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Health · indicator 38

Out-of-pocket health expenditure as share of total h

Modi ahead

Rahul India

57.59

synthetic 2023

Modi India

43.89

actual 2023

Difference

-24%

vs counterfactual

Placebo rank

2/36

p = 0.056

What this measures

Out-of-pocket health expenditure as share of total h is the share of all health spending that households pay directly at the point of care, rather than through insurance or the state. A falling number is an improvement.

India stood at 69.07 in 2013, before the two paths separate. By 2023 Modi’s current India had fallen to 43.89, while Rahul’s India — the blend of comparison countries that tracked India before 2014 — reached 57.59.

That leaves Modi’s current India 24% lower than Rahul’s India — better than where comparable economies ended up. Modi’s current India ranks 2/36 against placebo countries (p = 0.056), so the gap is larger than chance usually produces.

Both paths, 1984–2023

Weights fitted on 2000-2013 only; the counterfactual is projected across 2014-2023.

Modi India · actualRahul India · syntheticModi ahead

Divergence

Modi India minus Rahul India, in % of health spend.

What Rahul’s India is made of

Donor weights, solved on pre-2014 data. 35 countries in the pool; those not listed carry zero weight.

  • Côte d'Ivoire
    42.5%
  • Bangladesh
    38.1%
  • Myanmar
    19.4%

Method & reliability

Measure
oop_health_pct
Source type
Direct measure
Estimation window
2000-2013
Projection window
2014-2023
Donor pool
35 countries
Pre-2014 fit (RMSPE)
2.5% of pre-period mean
Placebo rank
2/36
Standardised p-value
0.056
BH-adjusted q across tier 1
0.224

The q-value applies a Benjamini–Hochberg correction across all 20 indicators with a counterfactual. We report p as the primary figure because each indicator is treated as a separate question rather than one family of hypotheses — but no result on this site survives q ≤ 0.10, and a reader who prefers the family view should read the p-values accordingly.

How this was calculated

Nothing here is chosen by hand. The comparison countries are not picked for being like India — they are whatever mix best reproduces India’s own path before 2014 on this particular measure.

  1. 1Describe India before 2014

    India's out-of-pocket health expenditure as share of total h is summarised over 2000-2013 — the value at five evenly spaced years starting 2000, plus three background controls averaged across the whole window: GDP per capita, urbanisation and life expectancy.

  2. 2Find the blend that matches it

    Each of the 35 comparison countries is described the same way. An optimiser then searches for the weighted mix of them whose pre-2014 path sits closest to India's. Weights cannot be negative and must sum to 100%, so the result is always a real combination of real countries — never an extrapolation.

  3. 3Check the match is good enough

    The blend misses India's actual pre-2014 path by 2.5% on average. That is close enough to treat the projection as meaningful.

  4. 4Project it forward and compare

    The weights are frozen and applied to 2014-2023, years the optimiser never saw. That projection is Rahul's India. The difference against what actually happened is the gap shown above.

  5. 5Test it against the other countries

    The whole procedure is re-run pretending each comparison country was the one treated in 2014. India's break ranks 2/36 against those placebos, giving p = 0.056 — larger than chance would usually produce.

Why Côte d'Ivoire?

Côte d'Ivoire carries 43% of the weight here — not because it resembles India economically or politically, but because its out-of-pocket health expenditure as share of total h moved like India’s did between 2000 and 2013. On 26 of the other 27 indicators on this site it carries no weight at all; where it does appear, the largest is catastrophic health spending (health-coverage proxy) at 36%. The blend is re-solved from scratch for every indicator, which is why the same country can dominate one estimate and be absent from the next.

3 of 35 comparison countries carry any weight at all. The rest are assigned zero by the optimiser.

The counterfactual is 'India without the 2014 structural break', estimated from comparator countries. It is not a forecast of any individual's policies. Sources: World Bank WDI API (2026-07-13); IRENA via Our World in Data.