Evolution and patterns of global health financing 1995–2014: development assistance for health, and government, prepaid private, and out-of-pocket health spending in 184 countries

Dieleman, Joseph and Campbell, Madeline and Chapin, Abigail and Eldrenkamp, Erika and Fan, Victoria Y. and Haakenstad, Annie and Kates, Jennifer and Liu, Yingying and Matyasz, Taylor and Micah, Angela and Reynolds, Alex and Sadat, Nafis and Schneider, Matthew T. and Sorensen, Reed and Evans, Tim and Evans, David and Kurowski, Christoph and Tandon, Ajay and Abbas, Kaja M. and Abera, Semaw Ferede and Kiadaliri, Aliasghar Ahmad and Ahmed, Kedir Yimam and Ahmed, Muktar Beshir and Alam, Khurshid and Alizadeh-Navaei, Reza and Alkerwi, Ala'a and Amini, Erfan and Ammar, Walid and Amrock, Stephen Marc and Antonio, Carl Abelardo T. and Atey, Tesfay Mehari and Avila-Burgos, Leticia and Awasthi, Ashish and Barac, Aleksandra and Bernal, Oscar Alberto and Beyene, Addisu Shunu and Beyene, Tariku Jibat and Birungi, Charles and Bizuayehu, Habtamu Mellie and Breitborde, Nicholas J. K. and Cahuana-Hurtado, Lucero and Castro, Ruben Estanislao and Catalia-Lopez, Ferran and Dalal, Koustuv and Dandona, Lalit and Dandona, Rakhi and de Jager, Pieter and Dharmaratne, Samath D. and Dubey, Manisha and Farinha, Carla Sofia e Sa and Faro, Andre and Feigl, Andrea B. and Fischer, Florian and Fitchett, Joseph Robert Anderson and Foigt, Nataliya and Giref, Ababi Zergaw and Gupta, Rahul and Hamidi, Samer and Harb, Hilda L. and Hay, Simon I. and Hendrie, Delia and Horino, Masako and Jürisson, Mikk and Jakovljevic, Mihajlo B. and Javanbakht, Mehdi and John, Denny and Jonas, Jost B. and Karimi, Seyed M. and Khang, Young-Ho and Khubchandani, Jagdish and Kim, Yun Jin and Kinge, Jonas M. and Krohn, Kristopher J. and Kumar, G. Anil and El Razek, Hassan Magdy Abd and El Razek, Mohammed Magdy Abd and Majeed, Azeem and Malekzadeh, Reza and Masiye, Felix and Meier, Toni and Meretoja, Atte and Miller, Ted R. and Mirrakhimov, Erkin M. and Mohammed, Shafiu and Nangia, Vinay and Olgiati, Stefano and Osman, Abdalla Sidahmed and Owolabi, Mayowa O. and Patel, Tejas and Caicedo, Angel J. Paternina and Pereira, David M. and Perelman, Julian and Polinder, Suzanne and Rafay, Anwar and Rahimi-Movaghar, Vafa and Rai, Rajesh Kumar and Ram, Usha and Ranabhat, Chhabi Lal and Roba, Hirbo Shore and Salama, Joseph and Savic, Miloje and Sepanlou, Sadaf G. and Shrime, Mark G. and Talongwa, Roberto Tchio and Te Ao, Braden J. and Tediosi, Fabrizio and Tesema, Azeb Gebresilassie and Thomson, Alan J. and Tobe-Gai, Ruoyan and Topor-Madry, Roman and Undurraga, Eduardo A. and Vasankari, Tommi and Violante, Francesco S. and Werdecker, Andrea and Wijeratne, Tissa and Xu, Gelin and Yonemoto, Naohiro and Younis, Mustafa Z. and Yu, Chuanhua and Zaidi, Zoubida and El Sayed Zaki, Maysaa and Murray, Christopher J. L.. (2017) Evolution and patterns of global health financing 1995–2014: development assistance for health, and government, prepaid private, and out-of-pocket health spending in 184 countries. Lancet, 389 (10083). pp. 1981-2004.

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Background: An adequate amount of prepaid resources for health is important to ensure access to health services and for the pursuit of universal health coverage. Previous studies on global health financing have described the relationship between economic development and health financing. In this study, we further explore global health financing trends and examine how the sources of funds used, types of services purchased, and development assistance for health disbursed change with economic development. We also identify countries that deviate from the trends.
Methods: We estimated national health spending by type of care and by source, including development assistance for health, based on a diverse set of data including programme reports, budget data, national estimates, and 964 National Health Accounts. These data represent health spending for 184 countries from 1995 through 2014. We converted these data into a common inflation-adjusted and purchasing power-adjusted currency, and used non-linear regression methods to model the relationship between health financing, time, and economic development.
Findings: Between 1995 and 2014, economic development was positively associated with total health spending and a shift away from a reliance on development assistance and out-of-pocket (OOP) towards government spending. The largest absolute increase in spending was in high-income countries, which increased to purchasing power-adjusted $5221 per capita based on an annual growth rate of 3·0%. The largest health spending growth rates were in upper-middle-income (5·9) and lower-middle-income groups (5·0), which both increased spending at more than 5% per year, and spent $914 and $267 per capita in 2014, respectively. Spending in low-income countries grew nearly as fast, at 4·6%, and health spending increased from $51 to $120 per capita. In 2014, 59·2% of all health spending was financed by the government, although in low-income and lower-middle-income countries, 29·1% and 58·0% of spending was OOP spending and 35·7% and 3·0% of spending was development assistance. Recent growth in development assistance for health has been tepid; between 2010 and 2016, it grew annually at 1·8%, and reached US$37·6 billion in 2016. Nonetheless, there is a great deal of variation revolving around these averages. 29 countries spend at least 50% more than expected per capita, based on their level of economic development alone, whereas 11 countries spend less than 50% their expected amount.
Interpretation: Health spending remains disparate, with low-income and lower-middle-income countries increasing spending in absolute terms the least, and relying heavily on OOP spending and development assistance. Moreover, tremendous variation shows that neither time nor economic development guarantee adequate prepaid health resources, which are vital for the pursuit of universal health coverage.
Faculties and Departments:09 Associated Institutions > Swiss Tropical and Public Health Institute (Swiss TPH) > Former Units within Swiss TPH > Health Systems and Policies (de Savigny)
UniBasel Contributors:Tediosi, Fabrizio
Item Type:Article, refereed
Article Subtype:Research Article
Corporate Creators:Global Burden of Disease Health Financing Collaborator Network
Note:Publication type according to Uni Basel Research Database: Journal article
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Last Modified:24 Oct 2017 08:52
Deposited On:24 Oct 2017 08:52

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