Citation
Dieleman, Joseph L.; Sadat, Nafis; Chang, Angela Y.; Fullman, Nancy; Abbafati, Cristiana; Acharya, Pawan; Adou, Arsène K.; Ahmad Kiadaliri, Aliasghar; Alam, Khurshid; & Alizadeh-Navaei, Reza, et al. (2018). Trends in Future Health Financing and Coverage: Future Health Spending and Universal Health Coverage in 188 Countries, 2016-40. Lancet, 391(10132), 1783-1798. PMCID: PMC5946843Abstract
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 trillion (95% uncertainty interval 10 trillion to 10 trillion) in 2015 to $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) to $413 (263-668) in 2040 in low-income countries, and from $140 (90-200) to $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.
URL
http://dx.doi.org/10.1016/S0140-6736(18)30697-4Reference Type
Journal ArticleYear Published
2018Journal Title
LancetAuthor(s)
Dieleman, Joseph L.Sadat, Nafis
Chang, Angela Y.
Fullman, Nancy
Abbafati, Cristiana
Acharya, Pawan
Adou, Arsène K.
Ahmad Kiadaliri, Aliasghar
Alam, Khurshid
Alizadeh-Navaei, Reza
Alkerwi, Ala'a
Ammar, Walid
Antonio, Carl A. T.
Aremu, Olatunde
Asgedom, Solomon W.
Atey, Tesfay
Avila-Burgos, Leticia
Ayer, Rakesh
Badali, Hamid
Banach, Maciej
Banstola, Amrit
Barac, Aleksandra
Belachew, Abate B.
Birungi, Charles
Bragazzi, Nicola L.
Breitborde, Nicholas
Cahuana-Hurtado, Lucero
Car, Josip
Catalá-López, Ferrán
Chapin, Abigail
Chen, Catherine S.
Dandona, Lalit
Dandona, Rakhi
Daryani, Ahmad
Dharmaratne, Samath D.
Dubey, Manisha
Edessa, Dumessa
Eldrenkamp, Erika
Eshrati, Babak
Faro, André
Feigl, Andrea B.
Fenny, Ama P.
Fischer, Florian
Foigt, Nataliya
Foreman, Kyle J.
Ghimire, Mamata
Goli, Srinivas
Hailu, Alemayehu D.
Hamidi, Samer
Harb, Hilda L.
Hay, Simon I.
Hendrie, Delia
Ikilezi, Gloria
Javanbakht, Mehdi
John, Denny
Jonas, Jost B.
Kaldjian, Alexander
Kasaeian, Amir
Kasahun, Yawukal C.
Khalil, Ibrahim A.
Khang, Young-Ho
Khubchandani, Jagdish
Kim, Yun J.
Kinge, Jonas M.
Kosen, Soewarta
Krohn, Kristopher J.
Kumar, G. Anil
Lafranconi, Alessandra
Lam, Hilton
Listl, Stefan
Magdy Abd El Razek, Hassan
Magdy Abd El Razek, Mohammed
Majeed, Azeem
Malekzadeh, Reza
Malta, Deborah C.
Martinez, Gabriel
Mensah, George A.
Meretoja, Atte
Micah, Angela
Miller, Ted R.
Mirrakhimov, Erkin M.
Mlashu, Fitsum W.
Mohammed, Ebrahim
Mohammed, Shafiu
Moses, Mark
Mousavi, Seyyed M.
Naghavi, Mohsen
Nangia, Vinay
Ngalesoni, Frida Namnyak
Nguyen, Cuong T.
Nguyen, Trang H.
Niriayo, Yirga
Noroozi, Mehdi
Owolabi, Mayowa O.
Patel, Tejas
Pereira, David M.
Polinder, Suzanne
Qorbani, Mostafa
Rafay, Anwar
Rafiei, Alireza
Rahimi-Movaghar, Vafa
Rai, Nitin
Ram, Usha
Ranabhat, Chhabi L.
Ray, Sarah E.
Reiner, Robert C., Jr.
Sajadi, Haniye Sadat
Santoro, Rocco
Santos, João Vasco
Sarker, Abdur R.
Sartorius, Benn
Satpathy, Maheswar
Sepanlou, Sadaf G.
Shaikh, Masood Ali
Sharif, Mehdi
She, Jun
Sheikh, Aziz
Shrime, Mark G.
Sisay, Mekonnen
Soneji, Samir
Soofi, Moslem
Sorensen, Reed J. D.
Tadesse, Henok
Tao, Tianchan
Templin, Tara
Tesema, Azeb G.
Thapa, Subash
Tobe-Gai, Ruoyan
Topor-Madry, Roman
Tran Kiem, Cécile
Tran, Khanh B.
Tran, Tung T.
Undurraga, Eduardo A.
Vasankari, Tommi
Violante, Francesco S.
Werdecker, Andrea
Wijeratne, Tissa
Xu, Gelin
Yonemoto, Naohiro
Younis, Mustafa Z.
Yu, Chuanhua
Zaki, Maysaa E. S.
Zlavog, Bianca
Murray, Christopher J. L.