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Trends in future health financing and coverage: future health spending and universal health coverage in 188 countries, 2016–40

Ram, Usha; Banstola, Amrit; Goli, Srinivas; Dieleman, Joseph L; Hailu, Alemayehu Desalegne; Sadat, Nafis; Hamidi, Samer; Chang, Angela Y; Fullman, Nancy; Harb, Hilda L; Abbafati, Cristiana; Hay, Simon I; Hendrie, Delia; Acharya, Pawan; Ikilezi, Gloria; Adou, Arsène Kouablan; Ahmad Kiadaliri, Aliasghar; Javanbakht, Mehdi; Alam, Khurshid; John, Denny; Jonas, Jost B; Alizadeh-Navaei, Reza; Kaldjian, Alexander; Alkerwi, Ala'a; Kasaeian, Amir; Ammar, Walid; Kasahun, Yawukal Chane; Antonio, Carl Abelardo T; Aremu, Olatunde; Khalil, Ibrahim A; Khang, Young-Ho; Asgedom, Solomon Weldegebreal; Khubchandani, Jagdish; Atey, Tesfay Mehari; Avila-Burgos, Leticia; Kim, Yun Jin; Ayer, Rakesh; Kinge, Jonas M; Badali, Hamid; Kosen, Soewarta; Krohn, Kristopher J; Banach, Maciej; Kumar, G Anil; Lafranconi, Alessandra; Barac, Aleksandra; Lam, Hilton; Belachew, Abate Bekele; Listl, Stefan; Birungi, Charles; Magdy Abd El Razek, Hassan; Bragazzi, Nicola L; Breitborde, Nicholas J K; Magdy Abd El Razek, Mohammed; Majeed, Azeem; Cahuana-Hurtado, Lucero; Malekzadeh, Reza; Car, Josip; Catalá-López, Ferrán; Malta, Deborah Carvalho; Martinez, Gabriel; Chapin, Abigail; Mensah, George A; Chen, Catherine S; Dandona, Lalit; Meretoja, Atte; Dandona, Rakhi; Micah, Angela; Daryani, Ahmad; Miller, Ted R; Dharmaratne, Samath D; Mirrakhimov, Erkin M; Dubey, Manisha; Mlashu, Fitsum Weldegebreal; Edessa, Dumessa; Mohammed, Ebrahim; Eldrenkamp, Erika; Mohammed, Shafiu; Moses, Mark; Eshrati, Babak; Mousavi, Seyyed Meysam; Faro, André; Naghavi, Mohsen; Feigl, Andrea B; Nangia, Vinay; Fenny, Ama P; Ngalesoni, Frida Namnyak; Fischer, Florian; Nguyen, Cuong Tat; Foigt, Nataliya; Foreman, Kyle J; Nguyen, Trang Huyen; Niriayo, Yirga; Ghimire, Mamata; Noroozi, Mehdi; Owolabi, Mayowa O; Patel, Tejas; Pereira, David M; Polinder, Suzanne; Qorbani, Mostafa; Rafay, Anwar; Rafiei, Alireza; Rahimi-Movaghar, Vafa; Rai, Rajesh Kumar; Ranabhat, Chhabi Lal; Ray, Sarah E; Reiner, Robert C; Sajadi, Haniye Sadat; Santoro, Rocco; Santos, João Vasco; Sarker, Abdur Razzaque; Sartorius, Benn; Satpathy, Maheswar; Sepanlou, Sadaf G; Shaikh, Masood Ali; Sharif, Mehdi; She, Jun; Sheikh, Aziz; Shrime, Mark G; Sisay, Mekonnen; Soneji, Samir; Soofi, Moslem; Sorensen, Reed J D; Tadesse, Henok; Tao, Tianchan; Templin, Tara; Tesema, Azeb Gebresilassie; Thapa, Subash; Tobe-Gai, Ruoyan; Topor-Madry, Roman; Tran, Bach Xuan; Tran, Khanh Bao; Tran, Tung Thanh; Undurraga, Eduardo A; Vasankari, Tommi; Violante, Francesco S; Werdecker, Andrea; Wijeratne, Tissa; Xu, Gelin; Yonemoto, Naohiro; Younis, Mustafa Z; Yu, Chuanhua; Zaki, Maysaa El Sayed; Zlavog, Bianca; Murray, Christopher J L

Authors

Usha Ram

Srinivas Goli

Joseph L Dieleman

Alemayehu Desalegne Hailu

Nafis Sadat

Samer Hamidi

Angela Y Chang

Nancy Fullman

Hilda L Harb

Cristiana Abbafati

Simon I Hay

Delia Hendrie

Pawan Acharya

Gloria Ikilezi

Arsène Kouablan Adou

Aliasghar Ahmad Kiadaliri

Mehdi Javanbakht

Khurshid Alam

Denny John

Jost B Jonas

Reza Alizadeh-Navaei

Alexander Kaldjian

Ala'a Alkerwi

Amir Kasaeian

Walid Ammar

Yawukal Chane Kasahun

Carl Abelardo T Antonio

Olatunde Aremu

Ibrahim A Khalil

Young-Ho Khang

Solomon Weldegebreal Asgedom

Jagdish Khubchandani

Tesfay Mehari Atey

Leticia Avila-Burgos

Yun Jin Kim

Rakesh Ayer

Jonas M Kinge

Hamid Badali

Soewarta Kosen

Kristopher J Krohn

Maciej Banach

G Anil Kumar

Alessandra Lafranconi

Aleksandra Barac

Hilton Lam

Abate Bekele Belachew

Stefan Listl

Charles Birungi

Hassan Magdy Abd El Razek

Nicola L Bragazzi

Nicholas J K Breitborde

Mohammed Magdy Abd El Razek

Azeem Majeed

Lucero Cahuana-Hurtado

Reza Malekzadeh

Josip Car

Ferrán Catalá-López

Deborah Carvalho Malta

Gabriel Martinez

Abigail Chapin

George A Mensah

Catherine S Chen

Lalit Dandona

Atte Meretoja

Rakhi Dandona

Angela Micah

Ahmad Daryani

Ted R Miller

Samath D Dharmaratne

Erkin M Mirrakhimov

Manisha Dubey

Fitsum Weldegebreal Mlashu

Dumessa Edessa

Ebrahim Mohammed

Erika Eldrenkamp

Shafiu Mohammed

Mark Moses

Babak Eshrati

Seyyed Meysam Mousavi

André Faro

Mohsen Naghavi

Andrea B Feigl

Vinay Nangia

Ama P Fenny

Frida Namnyak Ngalesoni

Florian Fischer

Cuong Tat Nguyen

Nataliya Foigt

Kyle J Foreman

Trang Huyen Nguyen

Yirga Niriayo

Mamata Ghimire

Mehdi Noroozi

Mayowa O Owolabi

Tejas Patel

David M Pereira

Suzanne Polinder

Mostafa Qorbani

Anwar Rafay

Alireza Rafiei

Vafa Rahimi-Movaghar

Rajesh Kumar Rai

Chhabi Lal Ranabhat

Sarah E Ray

Robert C Reiner

Haniye Sadat Sajadi

Rocco Santoro

João Vasco Santos

Abdur Razzaque Sarker

Benn Sartorius

Maheswar Satpathy

Sadaf G Sepanlou

Masood Ali Shaikh

Mehdi Sharif

Jun She

Aziz Sheikh

Mark G Shrime

Mekonnen Sisay

Samir Soneji

Moslem Soofi

Reed J D Sorensen

Henok Tadesse

Tianchan Tao

Tara Templin

Azeb Gebresilassie Tesema

Subash Thapa

Ruoyan Tobe-Gai

Roman Topor-Madry

Bach Xuan Tran

Khanh Bao Tran

Tung Thanh Tran

Eduardo A Undurraga

Tommi Vasankari

Francesco S Violante

Andrea Werdecker

Tissa Wijeratne

Gelin Xu

Naohiro Yonemoto

Mustafa Z Younis

Chuanhua Yu

Maysaa El Sayed Zaki

Bianca Zlavog

Christopher J L Murray



Contributors

Global Burden of Disease Health Financing Collaborator Network
Research Group

Abstract

Background: Achieving universal health coverage (UHC) requires health financing systems that provide prepaid pooled resources for key health services without placing undue financial stress on households. Understanding current and future trajectories of health financing is vital for progress towards UHC. We used historical health financing data for 188 countries from 1995 to 2015 to estimate future scenarios of health spending and pooled health spending through to 2040. Methods: We extracted historical data on gross domestic product (GDP) and health spending for 188 countries from 1995 to 2015, and projected annual GDP, development assistance for health, and government, out-of-pocket, and prepaid private health spending from 2015 through to 2040 as a reference scenario. These estimates were generated using an ensemble of models that varied key demographic and socioeconomic determinants. We generated better and worse alternative future scenarios based on the global distribution of historic health spending growth rates. Last, we used stochastic frontier analysis to investigate the association between pooled health resources and UHC index, a measure of a country's UHC service coverage. Finally, we estimated future UHC performance and the number of people covered under the three future scenarios. Findings: In the reference scenario, global health spending was projected to increase from US$10 trillion (95% uncertainty interval 10 trillion to 10 trillion) in 2015 to $20 trillion (18 trillion to 22 trillion) in 2040. Per capita health spending was projected to increase fastest in upper-middle-income countries, at 4·2% (3·4–5·1) per year, followed by lower-middle-income countries (4·0%, 3·6–4·5) and low-income countries (2·2%, 1·7–2·8). Despite global growth, per capita health spending was projected to range from only $40 (24–65) to $413 (263–668) in 2040 in low-income countries, and from $140 (90–200) to $1699 (711–3423) in lower-middle-income countries. Globally, the share of health spending covered by pooled resources would range widely, from 19·8% (10·3–38·6) in Nigeria to 97·9% (96·4–98·5) in Seychelles. Historical performance on the UHC index was significantly associated with pooled resources per capita. Across the alternative scenarios, we estimate UHC reaching between 5·1 billion (4·9 billion to 5·3 billion) and 5·6 billion (5·3 billion to 5·8 billion) lives in 2030. Interpretation: We chart future scenarios for health spending and its relationship with UHC. Ensuring that all countries have sustainable pooled health resources is crucial to the achievement of UHC. Funding: The Bill & Melinda Gates Foundation.

Citation

Banstola, A. (2018). Trends in future health financing and coverage: future health spending and universal health coverage in 188 countries, 2016–40. Lancet, 391(10132), 1783-1798. https://doi.org/10.1016/s0140-6736%2818%2930697-4

Journal Article Type Article
Acceptance Date Apr 1, 2018
Online Publication Date Apr 17, 2018
Publication Date May 5, 2018
Deposit Date Sep 24, 2019
Publicly Available Date Sep 24, 2019
Journal The Lancet
Print ISSN 0140-6736
Electronic ISSN 1474-547X
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 391
Issue 10132
Pages 1783-1798
DOI https://doi.org/10.1016/s0140-6736%2818%2930697-4
Public URL https://uwe-repository.worktribe.com/output/3240194
Additional Information This article is maintained by: Elsevier; Article Title: Trends in future health financing and coverage: future health spending and universal health coverage in 188 countries, 2016–40; Journal Title: The Lancet; CrossRef DOI link to publisher maintained version: https://doi.org/10.1016/S0140-6736(18)30697-4; Content Type: article; Copyright: © 2018 The Author(s). Published by Elsevier Ltd.

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