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1. Future and potential spending on health 2015-40 : Development assistance for health, and government, prepaid private, and out-of-pocket health spending in 184 countries

Author

Dieleman, J. L., Campbell, M., Chapin, A., Eldrenkamp, E., Fan, V. Y., Haakenstad, A., Kates, J., Li, Z., Matyasz, T., Micah, A., Reynolds, A., Sadat, N., Schneider, M. T., Sorensen, R., Abbas, K. M., Abera, S. F., Ahmad Kiadaliri, A., Ahmed, M. B., Alam, K., Alizadeh-Navaei, R., Alkerwi, A., Amini, E., Ammar, W., Antonio, C. A. T., Atey, T. M., Avila-Burgos, L., Awasthi, A., Barac, A., Berheto, T. M., Beyene, A. S., Beyene, T. J., Birungi, C., Bizuayehu, H. M., Breitborde, N. J. K., Cahuana-Hurtado, L., Castro, R. E., Catalá-López, F., Dalal, Koustuv, Dandona, L., Dharmaratne, R. D. S. D., Dubey, M., Faro, A., Feigl, A. B., Fischer, F., Fitchett, J. R. A., Foigt, N., Giref, A. Z., Gupta, R., Hamidi, S., Harb, H. L., Hay, S. I., Hendrie, D., Horino, M., JÌrisson, M., Jakovljevic, M. B., Javanbakht, M., John, D., Jonas, J. B., Karimi, S. M., Khang, Y. -H, Khubchandani, J., Kim, Y. J., Kinge, J. M., Krohn, K. J., Kumar, G. A., Leung, R., Magdy Abd El Razek, H., Magdy Abd El Razek, M., Majeed, A., Malekzadeh, R., Malta, D. C., Meretoja, A., Miller, T. R., Mirrakhimov, E. M., Mohammed, S., Molla, G., Nangia, V., Olgiati, S., Owolabi, M. O., Patel, T., Paternina Caicedo, A. J., Pereira, D. M., Perelman, J., Polinder, S., Rafay, A., Rahimi-Movaghar, V., Rai, R. K., Ram, U., Ranabhat, C. L., Roba, H. S., Savic, M., Sepanlou, S. G., Te Ao, B. J., Tesema, A. G., Thomson, A. J., Tobe-Gai, R., Topor-Madry, R., Undurraga, E. A., Vargas, V., Vasankari, T., Violante, F. S., Wijeratne, T., Xu, G., Yonemoto, N., Younis, M. Z., Yu, C., Zaidi, Z., El Sayed Zaki, M., Murray, C. J. L., Network, Global Burden of Disease Health Financing Collaborator, Dieleman, J. L., Campbell, M., Chapin, A., Eldrenkamp, E., Fan, V. Y., Haakenstad, A., Kates, J., Li, Z., Matyasz, T., Micah, A., Reynolds, A., Sadat, N., Schneider, M. T., Sorensen, R., Abbas, K. M., Abera, S. F., Ahmad Kiadaliri, A., Ahmed, M. B., Alam, K., Alizadeh-Navaei, R., Alkerwi, A., Amini, E., Ammar, W., Antonio, C. A. T., Atey, T. M., Avila-Burgos, L., Awasthi, A., Barac, A., Berheto, T. M., Beyene, A. S., Beyene, T. J., Birungi, C., Bizuayehu, H. M., Breitborde, N. J. K., Cahuana-Hurtado, L., Castro, R. E., Catalá-López, F., Dalal, Koustuv, Dandona, L., Dharmaratne, R. D. S. D., Dubey, M., Faro, A., Feigl, A. B., Fischer, F., Fitchett, J. R. A., Foigt, N., Giref, A. Z., Gupta, R., Hamidi, S., Harb, H. L., Hay, S. I., Hendrie, D., Horino, M., JÌrisson, M., Jakovljevic, M. B., Javanbakht, M., John, D., Jonas, J. B., Karimi, S. M., Khang, Y. -H, Khubchandani, J., Kim, Y. J., Kinge, J. M., Krohn, K. J., Kumar, G. A., Leung, R., Magdy Abd El Razek, H., Magdy Abd El Razek, M., Majeed, A., Malekzadeh, R., Malta, D. C., Meretoja, A., Miller, T. R., Mirrakhimov, E. M., Mohammed, S., Molla, G., Nangia, V., Olgiati, S., Owolabi, M. O., Patel, T., Paternina Caicedo, A. J., Pereira, D. M., Perelman, J., Polinder, S., Rafay, A., Rahimi-Movaghar, V., Rai, R. K., Ram, U., Ranabhat, C. L., Roba, H. S., Savic, M., Sepanlou, S. G., Te Ao, B. J., Tesema, A. G., Thomson, A. J., Tobe-Gai, R., Topor-Madry, R., Undurraga, E. A., Vargas, V., Vasankari, T., Violante, F. S., Wijeratne, T., Xu, G., Yonemoto, N., Younis, M. Z., Yu, C., Zaidi, Z., El Sayed Zaki, M., Murray, C. J. L., and Network, Global Burden of Disease Health Financing Collaborator

Abstract

Background: The amount of resources, particularly prepaid resources, available for health can affect access to health care and health outcomes. Although health spending tends to increase with economic development, tremendous variation exists among health financing systems. Estimates of future spending can be beneficial for policy makers and planners, and can identify financing gaps. In this study, we estimate future gross domestic product (GDP), all-sector government spending, and health spending disaggregated by source, and we compare expected future spending to potential future spending. Methods: We extracted GDP, government spending in 184 countries from 1980-2015, and health spend data from 1995-2014. We used a series of ensemble models to estimate future GDP, all-sector government spending, development assistance for health, and government, out-of-pocket, and prepaid private health spending through 2040. We used frontier analyses to identify patterns exhibited by the countries that dedicate the most funding to health, and used these frontiers to estimate potential health spending for each low-income or middle-income country. All estimates are inflation and purchasing power adjusted. Findings: We estimated that global spending on health will increase from US$9.21 trillion in 2014 to $24.24 trillion (uncertainty interval [UI] 20.47-29.72) in 2040. We expect per capita health spending to increase fastest in upper-middle-income countries, at 5.3% (UI 4.1-6.8) per year. This growth is driven by continued growth in GDP, government spending, and government health spending. Lower-middle income countries are expected to grow at 4.2% (3.8-4.9). High-income countries are expected to grow at 2.1% (UI 1.8-2.4) and low-income countries are expected to grow at 1.8% (1.0-2.8). Despite this growth, health spending per capita in low-income countries is expected to remain low, at $154 (UI 133-181) per capita in 2030 and $195 (157-258) per capita in 2040. Increases in national hea

Published
2017
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2. Evolution and patterns of global health financing 1995-2014 : Development assistance for health, and government, prepaid private, and out-of-pocket health spending in 184 countries

Author

Dieleman, J., Campbell, M., Chapin, A., Eldrenkamp, E., Fan, V. Y., Haakenstad, A., Kates, J., Liu, Y., Matyasz, T., Micah, A., Reynolds, A., Sadat, N., Schneider, M. T., Sorensen, R., Evans, T., Evans, D., Kurowski, C., Tandon, A., Abbas, K. M., Abera, S. F., Ahmad Kiadaliri, A., Ahmed, K. Y., Ahmed, M. B., Alam, K., Alizadeh-Navaei, R., Alkerwi, A., Amini, E., Ammar, W., Amrock, S. M., Antonio, C. A. T., Atey, T. M., Avila-Burgos, L., Awasthi, A., Barac, A., Bernal, O. A., Beyene, A. S., Beyene, T. J., Birungi, C., Bizuayehu, H. M., Breitborde, N. J. K., Cahuana-Hurtado, L., Castro, R. E., Catalá-López, F., Dalal, Koustuv, Dandona, L., Dandona, R., De Jager, P., Dharmaratne, S. D., Dubey, M., Farinha, C. S. E. S., Faro, A., Feigl, A. B., Fischer, F., Fitchett, J. R. A., Foigt, N., Giref, A. Z., Gupta, R., Hamidi, S., Harb, H. L., Hay, S. I., Hendrie, D., Horino, M., JÌrisson, M., Jakovljevic, M. B., Javanbakht, M., John, D., Jonas, J. B., Karimi, S. M., Khang, Y. -H, Khubchandani, J., Kim, Y. J., Kinge, J. M., Krohn, K. J., Kumar, G. A., Magdy Abd El Razek, H., Magdy Abd El Razek, M., Majeed, A., Malekzadeh, R., Masiye, F., Meier, T., Meretoja, A., Miller, T. R., Mirrakhimov, E. M., Mohammed, S., Nangia, V., Olgiati, S., Osman, A. S., Owolabi, M. O., Patel, T., Paternina Caicedo, A. J., Pereira, D. M., Perelman, J., Polinder, S., Rafay, A., Rahimi-Movaghar, V., Rai, R. K., Ram, U., Ranabhat, C. L., Roba, H. S., Salama, J., Savic, M., Sepanlou, S. G., Shrime, M. G., Talongwa, R. T., Te Ao, B. J., Tediosi, F., Tesema, A. G., Thomson, A. J., Tobe-Gai, R., Topor-Madry, R., Undurraga, E. A., Vasankari, T., Violante, F. S., Werdecker, A., Wijeratne, T., Xu, G., Yonemoto, N., Younis, M. Z., Yu, C., Zaidi, Z., El Sayed Zaki, M., Murray, C. J. L., Network, Global Burden of Disease Health Financing Collaborator, Dieleman, J., Campbell, M., Chapin, A., Eldrenkamp, E., Fan, V. Y., Haakenstad, A., Kates, J., Liu, Y., Matyasz, T., Micah, A., Reynolds, A., Sadat, N., Schneider, M. T., Sorensen, R., Evans, T., Evans, D., Kurowski, C., Tandon, A., Abbas, K. M., Abera, S. F., Ahmad Kiadaliri, A., Ahmed, K. Y., Ahmed, M. B., Alam, K., Alizadeh-Navaei, R., Alkerwi, A., Amini, E., Ammar, W., Amrock, S. M., Antonio, C. A. T., Atey, T. M., Avila-Burgos, L., Awasthi, A., Barac, A., Bernal, O. A., Beyene, A. S., Beyene, T. J., Birungi, C., Bizuayehu, H. M., Breitborde, N. J. K., Cahuana-Hurtado, L., Castro, R. E., Catalá-López, F., Dalal, Koustuv, Dandona, L., Dandona, R., De Jager, P., Dharmaratne, S. D., Dubey, M., Farinha, C. S. E. S., Faro, A., Feigl, A. B., Fischer, F., Fitchett, J. R. A., Foigt, N., Giref, A. Z., Gupta, R., Hamidi, S., Harb, H. L., Hay, S. I., Hendrie, D., Horino, M., JÌrisson, M., Jakovljevic, M. B., Javanbakht, M., John, D., Jonas, J. B., Karimi, S. M., Khang, Y. -H, Khubchandani, J., Kim, Y. J., Kinge, J. M., Krohn, K. J., Kumar, G. A., Magdy Abd El Razek, H., Magdy Abd El Razek, M., Majeed, A., Malekzadeh, R., Masiye, F., Meier, T., Meretoja, A., Miller, T. R., Mirrakhimov, E. M., Mohammed, S., Nangia, V., Olgiati, S., Osman, A. S., Owolabi, M. O., Patel, T., Paternina Caicedo, A. J., Pereira, D. M., Perelman, J., Polinder, S., Rafay, A., Rahimi-Movaghar, V., Rai, R. K., Ram, U., Ranabhat, C. L., Roba, H. S., Salama, J., Savic, M., Sepanlou, S. G., Shrime, M. G., Talongwa, R. T., Te Ao, B. J., Tediosi, F., Tesema, A. G., Thomson, A. J., Tobe-Gai, R., Topor-Madry, R., Undurraga, E. A., Vasankari, T., Violante, F. S., Werdecker, A., Wijeratne, T., Xu, G., Yonemoto, N., Younis, M. Z., Yu, C., Zaidi, Z., El Sayed Zaki, M., Murray, C. J. L., and Network, Global Burden of Disease Health Financing Collaborator

Abstract

Background: An 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. Methods: We 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. Findings: Between 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%

Published
2017
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