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Trends in future health financing and coverage: future health spending and universal health coverage in 188 countries, 2016–40
Authors
C Abbafati
P Acharya
+99 more
AK Adou
A Ahmad Kiadaliri
K Alam
R Alizadeh-Navaei
A Alkerwi
W Ammar
CAT Antonio
O Aremu
SW Asgedom
TM Atey
L Avila-Burgos
R Ayer
H Badali
M Banach
A Banstola
A Barac
AB Belachew
C Birungi
NL Bragazzi
NJK Breitborde
L Cahuana-Hurtado
J Car
F Catalá-López
AY Chang
A Chapin
CS Chen
L Dandona
R Dandona
A Daryani
SD Dharmaratne
JL Dieleman
M Dubey
D Edessa
E Eldrenkamp
B Eshrati
A Faro
AB Feigl
AP Fenny
F Fischer
N Foigt
KJ Foreman
N Fullman
M Ghimire
Global Burden of Disease Health Financing Collaborator Network
S Goli
AD Hailu
S Hamidi
HL Harb
SI Hay
D Hendrie
G Ikilezi
M Javanbakht
D John
JB Jonas
A Kaldjian
A Kasaeian
YC Kasahun
IA Khalil
YH Khang
J Khubchandani
YJ Kim
JM Kinge
S Kosen
KJ Krohn
GA Kumar
A Lafranconi
H Lam
S Listl
H Magdy Abd El Razek
M Magdy Abd El Razek
A Majeed
R Malekzadeh
DC Malta
G Martinez
GA Mensah
A Meretoja
A Micah
TR Miller
EM Mirrakhimov
FW Mlashu
E Mohammed
S Mohammed
M Moses
SM Mousavi
M Naghavi
V Nangia
FN Ngalesoni
CT Nguyen
TH Nguyen
Y Niriayo
M Noroozi
MO Owolabi
T Patel
DM Pereira
S Polinder
M Qorbani
A Rafay
A Rafiei
N Sadat
Publication date
1 January 2018
Publisher
'Elsevier BV'
Doi
Abstract
This online publication has been corrected. The corrected version first appeared at thelancet.com on May 3, 2018© 2018 The Author(s). Background: Achieving 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. Methods: We 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. Findings: In the reference scenario, global health spending was projected to increase from US
10
t
r
i
l
l
i
o
n
(
95
10 trillion (95% uncertainty interval 10 trillion to 10 trillion) in 2015 to
10
t
r
i
ll
i
o
n
(
95
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
)
t
o
40 (24–65) to
40
(
24–65
)
t
o
413 (263–668) in 2040 in low-income countries, and from
140
(
90
–
200
)
t
o
140 (90–200) to
140
(
90–200
)
t
o
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. Interpretation: We 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.The Bill & Melinda Gates Foundation
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