India's per capita health spending is at its highest in real terms and the share of out-of-pocket health spending is declining, according to National Health Accounts data. Private health insurance spending shows the highest growth, but 77% of people were not covered by it in 2017-18, and the trend of falling out-of-pocket spending seems to have reversed course in 2019-20. State spending on health is 1.45 to 2.18 times central spending, but both need to increase spending to meet the target of spending 2.5% of GDP on health. Supply inadequacies are a key driver of people choosing private facilities over public ones.