Abstract
Background: Achieving universal health coverage (UHC) requires increased domestic financing of health by low-income countries (LICs) and middle-income countries (MICs). It is critical to understand how much governments have devoted to health from their own sources and how much growth might be realistic over time. Methods: Using data from WHO’s Global Health Expenditure Database, we examined how the composition of current health expenditure changed by financing source and the main sources of growth in health expenditures from 2000-2015. We also disaggregated how much growth in government expenditures on health from domestic sources was due to economic growth, growth in the tax base, reallocations in government expenditures towards health, and the interactions of these factors. Results: Lower MICs (LMICs) and upper MICs (UMICs), as a group, saw a significant reduction in out-of-pocket expenditures and a significant growth in government expenditures on health from domestic sources as a share of current health expenditures over the period. This trend indicates likely progress in the pathway to UHC. For LICs, these trends were much more muted. Growth in government expenditure on health from domestic sources was driven primarily by economic growth in LICs, LMICs, and UMICs. Growth in government expenditure on health due to a strengthened tax base was most important in UMICs. For high-income countries, where economic growth was relatively slower and tax bases were already strong, the largest driver of growth in government expenditure on health from domestic sources was reallocation of the government budget towards health. Conclusions: Given these findings from 2000-2015, discussions about a government’s ability to reallocate to health from its overall budget need to be evidence based and pragmatic. Dialogue on domestic resource mobilization needs to emphasize overall economic growth and growth in the tax base as well as the share of health in the government budget.
Highlights
Achieving universal health coverage (UHC) requires increased domestic financing of health by low-income countries (LICs) and middle-income countries (MICs)
We show how much of the growth in GGHE-D, in real terms, from 2000 to 2015 was due to economic growth alone, expansion in public spending measured by general government expenditure (GGE)/gross domestic product (GDP), or reallocation of GGE towards health measured by GGHE-D/GGE
Key drivers of growth for the increases in GGHE-D from 2000 to 2015 With the Global Health Expenditure Database (GHED) database, we can identify how much of the growth in GGHE-D, in real terms, from 2000 to 2015 is due to (i) economic growth alone, (ii) expansion in public spending measured by government spending as a share of GDP (GGE/GDP), (iii) reallocation of GGE towards health measured by GGHE-D/GGE and (iv) interactions across these factors
Summary
Achieving universal health coverage (UHC) requires increased domestic financing of health by low-income countries (LICs) and middle-income countries (MICs). Results: Lower MICs (LMICs) and upper MICs (UMICs), as a group, saw a significant reduction in out-of-pocket expenditures and a significant growth in government expenditures on health from domestic sources as a share of current health expenditures over the period. This trend indicates likely progress in the pathway to UHC. Some MICs are transitioning out of grant or concessional external finance mechanisms, such as support from Gavi, the Vaccine Alliance, The Global Fund to Fight AIDS, Tuberculosis and Malaria, and World Bank International Development Association credits Such MICs need to replace these sources of external finance with domestic financing. Our goal was to understand the recent experience of LICs and MICs in financing their health sectors in order to better estimate the possible scope for future domestic resource mobilization
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