest percentage of out of pocket health expenditure (52%) is made towards medicines (see Figure 3).
This is followed by private hospitals (22%), medical and diagnostic labs (10%), and patient transportation, and emergency rescue (6%). Out of pocket expenditure is typically financed by household revenues (71%) (see Figure 4).
Note that 86% of rural population and 82% of urban population are not covered under any scheme of health expenditure support. Due to high out of pocket healthcare expenditure, about 7% population is pushed below the poverty threshold every year.
Out of the total number of persons covered under health insurance in India, three-fourths are covered under government sponsored health schemes and the balance one-fourth are covered by private insurers. With respect to the government sponsored health insurance, more claims have been made in comparison to the premiums collected, i.e., the returns to the government have been negative.
It is in this context that the newly proposed National Health Protection Mission will be implemented. First, the scheme seeks to provide coverage for hospitalisation at the secondary and tertiary levels of healthcare. The High Level Expert Group set up by the Planning Commission (2011) recommended that the focus of healthcare provision in the country should be towards providing primary health care. It observed that focus on prevention and early management of health problems can reduce the need for complicated specialist care provided at the tertiary level. Note that depending on the level of care required, health institutions in India are broadly classified into three types: primary care (provided at primary health centres), secondary care (provided at district hospitals), and tertiary care institutions (provided at specialised hospitals like AIIMS).
Second, the focus of the Mission seems to be on hospitalisation (including pre and post hospitalisation charges). However, most of the out of the pocket expenditure made by consumers is actually on buying medicines (52%) as seen in Figure 3. Further, these purchases are mostly made for patients who do not need hospitalisation.
