Health financing has undergone global growth in the past 20 years and will continue growing, albeit more slowly, according to a study recently published in The Lancet. Development assistance for health (DAH) will remain vital in many low-income countries, as per capita health spending shows persistent international inequalities.
This study estimated health spending among 195 nations and territories between 1995 and 2016, as well as DAH between 1990 and 2018. Spending was divided into government, prepaid private health, and out-of-pocket spending. Linear mixed-effects models were used to predict health spending and DAH from the near future to 2050. All data were adjusted for inflation and standardized to 2018 US dollars, and uncertainty due to low-quality or missing data was estimated. Demographic decomposition was used to examine variances in government health spending in the study period in the context of the transition in health financing. The future of health spending was projected with 2 alternative future scenarios.
Health spending increased annually by 4% (95% CI, 3.89-4.12), or 2.72% (95% CI, 2.61-2.84) per capita between 1995 and 2016. Among 22 of the 195 countries, health spending increased by less than $1 per capita. Upper-middle-income countries experienced the highest annual growth per capita at 5.55% (95% CI, 5.18-5.95), largely explained by increases in government health spending, whereas the 3.71% (95% CI, 3.10-4.34) growth rate among lower-middle-income countries was mostly due to DAH. High-income countries spent $5252 (95% CI, 5184-5319) per capita, upper-middle-income countries spent $491 (95% CI, 461-524), lower-middle-income countries spent $81 (95% CI, 74-89), and low-income countries spent $40 (95% CI, 38-43).
Just 0.4% of global health spending occurred in low-income countries in 2016 despite their accounting for 10% of the population. DAH in 2018 came mostly from the United States and from private charity. Global health spending is projected to grow from $8 trillion (95% CI, 7.8-8.1 trillion) to $15.0 trillion (95% CI, 14-16 trillion) by 2050, a slower rate of growth than seen in the past 2 decades and with persistent disparities between countries. Low-income countries are expected to constitute 15.7% of the population and comprise just 0.6% of health spending by 2050. The study showed a per-capita health spending ratio of 130.2 (95% CI, 122.9-136.9) between high- and low-income countries in 2016.
Limitations to this study include weaknesses in input data, uncertainty in datasets, dependence of future scenarios on events in the previous 10 years, a reliance on gross domestic product growth for development assistance for health models, inability to measure health spending inequities inside individual countries, and a lack of accounting for the changing nature of health spending.
The study researchers conclude that “[health] spending per capita, which has increased steadily since 1995, is projected to continue increasing well into the future, but at a slower rate of growth, and large existing disparities in per capita spending by country are projected to persist in the coming decades.”
Disclosure: Several authors report financial associations with pharmaceutical companies. See the reference for a full list of author disclosures.
Chang AY, Cowling K, Micah AE, et al; Global Burden of Disease Health Financing Collaborator Network. Past, present, and future of global health financing: a review of development assistance, government, out-of-pocket, and other private spending on health for 195 countries, 1995–2050 [published online April 24, 2019]. Lancet. doi:10.1016/S0140-6736(19)30841-4