Future and potential spending on health 2015-40: Development assistance for health, and government, prepaid private, and out-of-pocket health spending in 184 countries

Joseph L. Dieleman, Madeline Campbell, Abigail Chapin, Erika Eldrenkamp, Victoria Y. Fan, Annie Haakenstad, Jennifer Kates, Zhiyin Li, Taylor Matyasz, Angela Micah, Alex Reynolds, Nafis Sadat, Matthew T. Schneider, Reed Sorensen, Kaja M. Abbas, Semaw Ferede Abera, Aliasghar Ahmad Kiadaliri, Muktar Beshir Ahmed, Khurshid Alam, Reza Alizadeh-Navaei & 89 others A. Alkerwi, Erfan Amini, Walid Ammar, Carl Abelardo T. Antonio, Tesfay Mehari Atey, Leticia Avila-Burgos, Ashish Awasthi, Aleksandra Barac, Tezera Moshago Berheto, Addisu Shunu Beyene, Tariku Jibat Beyene, Charles Birungi, Habtamu Mellie Bizuayehu, Nicholas J.K. Breitborde, Lucero Cahuana-Hurtado, Ruben Estanislao Castro, Ferran Catalá-López, Koustuv Dalal, Lalit Dandona, Rakhi Dandona Samath D. Dharmaratne, Manisha Dubey, Andé Faro, Andrea B. Feigl, Florian Fischer, Joseph R. Anderson Fitchett, Nataliya Foigt, Ababi Zergaw Giref, Rahul Gupta, Samer Hamidi, Hilda L. Harb, Simon I. Hay, Delia Hendrie, Masako Horino, Mikk Jürisson, Mihajlo B. Jakovljevic, Mehdi Javanbakht, Denny John, Jost B. Jonas, Seyed M. Karimi, Young Ho Khang, Jagdish Khubchandani, Yun Jin Kim, Jonas M. Kinge, Kristopher J. Krohn, G.A. Kumar, Ricky Leung, Hassan Magdy Abd El Razek, Mohammed Magdy Abd El Razek, Azeem Majeed, Reza Malekzadeh, Deborah Carvalho Malta, Atte Meretoja, Ted R. Miller, Erkin M. Mirrakhimov, Shafiu Mohammed, Gedefaw Molla, Vinay Nangia, Stefano Olgiati, Mayowa O. Owolabi, Tejas Patel, Angel J. Paternina Caicedo, David M. Pereira, Julian Perelman, Suzanne Polinder, Anwar Rafay, Vafa Rahimi-Movaghar, Rajesh Kumar Rai, Usha Ram, Chhabi Lal Ranabhat, Hirbo Shore Roba, Miloje Savic, Sadaf G. Sepanlou, Braden J. Te Ao, Azeb Gebresilassie Tesema, Alan J. Thomson, Ruoyan Tobe-Gai, Roman Topor-Madry, Eduardo A. Undurraga, Veronica Vargas, Tommi Vasankari, Francesco S. Violante, Tissa Wijeratne, Gelin Xu, Naohiro Yonemoto, Mustafa Z. Younis, Chuanhua Yu, Zoubida Zaidi, Maysaa El Sayed Zaki, Christopher J.L. Murray

Research output: Contribution to journalArticleAcademicpeer-review

42 Citations (Scopus)

Abstract

Background: The amount of resources, particularly prepaid resources, available for health can affect access to health care and health outcomes. Although health spending tends to increase with economic development, tremendous variation exists among health financing systems. Estimates of future spending can be beneficial for policy makers and planners, and can identify financing gaps. In this study, we estimate future gross domestic product (GDP), all-sector government spending, and health spending disaggregated by source, and we compare expected future spending to potential future spending. Methods: We extracted GDP, government spending in 184 countries from 1980-2015, and health spend data from 1995-2014. We used a series of ensemble models to estimate future GDP, all-sector government spending, development assistance for health, and government, out-of-pocket, and prepaid private health spending through 2040. We used frontier analyses to identify patterns exhibited by the countries that dedicate the most funding to health, and used these frontiers to estimate potential health spending for each low-income or middle-income country. All estimates are inflation and purchasing power adjusted. Findings: We estimated that global spending on health will increase from US$9.21 trillion in 2014 to $24.24 trillion (uncertainty interval [UI] 20.47-29.72) in 2040. We expect per capita health spending to increase fastest in upper-middle-income countries, at 5.3% (UI 4.1-6.8) per year. This growth is driven by continued growth in GDP, government spending, and government health spending. Lower-middle income countries are expected to grow at 4.2% (3.8-4.9). High-income countries are expected to grow at 2.1% (UI 1.8-2.4) and low-income countries are expected to grow at 1.8% (1.0-2.8). Despite this growth, health spending per capita in low-income countries is expected to remain low, at $154 (UI 133-181) per capita in 2030 and $195 (157-258) per capita in 2040. Increases in national health spending to reach the level of the countries who spend the most on health, relative to their level of economic development, would mean $321 (157-258) per capita was available for health in 2040 in low-income countries. Interpretation: Health spending is associated with economic development but past trends and relationships suggest that spending will remain variable, and low in some low-resource settings. Policy change could lead to increased health spending, although for the poorest countries external support might remain essential.
LanguageEnglish
Pages2005-2030
JournalThe Lancet
Volume389
Issue number10083
DOIs
Publication statusPublished - 20 May 2017

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Health Expenditures
Health
Gross Domestic Product
Uncertainty
Economic Development
Growth
Healthcare Financing
Health Services Accessibility
Health Resources
Population Growth
Economic Inflation
Administrative Personnel

Cite this

Dieleman, Joseph L. ; Campbell, Madeline ; Chapin, Abigail ; Eldrenkamp, Erika ; Fan, Victoria Y. ; Haakenstad, Annie ; Kates, Jennifer ; Li, Zhiyin ; Matyasz, Taylor ; Micah, Angela ; Reynolds, Alex ; Sadat, Nafis ; Schneider, Matthew T. ; Sorensen, Reed ; Abbas, Kaja M. ; Abera, Semaw Ferede ; Ahmad Kiadaliri, Aliasghar ; Ahmed, Muktar Beshir ; Alam, Khurshid ; Alizadeh-Navaei, Reza ; Alkerwi, A. ; Amini, Erfan ; Ammar, Walid ; Antonio, Carl Abelardo T. ; Atey, Tesfay Mehari ; Avila-Burgos, Leticia ; Awasthi, Ashish ; Barac, Aleksandra ; Berheto, Tezera Moshago ; Beyene, Addisu Shunu ; Beyene, Tariku Jibat ; Birungi, Charles ; Bizuayehu, Habtamu Mellie ; Breitborde, Nicholas J.K. ; Cahuana-Hurtado, Lucero ; Castro, Ruben Estanislao ; Catalá-López, Ferran ; Dalal, Koustuv ; Dandona, Lalit ; Dharmaratne, Rakhi Dandona Samath D. ; Dubey, Manisha ; Faro, Andé ; Feigl, Andrea B. ; Fischer, Florian ; Anderson Fitchett, Joseph R. ; Foigt, Nataliya ; Giref, Ababi Zergaw ; Gupta, Rahul ; Hamidi, Samer ; Harb, Hilda L. ; Hay, Simon I. ; Hendrie, Delia ; Horino, Masako ; Jürisson, Mikk ; Jakovljevic, Mihajlo B. ; Javanbakht, Mehdi ; John, Denny ; Jonas, Jost B. ; Karimi, Seyed M. ; Khang, Young Ho ; Khubchandani, Jagdish ; Kim, Yun Jin ; Kinge, Jonas M. ; Krohn, Kristopher J. ; Kumar, G.A. ; Leung, Ricky ; Magdy Abd El Razek, Hassan ; Magdy Abd El Razek, Mohammed ; Majeed, Azeem ; Malekzadeh, Reza ; Malta, Deborah Carvalho ; Meretoja, Atte ; Miller, Ted R. ; Mirrakhimov, Erkin M. ; Mohammed, Shafiu ; Molla, Gedefaw ; Nangia, Vinay ; Olgiati, Stefano ; Owolabi, Mayowa O. ; Patel, Tejas ; Paternina Caicedo, Angel J. ; Pereira, David M. ; Perelman, Julian ; Polinder, Suzanne ; Rafay, Anwar ; Rahimi-Movaghar, Vafa ; Rai, Rajesh Kumar ; Ram, Usha ; Ranabhat, Chhabi Lal ; Roba, Hirbo Shore ; Savic, Miloje ; Sepanlou, Sadaf G. ; Te Ao, Braden J. ; Tesema, Azeb Gebresilassie ; Thomson, Alan J. ; Tobe-Gai, Ruoyan ; Topor-Madry, Roman ; Undurraga, Eduardo A. ; Vargas, Veronica ; Vasankari, Tommi ; Violante, Francesco S. ; Wijeratne, Tissa ; Xu, Gelin ; Yonemoto, Naohiro ; Younis, Mustafa Z. ; Yu, Chuanhua ; Zaidi, Zoubida ; El Sayed Zaki, Maysaa ; Murray, Christopher J.L. / Future and potential spending on health 2015-40 : Development assistance for health, and government, prepaid private, and out-of-pocket health spending in 184 countries. In: The Lancet. 2017 ; Vol. 389, No. 10083. pp. 2005-2030.
@article{2388d7e3ad6247c5a84deec27f044da6,
title = "Future and potential spending on health 2015-40: Development assistance for health, and government, prepaid private, and out-of-pocket health spending in 184 countries",
abstract = "Background: The amount of resources, particularly prepaid resources, available for health can affect access to health care and health outcomes. Although health spending tends to increase with economic development, tremendous variation exists among health financing systems. Estimates of future spending can be beneficial for policy makers and planners, and can identify financing gaps. In this study, we estimate future gross domestic product (GDP), all-sector government spending, and health spending disaggregated by source, and we compare expected future spending to potential future spending. Methods: We extracted GDP, government spending in 184 countries from 1980-2015, and health spend data from 1995-2014. We used a series of ensemble models to estimate future GDP, all-sector government spending, development assistance for health, and government, out-of-pocket, and prepaid private health spending through 2040. We used frontier analyses to identify patterns exhibited by the countries that dedicate the most funding to health, and used these frontiers to estimate potential health spending for each low-income or middle-income country. All estimates are inflation and purchasing power adjusted. Findings: We estimated that global spending on health will increase from US$9.21 trillion in 2014 to $24.24 trillion (uncertainty interval [UI] 20.47-29.72) in 2040. We expect per capita health spending to increase fastest in upper-middle-income countries, at 5.3{\%} (UI 4.1-6.8) per year. This growth is driven by continued growth in GDP, government spending, and government health spending. Lower-middle income countries are expected to grow at 4.2{\%} (3.8-4.9). High-income countries are expected to grow at 2.1{\%} (UI 1.8-2.4) and low-income countries are expected to grow at 1.8{\%} (1.0-2.8). Despite this growth, health spending per capita in low-income countries is expected to remain low, at $154 (UI 133-181) per capita in 2030 and $195 (157-258) per capita in 2040. Increases in national health spending to reach the level of the countries who spend the most on health, relative to their level of economic development, would mean $321 (157-258) per capita was available for health in 2040 in low-income countries. Interpretation: Health spending is associated with economic development but past trends and relationships suggest that spending will remain variable, and low in some low-resource settings. Policy change could lead to increased health spending, although for the poorest countries external support might remain essential.",
author = "Dieleman, {Joseph L.} and Madeline Campbell and Abigail Chapin and Erika Eldrenkamp and Fan, {Victoria Y.} and Annie Haakenstad and Jennifer Kates and Zhiyin Li and Taylor Matyasz and Angela Micah and Alex Reynolds and Nafis Sadat and Schneider, {Matthew T.} and Reed Sorensen and Abbas, {Kaja M.} and Abera, {Semaw Ferede} and {Ahmad Kiadaliri}, Aliasghar and Ahmed, {Muktar Beshir} and Khurshid Alam and Reza Alizadeh-Navaei and A. Alkerwi and Erfan Amini and Walid Ammar and Antonio, {Carl Abelardo T.} and Atey, {Tesfay Mehari} and Leticia Avila-Burgos and Ashish Awasthi and Aleksandra Barac and Berheto, {Tezera Moshago} and Beyene, {Addisu Shunu} and Beyene, {Tariku Jibat} and Charles Birungi and Bizuayehu, {Habtamu Mellie} and Breitborde, {Nicholas J.K.} and Lucero Cahuana-Hurtado and Castro, {Ruben Estanislao} and Ferran Catal{\'a}-L{\'o}pez and Koustuv Dalal and Lalit Dandona and Dharmaratne, {Rakhi Dandona Samath D.} and Manisha Dubey and And{\'e} Faro and Feigl, {Andrea B.} and Florian Fischer and {Anderson Fitchett}, {Joseph R.} and Nataliya Foigt and Giref, {Ababi Zergaw} and Rahul Gupta and Samer Hamidi and Harb, {Hilda L.} and Hay, {Simon I.} and Delia Hendrie and Masako Horino and Mikk J{\"u}risson and Jakovljevic, {Mihajlo B.} and Mehdi Javanbakht and Denny John and Jonas, {Jost B.} and Karimi, {Seyed M.} and Khang, {Young Ho} and Jagdish Khubchandani and Kim, {Yun Jin} and Kinge, {Jonas M.} and Krohn, {Kristopher J.} and G.A. Kumar and Ricky Leung and {Magdy Abd El Razek}, Hassan and {Magdy Abd El Razek}, Mohammed and Azeem Majeed and Reza Malekzadeh and Malta, {Deborah Carvalho} and Atte Meretoja and Miller, {Ted R.} and Mirrakhimov, {Erkin M.} and Shafiu Mohammed and Gedefaw Molla and Vinay Nangia and Stefano Olgiati and Owolabi, {Mayowa O.} and Tejas Patel and {Paternina Caicedo}, {Angel J.} and Pereira, {David M.} and Julian Perelman and Suzanne Polinder and Anwar Rafay and Vafa Rahimi-Movaghar and Rai, {Rajesh Kumar} and Usha Ram and Ranabhat, {Chhabi Lal} and Roba, {Hirbo Shore} and Miloje Savic and Sepanlou, {Sadaf G.} and {Te Ao}, {Braden J.} and Tesema, {Azeb Gebresilassie} and Thomson, {Alan J.} and Ruoyan Tobe-Gai and Roman Topor-Madry and Undurraga, {Eduardo A.} and Veronica Vargas and Tommi Vasankari and Violante, {Francesco S.} and Tissa Wijeratne and Gelin Xu and Naohiro Yonemoto and Younis, {Mustafa Z.} and Chuanhua Yu and Zoubida Zaidi and {El Sayed Zaki}, Maysaa and Murray, {Christopher J.L.}",
year = "2017",
month = "5",
day = "20",
doi = "10.1016/S0140-6736(17)30873-5",
language = "English",
volume = "389",
pages = "2005--2030",
journal = "The Lancet",
issn = "0140-6736",
publisher = "Elsevier",
number = "10083",

}

Dieleman, JL, Campbell, M, Chapin, A, Eldrenkamp, E, Fan, VY, Haakenstad, A, Kates, J, Li, Z, Matyasz, T, Micah, A, Reynolds, A, Sadat, N, Schneider, MT, Sorensen, R, Abbas, KM, Abera, SF, Ahmad Kiadaliri, A, Ahmed, MB, Alam, K, Alizadeh-Navaei, R, Alkerwi, A, Amini, E, Ammar, W, Antonio, CAT, Atey, TM, Avila-Burgos, L, Awasthi, A, Barac, A, Berheto, TM, Beyene, AS, Beyene, TJ, Birungi, C, Bizuayehu, HM, Breitborde, NJK, Cahuana-Hurtado, L, Castro, RE, Catalá-López, F, Dalal, K, Dandona, L, Dharmaratne, RDSD, Dubey, M, Faro, A, Feigl, AB, Fischer, F, Anderson Fitchett, JR, Foigt, N, Giref, AZ, Gupta, R, Hamidi, S, Harb, HL, Hay, SI, Hendrie, D, Horino, M, Jürisson, M, Jakovljevic, MB, Javanbakht, M, John, D, Jonas, JB, Karimi, SM, Khang, YH, Khubchandani, J, Kim, YJ, Kinge, JM, Krohn, KJ, Kumar, GA, Leung, R, Magdy Abd El Razek, H, Magdy Abd El Razek, M, Majeed, A, Malekzadeh, R, Malta, DC, Meretoja, A, Miller, TR, Mirrakhimov, EM, Mohammed, S, Molla, G, Nangia, V, Olgiati, S, Owolabi, MO, Patel, T, Paternina Caicedo, AJ, Pereira, DM, Perelman, J, Polinder, S, Rafay, A, Rahimi-Movaghar, V, Rai, RK, Ram, U, Ranabhat, CL, Roba, HS, Savic, M, Sepanlou, SG, Te Ao, BJ, Tesema, AG, Thomson, AJ, Tobe-Gai, R, Topor-Madry, R, Undurraga, EA, Vargas, V, Vasankari, T, Violante, FS, Wijeratne, T, Xu, G, Yonemoto, N, Younis, MZ, Yu, C, Zaidi, Z, El Sayed Zaki, M & Murray, CJL 2017, 'Future and potential spending on health 2015-40: Development assistance for health, and government, prepaid private, and out-of-pocket health spending in 184 countries', The Lancet, vol. 389, no. 10083, pp. 2005-2030. https://doi.org/10.1016/S0140-6736(17)30873-5

Future and potential spending on health 2015-40 : Development assistance for health, and government, prepaid private, and out-of-pocket health spending in 184 countries. / Dieleman, Joseph L.; Campbell, Madeline; Chapin, Abigail; Eldrenkamp, Erika; Fan, Victoria Y.; Haakenstad, Annie; Kates, Jennifer; Li, Zhiyin; Matyasz, Taylor; Micah, Angela; Reynolds, Alex; Sadat, Nafis; Schneider, Matthew T.; Sorensen, Reed; Abbas, Kaja M.; Abera, Semaw Ferede; Ahmad Kiadaliri, Aliasghar; Ahmed, Muktar Beshir; Alam, Khurshid; Alizadeh-Navaei, Reza; Alkerwi, A.; Amini, Erfan; Ammar, Walid; Antonio, Carl Abelardo T.; Atey, Tesfay Mehari; Avila-Burgos, Leticia; Awasthi, Ashish; Barac, Aleksandra; Berheto, Tezera Moshago; Beyene, Addisu Shunu; Beyene, Tariku Jibat; Birungi, Charles; Bizuayehu, Habtamu Mellie; Breitborde, Nicholas J.K.; Cahuana-Hurtado, Lucero; Castro, Ruben Estanislao; Catalá-López, Ferran; Dalal, Koustuv; Dandona, Lalit; Dharmaratne, Rakhi Dandona Samath D.; Dubey, Manisha; Faro, Andé; Feigl, Andrea B.; Fischer, Florian; Anderson Fitchett, Joseph R. ; Foigt, Nataliya; Giref, Ababi Zergaw; Gupta, Rahul; Hamidi, Samer; Harb, Hilda L.; Hay, Simon I.; Hendrie, Delia; Horino, Masako; Jürisson, Mikk; Jakovljevic, Mihajlo B.; Javanbakht, Mehdi; John, Denny; Jonas, Jost B.; Karimi, Seyed M.; Khang, Young Ho; Khubchandani, Jagdish; Kim, Yun Jin; Kinge, Jonas M.; Krohn, Kristopher J.; Kumar, G.A.; Leung, Ricky; Magdy Abd El Razek, Hassan; Magdy Abd El Razek, Mohammed; Majeed, Azeem; Malekzadeh, Reza; Malta, Deborah Carvalho; Meretoja, Atte; Miller, Ted R.; Mirrakhimov, Erkin M.; Mohammed, Shafiu; Molla, Gedefaw; Nangia, Vinay; Olgiati, Stefano; Owolabi, Mayowa O.; Patel, Tejas; Paternina Caicedo, Angel J.; Pereira, David M.; Perelman, Julian; Polinder, Suzanne; Rafay, Anwar; Rahimi-Movaghar, Vafa; Rai, Rajesh Kumar; Ram, Usha; Ranabhat, Chhabi Lal; Roba, Hirbo Shore; Savic, Miloje; Sepanlou, Sadaf G.; Te Ao, Braden J.; Tesema, Azeb Gebresilassie; Thomson, Alan J.; Tobe-Gai, Ruoyan; Topor-Madry, Roman; Undurraga, Eduardo A.; Vargas, Veronica; Vasankari, Tommi; Violante, Francesco S.; Wijeratne, Tissa; Xu, Gelin; Yonemoto, Naohiro; Younis, Mustafa Z.; Yu, Chuanhua; Zaidi, Zoubida; El Sayed Zaki, Maysaa; Murray, Christopher J.L.

In: The Lancet, Vol. 389, No. 10083, 20.05.2017, p. 2005-2030.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Future and potential spending on health 2015-40

T2 - The Lancet

AU - Dieleman, Joseph L.

AU - Campbell, Madeline

AU - Chapin, Abigail

AU - Eldrenkamp, Erika

AU - Fan, Victoria Y.

AU - Haakenstad, Annie

AU - Kates, Jennifer

AU - Li, Zhiyin

AU - Matyasz, Taylor

AU - Micah, Angela

AU - Reynolds, Alex

AU - Sadat, Nafis

AU - Schneider, Matthew T.

AU - Sorensen, Reed

AU - Abbas, Kaja M.

AU - Abera, Semaw Ferede

AU - Ahmad Kiadaliri, Aliasghar

AU - Ahmed, Muktar Beshir

AU - Alam, Khurshid

AU - Alizadeh-Navaei, Reza

AU - Alkerwi, A.

AU - Amini, Erfan

AU - Ammar, Walid

AU - Antonio, Carl Abelardo T.

AU - Atey, Tesfay Mehari

AU - Avila-Burgos, Leticia

AU - Awasthi, Ashish

AU - Barac, Aleksandra

AU - Berheto, Tezera Moshago

AU - Beyene, Addisu Shunu

AU - Beyene, Tariku Jibat

AU - Birungi, Charles

AU - Bizuayehu, Habtamu Mellie

AU - Breitborde, Nicholas J.K.

AU - Cahuana-Hurtado, Lucero

AU - Castro, Ruben Estanislao

AU - Catalá-López, Ferran

AU - Dalal, Koustuv

AU - Dandona, Lalit

AU - Dharmaratne, Rakhi Dandona Samath D.

AU - Dubey, Manisha

AU - Faro, Andé

AU - Feigl, Andrea B.

AU - Fischer, Florian

AU - Anderson Fitchett, Joseph R.

AU - Foigt, Nataliya

AU - Giref, Ababi Zergaw

AU - Gupta, Rahul

AU - Hamidi, Samer

AU - Harb, Hilda L.

AU - Hay, Simon I.

AU - Hendrie, Delia

AU - Horino, Masako

AU - Jürisson, Mikk

AU - Jakovljevic, Mihajlo B.

AU - Javanbakht, Mehdi

AU - John, Denny

AU - Jonas, Jost B.

AU - Karimi, Seyed M.

AU - Khang, Young Ho

AU - Khubchandani, Jagdish

AU - Kim, Yun Jin

AU - Kinge, Jonas M.

AU - Krohn, Kristopher J.

AU - Kumar, G.A.

AU - Leung, Ricky

AU - Magdy Abd El Razek, Hassan

AU - Magdy Abd El Razek, Mohammed

AU - Majeed, Azeem

AU - Malekzadeh, Reza

AU - Malta, Deborah Carvalho

AU - Meretoja, Atte

AU - Miller, Ted R.

AU - Mirrakhimov, Erkin M.

AU - Mohammed, Shafiu

AU - Molla, Gedefaw

AU - Nangia, Vinay

AU - Olgiati, Stefano

AU - Owolabi, Mayowa O.

AU - Patel, Tejas

AU - Paternina Caicedo, Angel J.

AU - Pereira, David M.

AU - Perelman, Julian

AU - Polinder, Suzanne

AU - Rafay, Anwar

AU - Rahimi-Movaghar, Vafa

AU - Rai, Rajesh Kumar

AU - Ram, Usha

AU - Ranabhat, Chhabi Lal

AU - Roba, Hirbo Shore

AU - Savic, Miloje

AU - Sepanlou, Sadaf G.

AU - Te Ao, Braden J.

AU - Tesema, Azeb Gebresilassie

AU - Thomson, Alan J.

AU - Tobe-Gai, Ruoyan

AU - Topor-Madry, Roman

AU - Undurraga, Eduardo A.

AU - Vargas, Veronica

AU - Vasankari, Tommi

AU - Violante, Francesco S.

AU - Wijeratne, Tissa

AU - Xu, Gelin

AU - Yonemoto, Naohiro

AU - Younis, Mustafa Z.

AU - Yu, Chuanhua

AU - Zaidi, Zoubida

AU - El Sayed Zaki, Maysaa

AU - Murray, Christopher J.L.

PY - 2017/5/20

Y1 - 2017/5/20

N2 - Background: The amount of resources, particularly prepaid resources, available for health can affect access to health care and health outcomes. Although health spending tends to increase with economic development, tremendous variation exists among health financing systems. Estimates of future spending can be beneficial for policy makers and planners, and can identify financing gaps. In this study, we estimate future gross domestic product (GDP), all-sector government spending, and health spending disaggregated by source, and we compare expected future spending to potential future spending. Methods: We extracted GDP, government spending in 184 countries from 1980-2015, and health spend data from 1995-2014. We used a series of ensemble models to estimate future GDP, all-sector government spending, development assistance for health, and government, out-of-pocket, and prepaid private health spending through 2040. We used frontier analyses to identify patterns exhibited by the countries that dedicate the most funding to health, and used these frontiers to estimate potential health spending for each low-income or middle-income country. All estimates are inflation and purchasing power adjusted. Findings: We estimated that global spending on health will increase from US$9.21 trillion in 2014 to $24.24 trillion (uncertainty interval [UI] 20.47-29.72) in 2040. We expect per capita health spending to increase fastest in upper-middle-income countries, at 5.3% (UI 4.1-6.8) per year. This growth is driven by continued growth in GDP, government spending, and government health spending. Lower-middle income countries are expected to grow at 4.2% (3.8-4.9). High-income countries are expected to grow at 2.1% (UI 1.8-2.4) and low-income countries are expected to grow at 1.8% (1.0-2.8). Despite this growth, health spending per capita in low-income countries is expected to remain low, at $154 (UI 133-181) per capita in 2030 and $195 (157-258) per capita in 2040. Increases in national health spending to reach the level of the countries who spend the most on health, relative to their level of economic development, would mean $321 (157-258) per capita was available for health in 2040 in low-income countries. Interpretation: Health spending is associated with economic development but past trends and relationships suggest that spending will remain variable, and low in some low-resource settings. Policy change could lead to increased health spending, although for the poorest countries external support might remain essential.

AB - Background: The amount of resources, particularly prepaid resources, available for health can affect access to health care and health outcomes. Although health spending tends to increase with economic development, tremendous variation exists among health financing systems. Estimates of future spending can be beneficial for policy makers and planners, and can identify financing gaps. In this study, we estimate future gross domestic product (GDP), all-sector government spending, and health spending disaggregated by source, and we compare expected future spending to potential future spending. Methods: We extracted GDP, government spending in 184 countries from 1980-2015, and health spend data from 1995-2014. We used a series of ensemble models to estimate future GDP, all-sector government spending, development assistance for health, and government, out-of-pocket, and prepaid private health spending through 2040. We used frontier analyses to identify patterns exhibited by the countries that dedicate the most funding to health, and used these frontiers to estimate potential health spending for each low-income or middle-income country. All estimates are inflation and purchasing power adjusted. Findings: We estimated that global spending on health will increase from US$9.21 trillion in 2014 to $24.24 trillion (uncertainty interval [UI] 20.47-29.72) in 2040. We expect per capita health spending to increase fastest in upper-middle-income countries, at 5.3% (UI 4.1-6.8) per year. This growth is driven by continued growth in GDP, government spending, and government health spending. Lower-middle income countries are expected to grow at 4.2% (3.8-4.9). High-income countries are expected to grow at 2.1% (UI 1.8-2.4) and low-income countries are expected to grow at 1.8% (1.0-2.8). Despite this growth, health spending per capita in low-income countries is expected to remain low, at $154 (UI 133-181) per capita in 2030 and $195 (157-258) per capita in 2040. Increases in national health spending to reach the level of the countries who spend the most on health, relative to their level of economic development, would mean $321 (157-258) per capita was available for health in 2040 in low-income countries. Interpretation: Health spending is associated with economic development but past trends and relationships suggest that spending will remain variable, and low in some low-resource settings. Policy change could lead to increased health spending, although for the poorest countries external support might remain essential.

U2 - 10.1016/S0140-6736(17)30873-5

DO - 10.1016/S0140-6736(17)30873-5

M3 - Article

VL - 389

SP - 2005

EP - 2030

JO - The Lancet

JF - The Lancet

SN - 0140-6736

IS - 10083

ER -