India's Government Health Expenditure as a share of GDP remains below the National Health Policy 2017 target despite a threefold nominal rise. Critically examine the reasons and suggest measures for achieving Universal Health Coverage.

The National Health Accounts (NHA) Estimates 2022-23 show Government Health Expenditure (GHE) tripling to ₹3.85 lakh crore, yet its GDP share stands at just 1.43%, well short of the National Health Policy (NHP) 2017 target of 2.5% by 2025 — exposing a gap between nominal fiscal effort and structural adequacy [1].

Reasons the GDP target remains unmet

• Denominator effect: nominal GHE tripled, but rapid GDP growth over the decade muted the ratio's rise (1.15% → 1.43%) [1].
• Federal fragmentation: health is a State subject; uneven state fiscal capacity limits aggregate GHE despite central schemes.
• Low base and competing priorities: GHE forms only 4.89% of General Government Expenditure, crowded out by other demands [1].
• Absorption gaps: weak utilisation and infrastructure deficits blunt spending impact.

Signs of progress toward UHC

• OOPE fell sharply from 64.2% to 43.4% of Total Health Expenditure, cutting catastrophic-spending risk [1].
• Social Security Expenditure rose 6% → 9.9%, driven by AB-PMJAY [1].
• Primary healthcare spending doubled to ₹1.4 lakh crore via Health & Wellness Centres [1].

Measures for UHC

• Front-load public spending toward the 2.5% goal through higher state allocations.
• Deepen primary care and Health & Wellness Centres to pre-empt costly hospitalisation.
• Expand PMJAY coverage; strengthen human resources and diagnostics.
• Adopt 15th Finance Commission grants to correct inter-state disparities.

Falling OOPE and rising public financing signal a maturing system; sustained, equitable investment aligned with SDG-3 can convert nominal gains into genuine Universal Health Coverage.