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

Global Burden of Disease Health Financing Collaborator Network

Research output: Contribution to journalArticle

50 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. Funding Bill & Melinda Gates Foundation.

Original languageEnglish (US)
Pages (from-to)2005-2030
Number of pages26
JournalThe Lancet
Volume389
Issue number10083
DOIs
StatePublished - May 20 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

ASJC Scopus subject areas

  • Medicine(all)

Cite this

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. / Global Burden of Disease Health Financing Collaborator Network.

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

Research output: Contribution to journalArticle

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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. Funding Bill & Melinda Gates Foundation.",
author = "{Global Burden of Disease Health Financing Collaborator Network} and 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 Kiadaliri, {Aliasghar Ahmad} and Ahmed, {Muktar Beshir} and Khurshid Alam and Reza Alizadeh-Navaei and Ala'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 Jk} and Lucero Cahuana-Hurtado and Castro, {Ruben Estanislao} and Ferran Catalia-Lopez and Koustuv Dalal and Lalit Dandona and Rakhi Dandona and Dharmaratne, {Samath D.} and Manisha Dubey and And{\'e} Faro and Feigl, {Andrea B.} and Florian Fischer and Fitchett, {Joseph R.Anderson} and Nataliya Foigt and Giref, {Ababi Zergaw} and Rahul Gupta and Samer Hamidi",
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TY - JOUR

T1 - Future and potential spending on health 2015–40

T2 - development assistance for health, and government, prepaid private, and out-of-pocket health spending in 184 countries

AU - Global Burden of Disease Health Financing Collaborator Network

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 - Kiadaliri, Aliasghar Ahmad

AU - Ahmed, Muktar Beshir

AU - Alam, Khurshid

AU - Alizadeh-Navaei, Reza

AU - Alkerwi, Ala'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 Jk

AU - Cahuana-Hurtado, Lucero

AU - Castro, Ruben Estanislao

AU - Catalia-Lopez, Ferran

AU - Dalal, Koustuv

AU - Dandona, Lalit

AU - Dandona, Rakhi

AU - Dharmaratne, Samath D.

AU - Dubey, Manisha

AU - Faro, Andé

AU - Feigl, Andrea B.

AU - Fischer, Florian

AU - Fitchett, Joseph R.Anderson

AU - Foigt, Nataliya

AU - Giref, Ababi Zergaw

AU - Gupta, Rahul

AU - Hamidi, Samer

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. Funding Bill & Melinda Gates Foundation.

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. Funding Bill & Melinda Gates Foundation.

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