Trends in future health financing and coverage: future health spending and universal health coverage in 188 countries, 2016–40. Issue 10132 (5th May 2018)

• Record Type: Journal Article
• Authors: Dieleman, Joseph L; Sadat, Nafis; Chang, Angela Y; Fullman, Nancy; Abbafati, Cristiana; Acharya, Pawan; Adou, Arsène Kouablan; Ahmad Kiadaliri, Aliasghar; Alam, Khurshid; Alizadeh-Navaei, Reza; Alkerwi, Ala'a; Ammar, Walid; Antonio, Carl Abelardo T; Aremu, Olatunde; Asgedom, Solomon Weldegebreal; Atey, Tesfay Mehari; Avila-Burgos, Leticia; Ayer, Rakesh; Badali, Hamid; Banach, Maciej; Banstola, Amrit; Barac, Aleksandra; Belachew, Abate Bekele; Birungi, Charles; Bragazzi, Nicola L; Breitborde, Nicholas J K; 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 Desalegne; 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 Chane; Khalil, Ibrahim A; Khang, Young-Ho; Khubchandani, Jagdish; Kim, Yun Jin; 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 Carvalho; Martinez, Gabriel; Mensah, George A; Meretoja, Atte; Micah, Angela; Miller, Ted R; Mirrakhimov, Erkin M; Mlashu, Fitsum Weldegebreal; Mohammed, Ebrahim; Mohammed, Shafiu; Moses, Mark; Mousavi, Seyyed Meysam; Naghavi, Mohsen; Nangia, Vinay; Ngalesoni, Frida Namnyak; Nguyen, Cuong Tat; Nguyen, Trang Huyen; Niriayo, Yirga; Noroozi, Mehdi; Owolabi, Mayowa O; Patel, Tejas; Pereira, David M; Polinder, Suzanne; Qorbani, Mostafa; Rafay, Anwar; Rafiei, Alireza; Rahimi-Movaghar, Vafa; Rai, Rajesh Kumar; Ram, Usha; Ranabhat, Chhabi Lal; Ray, Sarah E; Reiner, Robert C; Sajadi, Haniye Sadat; Santoro, Rocco; Santos, João Vasco; Sarker, Abdur Razzaque; 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 Gebresilassie; Thapa, Subash; Tobe-Gai, Ruoyan; Topor-Madry, Roman; Tran, Bach Xuan; Tran, Khanh Bao; Tran, Tung Thanh; Undurraga, Eduardo A; Vasankari, Tommi; Violante, Francesco S; Werdecker, Andrea; Wijeratne, Tissa; Xu, Gelin; Yonemoto, Naohiro; Younis, Mustafa Z; Yu, Chuanhua; Zaki, Maysaa El Sayed; Zlavog, Bianca; Murray, Christopher J L;
• Is Part Of: Lancet. Volume 391:Issue 10132(2018)
• Page Start: 1783
• Page End: 1798
• Publication Date: 2018-05-05
• Subjects: Medicine -- Periodicals; Medicine -- Periodicals; Medicine; Medicine; Electronic journals; Periodicals; 610.5
• DOI: 10.1016/S0140-6736(18)30697-4
• Languages: English
• ISSNs: 0140-6736

Abstract

Summary: 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. Funding: The Bill & Melinda Gates Foundation.