The fall in out-of-pocket expenditure from 62.6% of total health expenditure in 2014-15 to 43.4% in 2022-23 is the single most consequential figure here, and it deserves to be read carefully. Out-of-pocket spending is what a household pays directly at the point of care, and it is the mechanism by which illness converts into poverty — a hospitalisation that must be financed by selling land or borrowing at high interest does lasting damage regardless of the medical outcome. A share above 60% meant the Indian health system was financed principally by the sick themselves. The decline reflects several instruments working together rather than any one: cheaper generics through Jan Aushadhi, ceiling prices under DPCO, insurance cover of Rs 5 lakh per family per year under AB-PMJAY, free essential medicines at public facilities under the National Health Mission, and discounted medicines and implants through AMRIT pharmacies. At 43.4% the share remains high by international standards, so the direction is more encouraging than the level.