Government health expenditure is a primary means of financing health services in many countries. Research assessing the relation between government... health expenditure and development assistance for health channelled to governments (DAH-G) has produced contradictory conclusions. This research aims to credibly estimate displacement and measure if the DAH-G effect is symmetric or if increases and decreases in DAH-G have distinct effects.
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A corruption event in 2009 led to changes in how donors supported the Zambian health system. Donor funding was withdrawn from the district basket mechanism, originally designed to pool donor and government ...>financing for primary care. The withdrawal of these funds from the pooled financing mechanism raised questions from Government and donors regarding the impact on primary care financing during this period of aid volatility.
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A general consensus exists that as a country develops economically, health spending per capita rises and the share of that spending that is prepaid through government or private mechanisms also rises. However, the speed and magnitude of these change...s vary substantially across countries, even at similar levels of development. In this study, we use past trends and relationships to estimate future health spending, disaggregated by the source of those funds, to identify the financing trajectories that are likely to occur if current policies and trajectories evolve as expected.
Methods
We extracted data from WHO's Health Spending Observatory and the Institute for Health Metrics and Evaluation's Financing Global Health 2015 report. We converted these data to a common purchasing power-adjusted and inflation-adjusted currency. We used a series of ensemble models and observed empirical norms to estimate future government out-of-pocket private prepaid health spending and development assistance for health. We aggregated each country's estimates to generate total health spending from 2013 to 2040 for 184 countries. We compared these estimates with each other and internationally recognised benchmarks.
Findings
Global spending on health is expected to increase from US$7·83 trillion in 2013 to $18·28 (uncertainty interval 14·42–22·24) trillion in 2040 (in 2010 purchasing power parity-adjusted dollars). We expect per-capita health spending to increase annually by 2·7% (1·9–3·4) in high-income countries, 3·4% (2·4–4·2) in upper-middle-income countries, 3·0% (2·3–3·6) in lower-middle-income countries, and 2·4% (1·6–3·1) in low-income countries. Given the gaps in current health spending, these rates provide no evidence of increasing parity in health spending. In 1995 and 2015, low-income countries spent $0·03 for every dollar spent in high-income countries, even after adjusting for purchasing power, and the same is projected for 2040. Most importantly, health spending in many low-income countries is expected to remain low. Estimates suggest that, by 2040, only one (3%) of 34 low-income countries and 36 (37%) of 98 middle-income countries will reach the Chatham House goal of 5% of gross domestic product consisting of government health spending.
Interpretation
Despite remarkable health gains, past health financing trends and relationships suggest that many low-income and lower-middle-income countries will not meet internationally set health spending targets and that spending gaps between low-income and high-income countries are unlikely to narrow unless substantive policy interventions occur. Although gains in health system efficiency can be used to make progress, current trends suggest that meaningful increases in health system resources will require concerted action.
Funding
Bill & Melinda Gates Foundation.
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Donor financing to low- and middle-income countries for reproductive, maternal, newborn, and child health increased substantially from 2008 to 2013. However, increased spending by donors might not i...mprove outcomes, if funds are delivered in ways that undermine countries’ public financial management systems and incur high transaction costs for project implementation
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From 2000 to 2010, Rwanda implemented comprehensive health sector reforms to strengthen the public health system, with the aim of reducing maternal and newborn deaths in line with Millennium Develop...ment Goal 5, among many other improvements in national health. Based on a systematic review of the literature, national policy documents and three Demographic & Health Surveys (2000, 2005 and 2010), this paper describes the reforms and the policies they were based on, and provides data on the extent of Rwanda’s progress in expanding the coverage of four key women’s health services. Progress took place in 2000–2005 and became more rapid after 2006, mostly in rural areas, when the national facility-based childbirth policy, performance-based financing, and community-based health insurance were scaled up. Between 2006 and 2010, the following increases in coverage took place as compared to 2000–2005, particularly in rural areas, where most poor women live: births with skilled attendance (77% increase vs. 26%), institutional delivery (146% increase vs. 8%), and contraceptive prevalence (351% increase vs. 150%). The primary factors in these improvements were increases in the health workforce and their skills, performance-based financing, community-based health insurance, and better leadership and governance. Further research is needed to determine the impact of these changes on health outcomes in women and children.
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The GFF needs an additional US$2.5 billion from 2021 to 2025 to enable countries to protect health gains and accelerate progress toward the 2030 Goals. Of this amount, the GFF urgently needs to secure new pledges of US$1.2 billion by the end of 202...1 to help its current 36 partner countries protect and maintain essential health services and implement time-sensitive service delivery and health system improvements to enable a sharp bend of the curve back to a positive trajectory to close the gap to the SDGs.
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Monitoring financial protection and utilization of health services in Mongolia 2009-2018 is based on national representative household socioeconomic surveys. The study finds that between 2009 and 2018, despite ambitious ...hlight medbox">health reforms, the incidence of catastrophic health spending and impoverishing spending at the relative poverty line have increased. These increases were mainly driven by out-of-pocket spending on medicines and inpatient care. In the same period, inequity in access to and utilization of health services remained constant among population groups. Evidence suggests health financing policies need to be further strengthened to make progress towards universal health coverage. Continuous tracking of out-of-pocket payments and service utilization to inform policymaking is needed.
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The 2018 global health financing report presents health spending data for all WHO Member States between 2000 and 2016 based on the SHA 2011 methodo...logy. It shows a transformation trajectory for the global spending on health, with increasing domestic public funding and declining external financing. This report also presents, for the first time, spending on primary health care and specific diseases and looks closely at the relationship between spending and service coverage
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Thefirst report on Latin America and the Carribean presents key indicators on health and health systems in 33 Latin America and the Caribbean countries. . Analysis is based on the latest comparable... data across almost 100 indicators including equity, health status, determinants of health, health care resources and utilisation, health expenditure and financing, and quality of care. The editorial discusses the main challenges for the region brought by the COVID-19 pandemic, such as managing the outbreak as well as mobilising adequate resources and using them efficiently to ensure an effective response to the epidemic.
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Ukrainian decentralization reform has increased and democratized local government responsibility for health care at the level of local government closest to communities and has increased regional and local government responsibility for public ...class="attribute-to-highlight medbox">health. Decentralization affects health system reform in three important areas: health financing, individual health services and public health.
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Case report from The fYR MACEDONIA
NGO Social Contracting
Sustainable Financing of National HIV Responses
This report explores community-focused change initiatives in the financing, organization, and delivery of mental health services in Peru from 2013 to 2016. It examines the national dimension of refo...rms but focuses above all on implementation and results in the economically fragile district of Carabayllo, in northern Lima.
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Uzbekistan has started a process of health system reform that includes fundamental changes in service delivery and health financing arrangements, a...s well as digitalization of the health care sector. The reform was initiated in 2018 by the adoption of high-level legislation, which was put into practice in 2021 by initiation of a pilot project in the Syrdarya Oblast. The Government intention is to expand the new system to other regions and eventually implement planned reforms throughout the country. This review assesses the implementation of system changes and provides recommendations for future reform development. The report is organized around three key topics: transformation of primary health care provision, implementation of health financing reforms and development of the e-health system.
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Development assistance for health (DAH) is an important part of financing healthcare in low- and middle-income countries. We estimated the gross disbursement of DAH of the 29 Development Assistance ...Committee (DAC) member countries of the Organisation for Economic Co-operation and Development (OECD) for 2011–2019; and clarified its flows, including aid type,
channel, target region, and target health focus area. Data from the OECD iLibrary were used. The DAH definition was based on the OECD sector classification. For core funding to non-healthspecific multilateral agencies, we estimated DAH and its flows based on the OECD methodology for
calculating imputed multilateral official development assistance (ODA).
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This 2019 report Global health spending: A world in transition examines how countries progress towards financing UHC in a world in transition
This 2019 report Global health spending: A world in transition examines how countries progress towards financing UHC in a world in transition
It focuses on nine major priority areas, namely: Leadership and Governance for Health; Health Service Delivery; Human Resources for Health; ...n class="attribute-to-highlight medbox">Health Financing; Health Information Systems; Health Technologies; Community Ownership and Participation; Partnerships for Health Development; and Research for Health.
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Measuring progress towards universal health coverage.
This sixth edition of Health at a Glance Asia/Pacific presents a set of key indicators of health...pan> status, the determinants of health, health care resources and utilisation, health care expenditure and financing and quality of care across 27 Asia-Pacific countries and territories. It also provides a series of dashboards to compare performance across countries and territories, and a thematic analysis on the impact of the COVID-19 outbreak on Asia/Pacific health systems.
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