Analysis of out-of-pocket health expenditure using the WHO Global Health Expenditure Database (GHED): A systematic review

Abstract

Introduction: Tracking out-of-pocket (OOP) health expenditure is a very useful reference for knowing the progress of countries in the goal of universal health coverage (UHC) in 2030. The World Health Organization (WHO) has developed the Global Health Expenditure Database (GHED) to facilitate analysis of health financing in countries or regions. The paper explores the use of GHED in the analysis of OOP health expenditure in the specialized literature. Objective: To perform a systematic review of the studies in which GHED is used to analyze OOP health expenditure in countries or groups of countries. Methods: The systematic review followed the guidelines of the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA). The database used was PubMed. All publications that were available on PubMed by July 30, 2020, were identified. Results: Twenty-five papers were identified. The use of the GHED to analyze OOP health expenditure was reported in five studies, one country study, and four studies with regional comparisons. The included studies cover the period 1995-2016. Discussion: The use of the GHED for the analysis of the evolution of OOP health expenditure in countries or regions is not very widespread in the specialized literature. The GHED has proven to be a very useful instrument for international comparison, although the fact that there are differences with national reports (public expenditure reviews) makes it advisable to combine both sources of information in the analysis of country- specific health policies. Conclusion: The systematic use of the GHED can be useful to improve the quality of information and estimates, such as country-specific expenditure analyses. To this end, it is particularly important to characterize the levels of OOP health expenditure and to incorporate policy monitoring into the analyses.