Abstract
SummaryBackgroundAchieving universal health coverage (UHC) requires health financing systems that provide prepaid pooled resources for key health services without placing undue financial stress on households. Understanding current and future trajectories of health financing is vital for progress towards UHC. We used historical health financing data for 188 countries from 1995 to 2015 to estimate future scenarios of health spending and pooled health spending through to 2040.MethodsWe extracted historical data on gross domestic product (GDP) and health spending for 188 countries from 1995 to 2015, and projected annual GDP, development assistance for health, and government, out-of-pocket, and prepaid private health spending from 2015 through to 2040 as a reference scenario. These estimates were generated using an ensemble of models that varied key demographic and socioeconomic determinants. We generated better and worse alternative future scenarios based on the global distribution of historic health spending growth rates. Last, we used stochastic frontier analysis to investigate the association between pooled health resources and UHC index, a measure of a country's UHC service coverage. Finally, we estimated future UHC performance and the number of people covered under the three future scenarios.FindingsIn the reference scenario, global health spending was projected to increase from US$10 trillion (95% uncertainty interval 10 trillion to 10 trillion) in 2015 to $20 trillion (18 trillion to 22 trillion) in 2040. Per capita health spending was projected to increase fastest in upper-middle-income countries, at 4·2% (3·4–5·1) per year, followed by lower-middle-income countries (4·0%, 3·6–4·5) and low-income countries (2·2%, 1·7–2·8). Despite global growth, per capita health spending was projected to range from only $40 (24–65) to $413 (263–668) in 2040 in low-income countries, and from $140 (90–200) to $1699 (711–3423) in lower-middle-income countries. Globally, the share of health spending covered by pooled resources would range widely, from 19·8% (10·3–38·6) in Nigeria to 97·9% (96·4–98·5) in Seychelles. Historical performance on the UHC index was significantly associated with pooled resources per capita. Across the alternative scenarios, we estimate UHC reaching between 5·1 billion (4·9 billion to 5·3 billion) and 5·6 billion (5·3 billion to 5·8 billion) lives in 2030.InterpretationWe chart future scenarios for health spending and its relationship with UHC. Ensuring that all countries have sustainable pooled health resources is crucial to the achievement of UHC.FundingThe Bill & Melinda Gates Foundation.
Highlights
Estimates of future global and national health spending are valuable inputs for health system planning and can guide progress towards achieving universal health coverage (UHC)
The importance of UHC is highlighted by its codification in the Sustainable Development Goals (SDGs) in 2015, its thematic origins come from the Alma Ata Declaration of 1978.1,2 Nationally, the health benefits and protections against catastrophic health spending that result from UHC are highlighted by UHC exemplars such as Japan, Chile, and Thailand, and UHC initiatives or proposals are increasingly topping policy agendas.[3,4,5,6,7]
The largest growth rates were for out-of-pocket spending, followed by government health spending and development assistance for health (DAH)
Summary
Estimates of future global and national health spending are valuable inputs for health system planning and can guide progress towards achieving universal health coverage (UHC). UHC has emerged as both a global and national health priority, and progressive realisation of UHC is viewed as a critical path for improving health outcomes and achieving greater equity in health across all populations. The importance of UHC is highlighted by its codification in the Sustainable Development Goals (SDGs) in 2015, its thematic origins come from the Alma Ata Declaration of 1978.1,2 Nationally, the health benefits and protections against catastrophic health spending that result from UHC are highlighted by UHC exemplars such as Japan, Chile, and Thailand, and UHC initiatives or proposals are increasingly topping policy agendas.[3,4,5,6,7] Numerous case studies have sought to identify key factors in achieving UHC and have posited several drivers, including sustained political will, clearly defined health service packages, and phased implementation to ensure that all populations are covered.[8,9] across development and health-care settings, it is increasingly recognised that creating and maintaining robust health financing systems is important to achieving UHC. Health financing systems must be able to deliver a sufficient set www.thelancet.com Vol 391 May 5, 2018
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