Repository of Research and Investigative Information

Repository of Research and Investigative Information

Ilam University of Medical Sciences

Past, present, and future of global health financing: a review of development assistance, government, out-of-pocket, and other private spending on health for 195 countries, 1995-2050

Wed May 18 18:13:54 2022

(2019) Past, present, and future of global health financing: a review of development assistance, government, out-of-pocket, and other private spending on health for 195 countries, 1995-2050. Lancet. pp. 2233-2260. ISSN 0140-6736

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Abstract

Background Comprehensive and comparable estimates of health spending in each country are a key input for health policy and planning, and are necessary to support the achievement of national and international health goals. Previous studies have tracked past and projected future health spending until 2040 and shown that, with economic development, countries tend to spend more on health per capita, with a decreasing share of spending from development assistance and out-of-pocket sources. We aimed to characterise the past, present, and predicted future of global health spending, with an emphasis on equity in spending across countries. Methods We estimated domestic health spending for 195 countries and territories from 1995 to 2016, split into three categories-government, out-of-pocket, and prepaid private health spending-and estimated development assistance for health (DAH) from 1990 to 2018. We estimated future scenarios of health spending using an ensemble of linear mixed-effects models with time series specifications to project domestic health spending from 2017 through 2050 and DAH from 2019 through 2050. Data were extracted from a broad set of sources tracking health spending and revenue, and were standardised and converted to inflation-adjusted 2018 US dollars. Incomplete or low-quality data were modelled and uncertainty was estimated, leading to a complete data series of total, government, prepaid private, and out-of-pocket health spending, and DAH. Estimates are reported in 2018 US dollars, 2018 purchasing-power parity-adjusted dollars, and as a percentage of gross domestic product. We used demographic decomposition methods to assess a set of factors associated with changes in government health spending between 1995 and 2016 and to examine evidence to support the theory of the health financing transition. We projected two alternative future scenarios based on higher government health spending to assess the potential ability of governments to generate more resources for health. Findings Between 1995 and 2016, health spending grew at a rate of 4.00 (95 uncertainty interval 3.89-4.12) annually, although it grew slower in per capita terms (2.72 2.61-2.84) and increased by less than $ 1 per capita over this period in 22 of 195 countries. The highest annual growth rates in per capita health spending were observed in upper-middle-income countries (5.55% 5.18-5.95), mainly due to growth in government health spending, and in lower-middle-income countries (3.71% 3.10-4.34), mainly from DAH. Health spending globally reached $ 8.0 trillion (7.8-8.1) in 2016 (comprising 8.6% 8.4-8.7 of the global economy and $ 10.3 trillion 10.1-10.6 in purchasing-power parity-adjusted dollars), with a per capita spending of US$ 5252 (5184-5319) in high-income countries, $ 491 (461-524) in upper-middle-income countries, $ 81 (74-89) in lower-middle-income countries, and $ 40 (38-43) in low-income countries. In 2016, 0.4% (0.3-0.4) of health spending globally was in low-income countries, despite these countries comprising 10.0% of the global population. In 2018, the largest proportion of DAH targeted HIV/AIDS ($ 9.5 billion, 24.3% of total DAH), although spending on other infectious diseases (excluding tuberculosis and malaria) grew fastest from 2010 to 2018 (6.27% per year). The leading sources of DAH were the USA and private philanthropy (excluding corporate donations and the Bill & Melinda Gates Foundation). For the first time, we included estimates of China's contribution to DAH ($ 644.7 million in 2018). Globally, health spending is projected to increase to $ 15.0 trillion (14.0-16.0) by 2050 (reaching 9.4% 7.6-11.3 of the global economy and $ 21.3 trillion 19.8-23.1 in purchasing-power parity-adjusted dollars), but at a lower growth rate of 1.84% (1.68-2.02) annually, and with continuing disparities in spending between countries. In 2050, we estimate that 0.6% (0.6-0.7) of health spending will occur in currently low-income countries, despite these countries comprising an estimated 15.7% of the global population by 2050. The ratio between per capita health spending in high-income and low-income countries was 130.2 (122.9-136.9) in 2016 and is projected to remain at similar levels in 2050 (125.9 113.7-138.1). The decomposition analysis identified governments' increased prioritisation of the health sector and economic development as the strongest factors associated with increases in government health spending globally. Future government health spending scenarios suggest that, with greater prioritisation of the health sector and increased government spending, health spending per capita could more than double, with greater impacts in countries that currently have the lowest levels of government health spending. Interpretation Financing for global health has increased steadily over the past two decades and is projected to continue increasing in the future, although at a slower pace of growth and with persistent disparities in per-capita health spending between countries. Out-of-pocket spending is projected to remain substantial outside of high-income countries. Many low-income countries are expected to remain dependent on development assistance, although with greater government spending, larger investments in health are feasible. In the absence of sustained new investments in health, increasing efficiency in health spending is essential to meet global health targets.

Item Type: Article
Creators:
CreatorsEmail
Chang, A. Y.UNSPECIFIED
Cowling, K.UNSPECIFIED
Micah, A. E.UNSPECIFIED
Chapin, A.UNSPECIFIED
Chen, C. S.UNSPECIFIED
Ikilezi, G.UNSPECIFIED
Sadat, N.UNSPECIFIED
Tsakalos, G.UNSPECIFIED
Wu, J. J.UNSPECIFIED
Younker, T.UNSPECIFIED
Zhao, Y. X.UNSPECIFIED
Zlavog, B. S.UNSPECIFIED
Abbafati, C.UNSPECIFIED
Ahmed, A. E.UNSPECIFIED
Alam, K.UNSPECIFIED
Alipour, V.UNSPECIFIED
Aljunid, S. M.UNSPECIFIED
Almalki, M. J.UNSPECIFIED
Alvis-Guzman, N.UNSPECIFIED
Ammar, W.UNSPECIFIED
Andrei, C. L.UNSPECIFIED
Anjomshoa, M.UNSPECIFIED
Antonio, C. A. T.UNSPECIFIED
Arabloo, J.UNSPECIFIED
Aremu, O.UNSPECIFIED
Ausloos, M.UNSPECIFIED
Avila-Burgos, L.UNSPECIFIED
Awasthi, A.UNSPECIFIED
Ayanore, M. A.UNSPECIFIED
Azari, S.UNSPECIFIED
Azzopardi-Muscat, N.UNSPECIFIED
Bagherzadeh, M.UNSPECIFIED
Barnighausen, T. W.UNSPECIFIED
Baune, B. T.UNSPECIFIED
Bayati, M.UNSPECIFIED
Belay, Y. B.UNSPECIFIED
Belay, Y. A.UNSPECIFIED
Belete, H.UNSPECIFIED
Berbada, D. A.UNSPECIFIED
Berman, A. E.UNSPECIFIED
Beuran, M.UNSPECIFIED
Bijani, A.UNSPECIFIED
Busse, R.UNSPECIFIED
Cahuana-Hurtado, L.UNSPECIFIED
Camera, L. A.UNSPECIFIED
Catala-Lopez, F.UNSPECIFIED
Chauhan, B. G.UNSPECIFIED
Constantin, M. M.UNSPECIFIED
Crowe, C. S.UNSPECIFIED
Cucu, A.UNSPECIFIED
Dalal, K.UNSPECIFIED
De Neve, J. W.UNSPECIFIED
Deipatine, S.UNSPECIFIED
Demeke, F. M.UNSPECIFIED
Do, H. P.UNSPECIFIED
Dubey, M.UNSPECIFIED
El Tantawi, M.UNSPECIFIED
Eskandarieh, S.UNSPECIFIED
Esmaeili, R.UNSPECIFIED
Fakhar, M.UNSPECIFIED
Fazaeli, A. A.UNSPECIFIED
Fischer, F.UNSPECIFIED
Foigt, N. A.UNSPECIFIED
Fukumoto, T.UNSPECIFIED
Fullman, N.UNSPECIFIED
Galan, A.UNSPECIFIED
Gamkrelidze, A.UNSPECIFIED
Gezae, K. E.UNSPECIFIED
Ghajar, A.UNSPECIFIED
Ghashghaee, A.UNSPECIFIED
Goginashvili, K.UNSPECIFIED
Haakenstad, A.UNSPECIFIED
Bidgoli, H. H.UNSPECIFIED
Hamidi, S.UNSPECIFIED
Harb, H. L.UNSPECIFIED
Hasanpoor, E.UNSPECIFIED
Hassen, H. Y.UNSPECIFIED
Hay, S. I.UNSPECIFIED
Hendrie, D.UNSPECIFIED
Henok, A.UNSPECIFIED
Heredia-Pi, I.UNSPECIFIED
Herteliu, C.UNSPECIFIED
Hoang, C. L.UNSPECIFIED
Hole, M. K.UNSPECIFIED
Rad, E. H.UNSPECIFIED
Hossain, N.UNSPECIFIED
Hosseinzadeh, M.UNSPECIFIED
Hostiuc, S.UNSPECIFIED
Ilesanmi, O. S.UNSPECIFIED
Irvani, S. S. N.UNSPECIFIED
Jakovljevic, M.UNSPECIFIED
Jalali, A.UNSPECIFIED
James, S. L.UNSPECIFIED
Jonas, J. B.UNSPECIFIED
Jurisson, M.UNSPECIFIED
Kadel, R.UNSPECIFIED
Matin, B. K.UNSPECIFIED
Kasaeian, A.UNSPECIFIED
Kasaye, H. K.UNSPECIFIED
Kassaw, M. W.UNSPECIFIED
othersUNSPECIFIED
Keywords: sex-specific mortality systematic analysis disease coverage burden General & Internal Medicine
Divisions:
Page Range: pp. 2233-2260
Journal or Publication Title: Lancet
Journal Index: ISI
Volume: 393
Number: 10187
Identification Number: https://doi.org/10.1016/s0140-6736(19)30841-4
ISSN: 0140-6736
Depositing User: مهندس مهدی شریفی
URI: http://eprints.medilam.ac.ir/id/eprint/2397

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