Abstract
SummaryBackgroundAn adequate amount of prepaid resources for health is important to ensure access to health services and for the pursuit of universal health coverage. Previous studies on global health financing have described the relationship between economic development and health financing. In this study, we further explore global health financing trends and examine how the sources of funds used, types of services purchased, and development assistance for health disbursed change with economic development. We also identify countries that deviate from the trends.MethodsWe estimated national health spending by type of care and by source, including development assistance for health, based on a diverse set of data including programme reports, budget data, national estimates, and 964 National Health Accounts. These data represent health spending for 184 countries from 1995 through 2014. We converted these data into a common inflation-adjusted and purchasing power-adjusted currency, and used non-linear regression methods to model the relationship between health financing, time, and economic development.FindingsBetween 1995 and 2014, economic development was positively associated with total health spending and a shift away from a reliance on development assistance and out-of-pocket (OOP) towards government spending. The largest absolute increase in spending was in high-income countries, which increased to purchasing power-adjusted $5221 per capita based on an annual growth rate of 3·0%. The largest health spending growth rates were in upper-middle-income (5·9) and lower-middle-income groups (5·0), which both increased spending at more than 5% per year, and spent $914 and $267 per capita in 2014, respectively. Spending in low-income countries grew nearly as fast, at 4·6%, and health spending increased from $51 to $120 per capita. In 2014, 59·2% of all health spending was financed by the government, although in low-income and lower-middle-income countries, 29·1% and 58·0% of spending was OOP spending and 35·7% and 3·0% of spending was development assistance. Recent growth in development assistance for health has been tepid; between 2010 and 2016, it grew annually at 1·8%, and reached US$37·6 billion in 2016. Nonetheless, there is a great deal of variation revolving around these averages. 29 countries spend at least 50% more than expected per capita, based on their level of economic development alone, whereas 11 countries spend less than 50% their expected amount.InterpretationHealth spending remains disparate, with low-income and lower-middle-income countries increasing spending in absolute terms the least, and relying heavily on OOP spending and development assistance. Moreover, tremendous variation shows that neither time nor economic development guarantee adequate prepaid health resources, which are vital for the pursuit of universal health coverage.FundingThe Bill & Melinda Gates Foundation.
Highlights
Substantial disparities characterise the amount of resources spent on health globally.[1]
In many high-income countries, annual health spending has ballooned to higher than $5000 per capita. These divergent contexts are reflected in the thrust of public policy, with calls to rein in health spending growth in high-income countries, and appeals to mobilise more resources for health in low-income and middle-income countries.[2,3,4,5,6,7,8]
To explore the global health financing landscape and the patterns described by the health financing transition framework, this study examines spending on health in 184 countries over a 20-year period, 1995 to 2014
Summary
Substantial disparities characterise the amount of resources spent on health globally.[1]. In many high-income countries, annual health spending has ballooned to higher than $5000 per capita These divergent contexts are reflected in the thrust of public policy, with calls to rein in health spending growth in high-income countries, and appeals to mobilise more resources for health in low-income and middle-income countries.[2,3,4,5,6,7,8]. Notwithstanding these disparities, certain trends underpin health spending worldwide.[9,10,11] The health financing transition is defined by changes in the level and composition of health spending. The health financing transition has two key features, observed across countries and across time: (1) as countries experience economic development, they spend more per capita on health; and (2) less of that spending is out-ofpocket (OOP).[12,13,14] It has been theorised that both features of the health financing transition are driven by per capita income growth, technological advances, maturation of health financing system, greater government fiscal
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