Health Performance Index and Healthcare Expenditure in Assam: Are There any Structural Change?

  • Rimee BhuyanEmail author
  • Nizara Kalita
  • Gayatri Goswami
Part of the India Studies in Business and Economics book series (ISBE)


An increase in the state of health helps to achieve a maximum productive capacity of human capital and thereby increase the productivity of the market. So, sound health plays an important role for the economic growth and development of the country. But India is still lagging behind in achieving most of the health-related Millennium Development Goals. Within India, Assam is facing a lot of challenges to fulfill the goals of improving its health outcomes with an estimated GDP per capita Rs. 12,163 and the poverty head count ratio of 36.1% (2011), indicating Assam as one of the poorest states of India. However, some success has been achieved in the health outcomes of India by increasing the share of public expenditure on health with the implementation of National Rural Health Mission (NRHM). In this respect, the present study makes an attempt to examine the performance of health indicators in Assam over the years. In order to investigate whether there is any structural change in pre-launch and post-launch of NRHM, Bai and Perron test has been used for the period 1995–2013. The study also examines the relative influence of state public expenditure on the performance index of health indicators of Assam with the help of linear regression model. The study is based on secondary data collected from Ministry of Health and family Welfare department of India, Planning Commission of India and Reserve Bank of India’s State Finance-A study of the Budget. The study reveals that performance of health indicators of Assam has been showing a positive trend over time and there are three break points in the performance index namely 2002, 2005, and 2009. It has found that there is a positive and significant impact of public health expenditure on the performance index of health indicators of Assam. So, public intervention is necessary especially through the NRHM in making healthcare service affordable by all in order to improve health outcomes of Assam.


Health performance index Health expenditure Bai–Perron test Assam 


  1. Anand, S., & Ravallion, M. (1993). Human development in poor countries: On the role of private incomes and public services. The Journal of Economic Perspectives, 7(1), 133–150.CrossRefGoogle Scholar
  2. Bai, J., & Perron, P. (2002). Computation and analysis of multiple structural change models. Journal of Applied Econometrics, 18(1), 1–22.CrossRefGoogle Scholar
  3. Berman, P., & Ahuja, R. (2008). Government health spending in India. Economic and Political Weekly, 46(26–27), 209–216.Google Scholar
  4. Bhalotra, S. (2007). Spending to save? State health expenditure and infant mortality in India. Health Economics, 16, 911–928.CrossRefGoogle Scholar
  5. Bhat, R., & Jain, N. (2004). Analyzing of public expenditure on health using state level data. IIM Ahmedabad. Downloaded from, Accessed 10 April 2015.
  6. Chaurasia, R. A. (2013). India health sector performance assessment. MLC Foundation, Shyam Institute, Bhopal, MP 462003. Accessed from
  7. Dutta, I., & Bawari, S. (2007). Health and health care in Assam—a status report. CEHAT and OKD, Centre for Enquiry into Health and Allied Themes. Downloaded from, Accessed 10 April 2015.
  8. Gupta, I., & Choudhury, S. (2013). Scaling up health expenditure for universal health coverage: Prospects and challenges. India Infrastructure Report 2013/2014. Downloaded from, Accessed 10 April 2015.
  9. Hancock, T. (1993). Health, human development and the community eco-system: Three ecological models. Health Promotion International, Oxford Journals, 8(1), 41–47. Downloaded from, Accessed 10 April 2015.
  10. Hooda, S. K. (2013). Changing pattern of public expenditure on health in India, issues and challenges. ISID-PHFI Research Collaboration Programme. working paper series 01. Downloaded from, Accessed 10 April, 2015.
  11. Howitt, P. (2005). Health, human capital and economic growth: a Schumpeterian perspective. Pan American Health Organisation. Downloaded from, Accessed 15 Mar 2015.
  12. Joumard, I., & Kumar, A. (2015). Improving health outcomes and health care in India. OECD Economics Department. Working paper no. 1184. OECD Publishing. Downloaded from, Accessed 15 Mar 2015.
  13. Kutty, V. R. (2000). Historical analysis of the development of health care facilities in Kerala State, India. Health Policy and Planning, 15(1), 103–109.CrossRefGoogle Scholar
  14. Malik, G. (2005). An examination of the relationship between health and economic growth. ICRIER Working paper no. 185. Downloaded from, Accessed 15 Mar 2015.
  15. Manash, R. G., & Chakraborty, B. (2006). Human capital accumulation and endogenous growth in a dual economy. Hitotsubashi Journal of Economics, 47(2), 169–195.Google Scholar
  16. Rao, M. G., & Choudhury, M. (2012). Health care financing reforms in India. Working paper no.: 2012-100, National Institute of Public Finance and Policy. Downloaded from, Accessed 15 Mar 2015.
  17. World Bank. (2004). Assam health policy note. Washington, DC: World Bank. Downloaded from, Accessed 15 Mar 2015.

Copyright information

© Springer Nature Singapore Pte Ltd. 2018

Authors and Affiliations

  1. 1.Department of EconomicsGauhati UniversityGuwahatiIndia

Personalised recommendations