No study has yet attempted to measure mean out-of-pocket expenditure on health care at household level, separately for government and private health facilities in India. Therefore, this study analyses the change in the out-ofpocket expenditure between 1995-96 and 2004 for fifteen major states of India, separately for rural/urban sector and inpatient/outpatient care. Methods Using data from the 52nd and 60th rounds of the National Sample Survey, we present a disaggregated analysis of the trends and patterns of inflation adjusted household expenditure on health care. Results The analysis of average household expenditure on health care demonstrated that the mean outpatient care expenditure in government health sector decreased marginally at the aggregate level in both rural and urban sector, whereas it showed a significant increase in private facilities. A substantial rural-urban differential was also observed regarding households? mean hospitalization expenditure in private hospitals while the same was not true for government hospitals. Almost all states observed a very high growth in households? mean hospitalization expenditure in the private sector, while it was quite low in the government sector and even negative in rural areas of some states. The same pattern was observed in the growth pattern of households? outpatient care expenditure. Conclusions The analyses indicated a little improvement in the performance of government health sector in terms of out-of pocket expenditure. The improvement was more visible in developed and less developed states than in least developed states. Similarly, the improvement was more visible in rural areas than in urban areas.