Parkinson's Disease (PD) is a progressive neurodegenerative disorder characterized by motor symptoms, alongside non-motor manifestations. In advanced stages, people with PD (PwP) require extensive support to maintain mobility and quality of life, creating substantial demand on healthcare and reimbursement systems. Reported prevalence varies across Europe, with Germany at 350 per 100,000, Estonia at 314 per 100,000, Lithuania at 265 per 100,000, and Latvia at 217 per 100,000. This study applies a structured, qualitative comparative policy mapping approach (a subtype of comparative policy analysis) to describe and compare how national reimbursement and service-delivery rules shape access to PD treatments in Latvia, Lithuania, and Estonia, using Germany as a high-resource comparator. Key constructs, including availability, accessibility, affordability, and reimbursement, were defined a priori and operationalized into extractable indicators (e.g., formulary inclusion, reimbursement rate, cost-sharing, authorization requirements, and service-capacity proxies). Data sources included reimbursement agency databases, national formularies, policy documents, and expert input. Analysis was structured across three domains: pharmacological therapy, device-assisted therapies (DATs), and rehabilitation and supportive therapies. Findings show that Germany ensures broad access to all treatment domains, including newer pharmacological options, reimbursed DATs, and structured multidisciplinary rehabilitation. Estonia and Lithuania provide full reimbursement for standard medications but limited access to DATs and variable rehabilitation services. Latvia remains most constrained, with partial reimbursement for medications, no reimbursed DATs, and underdeveloped supportive therapies. Differences in reimbursement design (including cost-sharing and eligibility rules) and service capacity co-occur with broader system financing differences (total health expenditure: 12.6% of GDP in Germany vs. 7.6% in Latvia, 7.2% in Lithuania, and 7.0% in Estonia; government-funded expenditure: 10.1%, 4.9%, 4.7%, and 5.2%, respectively). These findings are descriptive and intended to clarify where policy design and implementation may plausibly contribute to cross-country variation in access.

Objectives: This study analyzes health financing patterns in Palestine from 2000 to 2023, with a focus on the 2023 expenditure indicators. It explores the growing burden of household out-of-pocket (OOP) payments, the allocation imbalance between curative and preventive care, and the need for increased government investment in health. Methodology: A systematic literature review, secondary data analysis, and expert interviews were conducted using data from the Palestinian Ministry of Health (MoH), Ministry of Finance, and the Palestinian Central Bureau of Statistics (PCBS). The latest indicators from 2023 were integrated to update policy insights. Results: In 2023, total current health expenditure (CHE) reached $1.87 billion, or 10.4% of GDP. Government contributions accounted for 46.4% of this spending, while households financed 42.1% through OOP payments, which accounts for more than double the WHO’s recommended ceiling. Per capita health expenditure stood at $363. Despite health expenditure reaching 10.4% of GDP in 2023, significant imbalances persist, with approximately 71–75% of spending directed toward curative care compared to only 1.5–4.8% allocated to preventive services. Combined with low government health expenditure (4.9% of GDP), this raises concerns about efficiency, equity, and long-term fiscal sustainability. Originality: This policy brief provides a context-specific analysis using the latest national data. It highlights financial vulnerabilities in the Palestinian health system and offers evidence-based recommendations to improve equity and efficiency under conditions of political and economic constraints.

Background: India has a complex health finance system comprising public and private financing. Despite the presence of a public healthcare system, the private sector is the major contributor to the healthcare services in India. Analyzing the relationship between government health expenditure and public health outcome is crucial, witnessing a shift in public health spending in recent years. This study helps understand how health expenditure trends align with major health indicators. Aim: This paper analyzes the correlation between Government of India’s health expenditure - measured across GDP (Gross Domestic Product), THE (Total Health Expenditure) - and the critical health indicators - neonatal, infant, child and maternal mortality rates and life expectancy at birth, over the study period 2013-14 to 2021-22. Methods: A longitudinal trend analysis was conducted for the period 2013-2021 using secondary published data. Health expenditure data were sourced from National Health Accounts (NHA) - India, and key health indicators were obtained from United Nations Inter-Agency Group for Child Mortality Estimation (UN-IGME) and the World Bank. Results: The Pearson correlational model demonstrated a significant inverse relationship between public health financing and mortality. GHE as a percentage of THE shows near-perfect negative correlation with NMR (r = -0.95), IMR (r = -0.96) and U5MR (r = -0.95%). Contrariwise, OOPE as a percentage of THE showed a strong near-positive relationship against NMR (r = 0.96), IMR (r = 0.97) and U5MR (r = 0.97). Moreover, sustained rise in per capita GHE is associated with reduced MMR. Conclusion: The study is evident of a positive association between increased public health expenditure and improved public health indicators in India. The findings demonstrate a transition from private and OOPE spending towards increased public health investment, which strongly correlates with positive public health indicators. Keywords: Government Health Expenditure (GHE); Out-of-Pocket-Expenditure (OOPE); Child Mortality; Maternal Mortality

This study examines the relationship between public health expenditure, economic growth, and health outcomes across eight northern states of India over the period of 2000–2021. Using panel data econometric techniques, the analysis employs Pooled Ordinary Least Squares, Random Effects, and Fixed Effects models, with Driscoll–Kraay standard errors to address heteroskedasticity, serial correlation, and cross-sectional dependence. To address potential endogeneity arising from unobserved common factors, an additional robustness check was conducted by estimating a two-way fixed effects model incorporating both state and year fixed effects. In addition, the Dumitrescu–Hurlin panel Granger causality approach is applied to explore the direction of causality among the variables. The core variables include infant mortality which is dependent variable while economic growth, and the growth rate of total public health expenditure are independent variables and gross fixed capital formation, urban population share, and mean years of education of women aged 20 and above are incorporated as control variables to mitigate model misspecification. The findings reveal that increases in public health expenditure, economic growth, and female education are associated with significant reductions in infant mortality. Urban population share, however, exhibits a positive association with IMR, reflecting the adverse health implications of rapid and unplanned urbanization in northern India. Gross fixed capital formation does not exert a statistically significant direct effect on infant mortality. The causality analysis indicates a bidirectional association between economic growth and infant mortality, suggesting mutual feedback effects, while a unidirectional causality runs from public health expenditure to infant mortality. These results underscore the critical role of sustained public investment in health, alongside inclusive economic growth and improvements in female education, in reducing infant mortality.

As per the World Bank Poverty and Inequality Platform (2021), approximately 12.92% of India’s population was below the poverty line in 2018, based on the international poverty line of $2.15 per day (PPP 2017). According to the National Health Authority (NHA) Estimates for 2018–19, the out-of-pocket health expenditure (OOPHE) share of total health expenditure (THE) was reported as 48.2% for the entire population, a decline from 64.2% in 2013–14. Thus, OOPHE is a major reason pushing households into poverty. Therefore, we seek to estimate the impact of OOPHE on poverty in India. We use data from the nationally representative survey on Household Social Consumption Health (2017–2018) and estimate poverty gap at the household level before and after making the OOPHE. Further, binary logit model was used for predicting the effects of various factors on the incidence of poverty. We find that the duration of hospitalization, household size, usage of private healthcare, out of pocket health expenditure, income, aged people in the family and caste are the significant determinants of impoverishment. Also, the implementation of various healthcare schemes and public health initiatives have not been substantial as they are found to be limited, and a significant proportion of the population is left with no health coverage. Findings stress on the need for the expansion of public health insurance coverage for safeguarding households against falling into poverty.

Intensive care is a cornerstone of modern health systems, yet it remains among the most resource-intensive and costly forms of care. While intensive care unit (ICU) costs represent a substantial portion of health care expenditures in many high-income countries, national-level data on ICU costs in Japan have been lacking. We aimed to estimate national ICU costs in Japan using administrative and hospital-level data, employing internationally comparable methods. We conducted a nationwide retrospective cohort study using the Diagnosis Procedure Combination Study Group database and the Hospital Bed Function Report during fiscal years 2018-2022. ICU costs were estimated using a bottom-up costing approach aligned with the method used in major international studies, and focused on certified adult and pediatric ICUs. Macroeconomic impact, temporal trends, and regional variation were assessed. We also analyzed the cost of intermediate care units (IMCU) and IMCU-ICU ratio. A total of 1,453,929 ICU patients were identified in the DPC Study Group database from 2018 to 2022, which covers 68.2% of all ICU beds in Japan. The mean ICU cost per patient-day was ¥197,277 (approximately $1,793 USD), and the estimated national ICU cost over the 2018-2022 period was ¥1,785 billion (mean ¥357 billion per year). This represented 0.065% of nominal gross domestic product (GDP), 0.56% of total health expenditures, 1.42% of hospital expenditures, and 2.17% of inpatient expenditures. The macroeconomic impact of ICU care was stable from 2018 to 2022. The proportion of ICU costs relative to nominal GDP, total health expenditures, and hospital expenditures in Japan was substantially lower than in the United States, Canada, and Australia. Regional variation was pronounced, with up to a 7.5-fold difference across prefectures. The estimated national IMCU cost over the 2018-2022 period was ¥2,838 billion (mean ¥568 billion per year), approximately 1.5 times greater than ICU cost (IMCU-ICU ratio is approximately 1.59). This study provides the first comprehensive national estimates of ICU costs in Japan using internationally aligned methods. These findings indicate lower ICU spending in Japan than in other high-income countries.

In China, despite broad coverage under the universal medical insurance system, the financial burden of healthcare measured by the proportion of out-of-pocket payments in total health expenditure, remains substantial. Commercial health insurance is expected to serve a supplementary role in alleviating this burden; however, rigorous empirical evidence on its effectiveness is limited. This study examines the association between commercial health insurance development and the out-of-pocket payment share in China. We employed provincial panel data from 31 mainland Chinese provinces spanning 2011–2022. Two-way fixed effects models were used to estimate the association between per capita commercial health insurance premium income (deflated to constant prices) and the share of out-of-pocket expenditure. We controlled provincial and year fixed effects, as well as key socioeconomics and healthcare covariates. Robust standard errors were clustered at the province and year levels. In addition, mediation analyses were conducted to explore the role of medical service utilization, and heterogeneity analysis was performed to assess the moderating effect of population ageing. The descriptive analysis indicated a negative correlation between the penetration of commercial health insurance and the share of out-of-pocket expenditure in total health spending. Regression estimates further demonstrated that a 10% increase in per capita premium income from commercial health insurance was associated with a statistically significant reduction of 0.43% points in the out-of-pocket share (β=-0.043, P < 0.01). This inverse association remained robust when the independent variable was lagged by one year. However, no evidence was found for a mediating effect via increased inpatient or outpatient service. In addition, the association between commercial health insurance and the out-of-pocket expenditure did not vary significantly across regions with different ageing rates. The findings indicate that the expansion of commercial health insurance in China is significantly associated with a reduction in the share of out-of-pocket expenditure, underscoring its potential contribution to strengthening household financial protection. The pattern of results is more consistent with a cost-sharing–related pathway than with increased service utilization. In the context of rapid population ageing and escalating healthcare costs, these results highlight the importance of further developing commercial health insurance as a complementary pillar to the universal medical insurance system. Policy efforts should prioritize optimizing benefit design and ensuring equitable access in order to enhance the system’s capacity to mitigate financial risks for households.

This article presents a comprehensive analysis of the health system of the Republic of Kazakhstan, its current state, key achievements and remaining challenges. Using the Harvard “Five Control Knobs” analytical framework (financing, payment, organization, regulation and behavior), as well as analysis of the dynamics of the main medical and demographic indicators and human resources for 2017-2023, the article seeks to fill the gap in the systemic understanding of the effectiveness of the ongoing reforms and their impact on the health of the population. Particular attention is paid to the relationship between the various components of the system and the identification of priority areas for further improvement.&lt;br /&gt; Our findings indicate a moderate improvement in population health, with average life expectancy increasing from 72.9 to 75.1 years and overall mortality returning to pre-pandemic levels. However, noncommunicable diseases continue to account for approximately 84% of all deaths. Total health expenditure remained low at 3.8% of GDP in 2023, while out-of-pocket spending accounted for 27.7% of current health expenditure, reflecting persistent gaps in financial protection. Although the introduction of mandatory social health insurance has expanded pooled financing, significant weaknesses persist in provider incentive structures, workforce distribution, and regulatory enforcement.&lt;br /&gt; Overall, the results suggest that while gradual progress has been achieved, chronic underfunding, system fragmentation, and governance challenges continue to constrain equity and efficiency, underscoring the need for coordinated, evidence-based reforms.

Development appears impressive when income rises rapidly, yet the real test of progress lies in whether households are shielded from illness-induced financial shock. The experience of Haryana’s health financing over the past decade reveals that welfare cannot be inferred from GDP growth alone; it must be examined through the structure of expenditure, the balance between public and private financing and the degree of financial protection available to citizens. Total Health Expenditure more than doubled over the study period, rising from ₹10,753 crore to ₹23,805 crore. Government Health Expenditure expanded substantially and its share increased from 25.59% to above 40% in recent years, though Private Health Expenditure continued to account for more than half of total spending. Out-of-Pocket Expenditure remained significant, even as its proportional share declined from 68.17% to nearly 51%, indicating partial but incomplete relief from direct household burden. Health Expenditure as a percentage of GSDP rose from 0.56% to 0.94% at its peak, yet remained below 1% throughout, despite the doubling of state income. Development appears impressive when income rises rapidly, yet the real test of progress lies in whether households are shielded from illness-induced financial shock. The experience of Haryana’s health financing over the past decade reveals that welfare cannot be inferred from GDP growth alone; it must be examined through the structure of expenditure, the balance between public and private financing and the degree of financial protection available to citizens. Total Health Expenditure more than doubled over the study period, rising from ₹10,753 crore to ₹23,805 crore. Government Health Expenditure expanded substantially and its share increased from 25.59% to above 40% in recent years, though Private Health Expenditure continued to account for more than half of total spending. Out-of-Pocket Expenditure remained significant, even as its proportional share declined from 68.17% to nearly 51%, indicating partial but incomplete relief from direct household burden. Health Expenditure as a percentage of GSDP rose from 0.56% to 0.94% at its peak, yet remained below 1% throughout, despite the doubling of state income. In this research financial protection indicators displayed gradual improvement. Catastrophic health expenditure, which peaked at 18.2%, declined to 14.5% in the latest estimates. The proportion of households resorting to borrowing or sale of assets reduced from double-digit levels to around 8%. Simultaneously, publicly financed insurance expanded considerably, with eligible beneficiaries increasing from 15.5 lakhs to 38.0 lakhs and claims rising sharply in recent years, reflecting deeper utilisation of institutional care. The evidence points toward a health financing transition marked by expanding public participation and insurance-based pooling, yet accompanied by persistent structural reliance on private and household spending. While nominal allocations and per capita spending increased, the limited share of health expenditure relative to GSDP suggests that fiscal prioritisation did not undergo a fundamental transformation. Improvements in financial protection were measurable but not absolute, as household out-of-pocket payments continued to represent a central component of the financing system. These patterns reaffirm that human well-being extends beyond aggregate output. Economic growth alone did not automatically translate into comprehensive financial security in health. Sustained public commitment, deeper risk pooling and strengthened primary and secondary care systems remain essential for converting economic expansion into durable gains in human capability and social protection.

Health economics is crucial for optimizing resource allocation and achieving equitable health outcomes in Africa. This study reviewed the historical evolution and current state of health economics in Africa, focusing on healthcare financing mechanisms, resource allocation strategies, and policy interventions. Data from peer-reviewed articles, research reports, and grey literature were synthesized from databases like PubMed, Scopus, Google Scholar and African Journals Online (AJOL). While healthcare financing dominated the literature, this review also covers resource allocation and broader health economics, highlighting key gaps in African research. Findings highlight significant challenges such as low public expenditure, high out-of-pocket costs, and inadequate insurance coverage. Out-of-pocket payments constitute over 40% of total health expenditure in half of the studied countries, while public health expenditure remains between $8 and $129 per capita annually, far below the $4,000 per capita in high-income countries. Only three African countries have met the Abuja Declaration target of allocating 15% of government budgets to health. Innovative financing mechanisms, such as community-based health insurance schemes and public-private partnerships, show promise in expanding coverage and improving service delivery. However, challenges in implementation, financial sustainability, and socio-cultural barriers persist. Technological innovations, including digital health solutions and telemedicine, could enhance efficiency by up to 15% by 2030. Primary challenges in Africa's health resource allocation include insufficient funding, inadequate human resources, inefficient management, poor data quality, and lack of political commitment. Policy recommendations include increasing public investment in health, improving resource allocation efficiency, and fostering sustainable financing through private sector and international donor partnerships.

BackgroundConsumption of foods high in fat, sugar, and sodium (HFSS) and obesity are rapidly increasing in India. Taxing HFSS foods has been proposed as one of the policy interventions to promote healthier diets globally. This study estimates the effect of this approach on nutrient intake, diet-related disease, and associated health and economic burdens in India.Methods and findingsWe use a nationally representative expenditure survey of 261,746 households, dietary requirements, and food composition tables to model individual nutrient intake. Consumer responsiveness to food price changes for three income terciles, captured in price elasticities, is estimated using an Almost Ideal Demand System model. Longer-term policy impacts are estimated through a novel dynamic microsimulation model, Health-GPS. Modelled policy outcomes include changes in risk exposures, disease incidence and burden, and total health expenditure. On average, 9.9% of total energy intake comes from HFSS items, based on the definition by the Food Safety and Standards Authority of India’s Labelling and Display Amendment Draft Regulations 2022. Applying the highest Goods and Services Tax (GST) rate of 40% on HFSS items is associated with a persistent average per capita decrease of 0.1705 kg/m2 (95% CI: −0.1709, −0.1700) in body mass index and 45.8 mg (95% CI: −45.9, −45.7) in daily sodium intake. Over 30 years, this could reduce annual disease incidence by up to 1.72% (95% CI: −1.78%, −1.66%) on average and prevent 0.63 million (95% CI: −0.71, −0.55) disability-adjusted life years per year from ischaemic heart disease, chronic kidney disease, stroke, diabetes, and asthma, reducing total health expenditure by US$601 million (95% CI: −624, −578) per year. Larger absolute health gains accrue to higher-income individuals, reflecting higher baseline HFSS food intake. Given substitution patterns and a price-inelastic demand, the tax change is expected to generate a 92.0% (95% CI: 88.2%, 95.7%) increase in tax revenue from foods and beverages with only a minor effect on household spending (+1.0%, 95% CI: + 0.0%, + 1.9%). This analysis only captures the potential health impacts of changes in energy and sodium intakes. In addition, it does not model underlying temporal trends in disease incidence beyond those due to demographic changes, which would make our health impact estimates conservative if baseline disease risks were to increase in the future.ConclusionsHigher taxation of HFSS foods could help mitigate rising incidence of diet-related diseases and morbidity in India, reduce healthcare costs, and serve as an additional source of revenue for the government.

Brazil's Unified Health System: history and challenges

This study examines the financing architecture of Sustainable Development Goal 3 (Good Health and Well-Being) through the interconnected pillars of Partnerships, Investment, and Accountability, with specific attention to West Africa, using Nigeria as a case study and comparable developing economies. Despite global commitment to the 2030 Agenda, the financing gap for Universal Health Coverage (UHC) in Sub-Saharan Africa remains substantial, worsened by macroeconomic instability, currency depreciation, post–COVID-19 fiscal pressures, and, in some cases, a lack of accountability. Using a qualitative descriptive design grounded in interpretivism, the study analyses secondary data from the World Health Organisation (WHO), the World Bank, and Nigerian fiscal policy frameworks. The theoretical foundation integrates the Human Capital Framework (World Bank, 2018), the Fiscal Space for Health Framework (Barasa et al., 2018), the Health Governance Model (Brinkerhoff &amp; Bossert, 2020), and the Health Systems Resilience Framework (Thomas et al., 2020) to examine structural constraints in health financing. Research shows that Nigeria’s reliance on Out-of-Pocket (OOP) payments—exceeding 70% of total health expenditure—continues to expose households to catastrophic costs and undermines equity objectives (World Bank, 2024; Adewole et al., 2021). While Public-Private Partnerships (PPPs) and Foreign Direct Investment (FDI) offer potential pathways for infrastructure expansion, they remain constrained by exchange rate volatility, regulatory uncertainty, and political risk. The study also identifies weaknesses in domestic accountability systems, particularly in the administration of the Basic Health Care Provision Fund (BHCPF) at sub-national levels (Eboreime et al., 2020). The study concludes that sustainable progress toward SDG 3 requires a shift from donor dependence to strengthened domestic resource mobilisation, mandatory social health insurance under the NHIA Act (2022), and institutionalised procurement transparency. Policy recommendations emphasise blended finance mechanisms, ring-fenced health taxes, Direct Facility Financing, and the adoption of Open Contracting Data Standards in health procurement.

Background:Heart failure (HF) is a complex clinical condition requiring resource-intensive management and substantial health expenditure. The adverse economic impact of medical care on patients or financial burden is increasingly recognised as a significant non-clinical entity affecting HF management in low- and middle-income countries (LMIC). We explored the factors associated with Financial Burden (FB) in HF patients in India.Methods:We recruited HF patients from 21 hospitals across India, selected to reflect regional diversity and varying stages of epidemiological transition. Trained personnel collected clinical and economic data using a validated and structured questionnaire. Expenditures were recorded in Indian rupees (INR) and converted to international dollars (INT$).Results:We recruited 1,859 participants. Nearly one-third of participants (30.2%) were women. The mean age was 55.9 (11.3) years, and the mean duration of formal education was 11.3 (3.8) years. Health insurance coverage was reported in one-third (32.2%) of the study population. The average annual out-of-pocket (OOP) expenditure was INR 1,06,566 (INT$ 4,709.10), constituting 92.6% (95% CI: 92.5–92.7) of the total health expenditure. Compared to the previous year, a decline in monthly income was reported by 32.3% of individuals and 36.2% of households. Catastrophic health spending (CHS) and distress financing (DF) were observed in 37.7% (35.5–39.9) and 17.7% (15.9–19.4) of the households, respectively. However, CHS and DF were lower [30.8% (26.2–35.4) and 13.6% (10.2–17.0), respectively] among those with health insurance compared to the uninsured [40.3% (37.6–43.0) and 18.9% (16.7–21.1), respectively].Conclusion:Seven out of 10 HF patients in India lack financial health protection. OOP expenditures, accounting for over 90% of total health spending, contribute significantly to economic distress in HF patients. Financial burden, affecting more than one-third of HF patients, carries profound implications for individual well-being. Addressing this financial burden, including CHS and DF, is essential for improving clinical outcomes and ensuring health equity.

Maternal and child health (MCH) outcomes in Nigeria remain poor, with maternal mortality exceeding 500 per 100,000 live births and under-five mortality at 102 per 1,000 far above global targets. This study investigates how health expenditure influences these outcomes using Nigeria Demographic and Health Survey (NDHS) 2018 and 2023–24, World Bank and WHO datasets. An Autoregressive Distributed Lag (ARDL) model was applied to analyze long- and short-run effects of public health expenditure (PHE) and out-of-pocket (OOP) spending on MMR and U5MR. Results show that Nigeria’s public health spending averages only 0.55% of GDP, while households contribute over 60% of total health expenditure. ARDL findings indicate that higher PHE significantly reduces mortality, while increased OOP payments worsen outcomes. The error correction term confirms a strong long-run relationship. The study concludes and recommends that improving public financing, expanding insurance coverage, reducing OOP payments, improving equity across geopolitical zones, and strengthening monitoring systems are essential to achieving SDG 3 on maternal and child survival.

To analyze the equity of total health expenditure in China from 2015 to 2021 and to provide a scientific basis for promoting the healthy development of total health expenditure in China. Total health expenditure was divided into three components: government health expenditure, social health expenditure, and out-of-pocket health payments. Data from 2015 to 2021 were extracted, and the concentration index and Kakwani index were used to evaluate the equity. Mainland China (excluding Hong Kong, Macau, and Taiwan) was divided into the northeast, east, central, and west regions, and the health resource density index (HRDI) of the China average was used as the reference standard to calculate the deficiency and deficiency ratio in each region. The stepwise regression analysis was used to analyze the influencing factors of per capita total health expenditure in China. The average percentages of government health expenditure, social health expenditure, and out-of-pocket health payments were 28.26%, 43.94%, and 27.79%, respectively, from 2015 to 2021. The concentration indices of total health expenditure, government health expenditure, social health expenditure, and out-of-pocket health payments were all greater than 0. The Kakwani index of total health expenditure, government health expenditure, and out-of-pocket health payments was less than 0, while the Kakwani index of social health expenditure was greater than 0 overall but became less than 0 in 2021. Both GDP and total health expenditure in the northeast region moved toward lower percentages, and GDP and total health expenditure in the east region moved toward higher percentages. Taking the HRDI of China’s average as the reference standard, the HRDI for total health expenditure, government health expenditure, social health expenditure, and out-of-pocket health payments in the east and central regions were higher than the reference standard, and the health expenditure in the east was more than 50% of the reference standard and the central region was more than 4% of the reference standard. The HRDI of total health expenditure, government health expenditure, social health expenditure, and out-of-pocket health payments in the west region was less than the reference standard, and the deficiency ratio of health expenditure in the west region was more than 46%. The HRDI of out-of-pocket health payments in the northeast region was higher than the reference standard from 2015 to 2020, and the HRDI of total health expenditure, government health expenditure, and social health expenditure in the northeast region was lower than the reference standard. Per capita disposable income and the number of health technicians per 1,000 population were the main factors influencing per capita total health expenditure in China from 2015 to 2021. The health financing structure was inappropriate, with a low percentage of government health expenditure and a high percentage of out-of-pocket health payments. Total health expenditure, government health expenditure, social health expenditure, and out-of-pocket health payments, all of the health expenditure tended to regions with higher levels of economic development. Total health expenditure, government health expenditure, and out-of-pocket health payments were regressive, and social health expenditure was progressive overall. Health expenditure was more adequate in the east and central regions and more inadequate in the west region. Per capita disposable income and the number of health technicians per 1,000 population had a greater impact on per capita total health expenditure in China.

Economic burden of Chagas disease in Latin American countries: a population-based cost-of-illness analysis from the RAISE study

In the low and middle-income country (LMIC) context of South Asia, mental health continues to sit in the shadows, under-resourced, misunderstood, and often silenced. Pakistan reflects this reality, with a wide gap between those who need care and those who receive it. Stigma, both public and self-directed, operates like an invisible wall, blocking identification, early help-seeking, and sustained care. A meaningful discussion must examine how cultural beliefs, structural gaps, and service delivery reinforce stigma and what needs to change at societal, policy, and health-system levels. The Burden and the Gap Pakistan, a lower-middle-income country of more than 255 million people,1 faces deep structural deficits in its mental health system. Mental health services receive less than 0.05% of total health expenditure,2 and the country has only about 500 psychiatrists, roughly 0.19 per 100,000 people.3 With few community-based services, large segments of the population lack access to specialist care.2 In this landscape of scarcity, stigma is not a side issue; it is central. When services are already limited, the fear of being judged or labeled “mentally ill” further delays or prevents help-seeking. This creates a vicious cycle: under-resourced systems make mental illness less visible, and that invisibility reinforces stigma and underinvestment.

ObjectiveVaccination is a proven method for preventing infectious diseases and their complications at individual and community levels. This study aimed to estimate actual public spending on immunisation and compare it with expenditures in other categories of direct medical costs and indirect costs related to absenteeism.MethodsThe analysis was based on previously published modelling framework Immunisation Planning Tool (IPT 2.0), populated with vaccine acquisition and administration cost data, vaccination coverage, demographic characteristics, and the scope of the immunisation programme, which defines the recommended schedules for specific patient populations in Poland. Spending on immunisation was compared with total health expenditure, budgets for drugs and prevention, and more specific expenditure categories (e.g., common diseases and drug groups classified by ATC system). In addition, it was compared with indirect costs related to absenteeism due to vaccine-preventable diseases.ResultsThe annual healthcare budget in 2024 in Poland was €44,752 million, of which €6,087 million (13.6%) was allocated to drug and €769 million (1.7%) to prevention. The immunisation programme cost €206 million (0.5%), with vaccine acquisition accounting for 91% of total immunisation costs. The annual per capita cost of vaccines was €4.99, which was notably lower than per capita reimbursement costs for drug classes used to treat diabetes (€12.12), cardiovascular diseases (€12.67), nervous system diseases (€9.42), and respiratory diseases (€7.68). Additionally, the total cost of absenteeism due to vaccine-preventable diseases (€371 million) significantly exceeded the total annual expenditure on the immunisation programme in Poland.ConclusionWith 1.7% of its healthcare budget allocated to prevention and 0.5% to vaccinations, Poland remains a country that invests relatively little in preventive measures. Given the high return on investment in immunisation—through reductions in both direct and indirect costs and in severe outcomes—increased and sustainable public funding for vaccination should be prioritised by healthcare policymakers. Sustainable public investment is crucial to addressing key immunisation challenges: low coverage, delayed introduction of cost-effective vaccines and service quality gaps. Rather than being driven by international expenditure comparisons, this investment should be justified by the evidence-based potential of immunisation to reduce the health and economic burden of vaccine-preventable diseases.

ABSTRACTOBJECTIVE To investigate the association between the 2014–2016 economic recession inBrazil and households’ direct expenditures on child health across thedistribution of such expenditures.METHODS Using longitudinal datasets that followed children born in Pelotas, in thestate of Rio Grande do Sul, in 2004 and 2015, estimates were obtained usinga Double–Hurdle model, which provides one outcome for the probability ofincurring any expenditure and another for the expected value of thoseexpenses when they occur.RESULTS The findings showed that the economic recession during this period reducedthe likelihood of incurring any health-related expenditure, excluding healthinsurance, by 34% among 12-month-old children and by 29% among 24-month-oldchildren. Regarding health insurance expenditures, the recession reduced thelikelihood of occurrence by 37% among 12-month-olds and by a substantial 68%among 24-month-olds. As for the amount spent, given that some expenditureoccurred, the economic recession was associated with an expected 15% highertotal spending excluding health insurance, and a 9% lower expected spendingon health insurance for 12-month-old children.CONCLUSIONS Thus, total health expenditures, excluding health insurance, were lesslikely to occur during the economic recession; however, when suchexpenditures occurred, their expected value was higher. In contrast,spending on health insurance was lower in both analyses, reinforcing itspreventive nature.