Tracking development assistance and government health expenditures for 35 malaria-eliminating countries: 1990–2017

Abstract Background Donor financing for malaria has declined since 2010 and this trend is projected to continue for the foreseeable future. These reductions have a significant impact on lower burden countries actively pursuing elimination, which are usually a lesser priority for donors. While domestic spending on malaria has been growing, it varies substantially in speed and magnitude across countries. A clear understanding of spending patterns and trends in donor and domestic financing is needed to uncover critical investment gaps and opportunities. Methods Building on the Institute for Health Metrics and Evaluation’s annual Financing Global Health research, data were collected from organizations that channel development assistance for health to the 35 countries actively pursuing malaria elimination. Where possible, development assistance for health (DAH) was categorized by spend on malaria intervention. A diverse set of data points were used to estimate government health expenditure on malaria, including World Malaria Reports and government reports when available. Projections were done using regression analyses taking recipient country averages and earmarked funding into account. Results Since 2010, DAH for malaria has been declining for the 35 countries actively pursuing malaria elimination (from $176 million in 2010 to$62 million in 2013). The Global Fund to Fight AIDS, Tuberculosis and Malaria is the largest external financier for malaria providing 96% of the total external funding for malaria in 2013, with vector control interventions being the highest cost driver in all regions. Government expenditure on malaria, while increasing, has not kept pace with diminishing DAH or rising national GDP rates, leading to a potential gap in service delivery needed to attain elimination. Conclusion Despite past gains, total financing available for malaria in elimination settings is declining. Health financing trends suggest that substantive policy interventions will be needed to ensure that malaria elimination is adequately financed and that available financing is effectively targeted to interventions that provide the best value for money

Tracking development assistance for HIV/AIDS: the international response to a global epidemic

Objective: To better understand the global response to HIV/AIDS, this study tracked development assistance for HIV/AIDS at a granular, program level. Methods: We extracted data from the Institute for Health Metrics and Evaluation's Financing Global Health 2015 report that captured development assistance for HIV/AIDS from 1990 to 2015 for all major bilateral and multilateral aid agencies. To build on these data, we extracted additional budget data, and disaggregated development assistance for HIV/AIDS into nine program areas, including prevention, treatment, and health system support. Results: Since 2000, $109.8 billion of development assistance has been provided for HIV/AIDS. Between 2000 and 2010, development assistance for HIV/AIDS increased at an annualized rate of 22.8$44.8 billion more in development assistance would have been available for HIV/AIDS. Since 1990, treatment and prevention were the most funded HIV/AIDS program areas receiving $24.6 billion and$22.7 billion, respectively. Since 2010, these two program areas and HIV/AIDS health system strengthening have continued to grow, marginally, with majority support from the US government and the Global Fund. An average of $252.9 of HIV/AIDS development assistance per HIV/AIDS prevalent case was disbursed between 2011 and 2013. Conclusion: The scale-up of development assistance for HIV/AIDS from 2000 to 2010 was unprecedented. During this period, international donors prioritized HIV/AIDS treatment, prevention, and health system support. Since 2010, funding for HIV/AIDS has plateaued

Spending on Children’s Personal Health Care in the United States, 1996-2013

ImportanceHealth care spending on children in the United States continues to rise, yet little is known about how this spending varies by condition, age and sex group, and type of care, nor how these patterns have changed over time.ObjectiveTo provide health care spending estimates for children and adolescents 19 years and younger in the United States from 1996 through 2013, disaggregated by condition, age and sex group, and type of care.Evidence reviewHealth care spending estimates were extracted from the Institute for Health Metrics and Evaluation Disease Expenditure 2013 project database. This project, based on 183 sources of data and 2.9 billion patient records, disaggregated health care spending in the United States by condition, age and sex group, and type of care. Annual estimates were produced for each year from 1996 through 2013. Estimates were adjusted for the presence of comorbidities and are reported using inflation-adjusted 2015 US dollars.FindingsFrom 1996 to 2013, health care spending on children increased from $149.6 (uncertainty interval [UI], 144.1-155.5) billion to$233.5 (UI, 226.9-239.8) billion. In 2013, the largest health condition leading to health care spending for children was well-newborn care in the inpatient setting. Attention-deficit/hyperactivity disorder and well-dental care (including dental check-ups and orthodontia) were the second and third largest conditions, respectively. Spending per child was greatest for infants younger than 1 year, at $11 741 (UI, 10 799-12 765) in 2013. Across time, health care spending per child increased from$1915 (UI, 1845-1991) in 1996 to $2777 (UI, 2698-2851) in 2013. The greatest areas of growth in spending in absolute terms were ambulatory care among all types of care and inpatient well-newborn care, attention-deficit/hyperactivity disorder, and asthma among all conditions.Conclusions and relevanceThese findings provide health policy makers and health care professionals with evidence to help guide future spending. Some conditions, such as attention-deficit/hyperactivity disorder and inpatient well-newborn care, had larger health care spending growth rates than other conditions

Assessing the Complex and Evolving Relationship between Charges and Payments in US Hospitals: 1996 – 2012

<div><p>Background</p><p>In 2013 the United States spent $2.9 trillion on health care, more than in any previous year. Much of the debate around slowing health care spending growth focuses on the complicated pricing system for services. Our investigation contributes to knowledge of health care spending by assessing the relationship between charges and payments in the inpatient hospital setting. In the US, charges and payments differ because of a complex set of incentives that connect health care providers and funders. Our methodology can also be applied to adjust charge data to reflect actual spending.</p><p>Methods</p><p>We extracted cause of health care encounter (cause), primary payer (payer), charge, and payment information for 50,172 inpatient hospital stays from 1996 through 2012. We used linear regression to assess the relationship between charges and payments, stratified by payer, year, and cause. We applied our estimates to a large, nationally representative hospital charge sample to estimate payments.</p><p>Results</p><p>The average amount paid per$1 charged varies significantly across three dimensions: payer, year, and cause. Among the 10 largest causes of health care spending, average payments range from 23 to 55 cents per dollar charged. Over time, the amount paid per dollar charged is decreasing for those with private or public insurance, signifying that inpatient charges are increasing faster than the amount insurers pay. Conversely, the amount paid by out-of-pocket payers per dollar charged is increasing over time for several causes. Applying our estimates to a nationally representative hospital charge sample generates payment estimates which align with the official US estimates of inpatient spending.</p><p>Conclusions</p><p>The amount paid per $1 charged fluctuates significantly depending on the cause of a health care encounter and the primary payer. In addition, the amount paid per charge is changing over time. Transparent accounting of hospital spending requires a detailed assessment of the substantial and growing gap between charges and payments. Understanding what is driving this divergence and generating accurate spending estimates can inform efforts to contain health care spending.</p></div

Weighted average from 1996–2012 of estimated payment ratios with 95% uncertainty intervals, shown by payer for the 10 largest causes of spending and the weighted average of all causes.

<p>Weighted average from 1996–2012 of estimated payment ratios with 95% uncertainty intervals, shown by payer for the 10 largest causes of spending and the weighted average of all causes.</p