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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Trends in future health financing and coverage: future health spending and universal health coverage in 188 countries, 2016–40
The Lancet, Volume 391, No. 10132, Year 2018
Notification
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Description
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. © 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license
Available Materials
https://efashare.b-cdn.net/share/pmc/articles/PMC5946843/bin/mmc1.pdf
Authors & Co-Authors
Dieleman, Joseph L.
Unknown Affiliation
Sadat, Nafis
Unknown Affiliation
Chang, Angela Y.
Unknown Affiliation
Fullman, Nancy
Unknown Affiliation
Abbafati, Cristiana
Unknown Affiliation
Acharya, Pawan
Unknown Affiliation
Adou, Arsène Kouablan
Unknown Affiliation
Kiadaliri, Ali Ahmad
Unknown Affiliation
Alam, Khurshid
Unknown Affiliation
Alizadeh-Navaei, Reza
Unknown Affiliation
Alkerwi, Ala'a Al A.
Unknown Affiliation
Ammar, Walid S.
Unknown Affiliation
Antonio, Carl Abelardo T.
Unknown Affiliation
Aremu, Olatunde
Unknown Affiliation
Asgedom, Solomon Weldegebreal
Unknown Affiliation
Atey, Tesfay Mehari
Unknown Affiliation
Ávila-Burgos, Leticia Del Socorro
Unknown Affiliation
Ayer, Rakesh
Unknown Affiliation
Badali, Hamid
Unknown Affiliation
Banach, Maciej P.
Unknown Affiliation
Banstola, Amrit
Unknown Affiliation
Barac, Aleksandra M.
Unknown Affiliation
Belachew, Abate B.
Unknown Affiliation
Birungi, Charles
Unknown Affiliation
Bragazzi, Nicola Luigi
Unknown Affiliation
Gething, P. W.
Unknown Affiliation
Cahuana-Hurtado, Lucero
Unknown Affiliation
Car, Josip
Unknown Affiliation
Catalá-López, Ferrán
Unknown Affiliation
Chapin, Abigail L.
Unknown Affiliation
Chen, Catherine S.
Unknown Affiliation
Dandona, Lalit
Unknown Affiliation
Dandona, Rakhi
Unknown Affiliation
Daryani, Ahamd
Unknown Affiliation
Dharmaratne, Samath Dhamminda
Unknown Affiliation
Dubey, Manisha
Unknown Affiliation
Edessa, Dumessa
Unknown Affiliation
Eldrenkamp, Erika
Unknown Affiliation
Eshrati, Babak
Unknown Affiliation
Faro, Andre
Unknown Affiliation
Feigl, Andrea B.
Unknown Affiliation
Fenny, Ama Pokuaa
Unknown Affiliation
Fischer, Florian
Unknown Affiliation
Foigt, Nataliya A.
Unknown Affiliation
Foreman, Kyle J.
Unknown Affiliation
Ghimire, Mamata
Unknown Affiliation
Goli, Srinivas
Unknown Affiliation
Hailu, Alemayehu Desalegne
Unknown Affiliation
Hamidi, Samer A.
Unknown Affiliation
Harb, Hilda L.
Unknown Affiliation
Hay, Simon I.
Unknown Affiliation
Hendrie, Delia V.
Unknown Affiliation
Ikilezi, Gloria
Unknown Affiliation
Javanbakht, Mehdi
Unknown Affiliation
John, Denny
Unknown Affiliation
Jonas, Jost Bruno
Unknown Affiliation
Kaldjian, Alexander S.
Unknown Affiliation
Kasaeian, Amir
Unknown Affiliation
Khang, Young-ho
Unknown Affiliation
Khubchandani, Jagdish
Unknown Affiliation
Kim, Yun-jin
Unknown Affiliation
Kinge, Jonas Minet Inet
Unknown Affiliation
Kosen, Soewarta
Unknown Affiliation
Krohn, Kristopher J.
Unknown Affiliation
Kumar, G. Anil
Unknown Affiliation
Lafranconi, Alessandra
Unknown Affiliation
Lam, Hilton Y.
Unknown Affiliation
Listl, Stefan M.
Unknown Affiliation
Magdy Abd El Razek, Hassan
Unknown Affiliation
Magdy Abd El Razek, Mohammed
Unknown Affiliation
Majeed, Azeem
Unknown Affiliation
Malekzadeh, Reza
Unknown Affiliation
Carvalho Malta, Deborah Carvalho
Unknown Affiliation
Mensah, George A.
Unknown Affiliation
Meretoja, Atte P.
Unknown Affiliation
Micah, Angela E.
Unknown Affiliation
Miller, Ted R.
Unknown Affiliation
Mirrakhimov, Erkin
Unknown Affiliation
Mlashu, Fitsum Weldegebreal
Unknown Affiliation
Yimer, Ebrahim M.
Unknown Affiliation
Mohammed, Shafiu Abdullah
Unknown Affiliation
Moses, Mark W.
Unknown Affiliation
Mousavi, Seyyed Meysam
Unknown Affiliation
Naghavi, Mohsen
Unknown Affiliation
Nangia, Vinay B.
Unknown Affiliation
Ngalesoni, Frida Namnyak
Unknown Affiliation
Nguyen, Cuong Tat
Unknown Affiliation
Nguyen, Trang Huyen Thi
Unknown Affiliation
Niriayo, Yirga Legesse
Unknown Affiliation
Noroozi, Mehdi
Unknown Affiliation
Owolabi, Mayowa O.
Unknown Affiliation
Patel, Tejas
Unknown Affiliation
Pereira, David M.
Unknown Affiliation
Polinder, Suzanne S.
Unknown Affiliation
Qorbani, Mostafa
Unknown Affiliation
Rafay, Anwar
Unknown Affiliation
Rafiei, Alireza
Unknown Affiliation
Rahimi-Movaghar, Vafa
Unknown Affiliation
Rai, Rajesh Kumar
Unknown Affiliation
Ram, Usha
Unknown Affiliation
Ranabhat, Chhabi Lal
Unknown Affiliation
Ray, Sarah E.
Unknown Affiliation
Reiner, Robert Charles
Unknown Affiliation
Sajadi, Haniye Sadat
Unknown Affiliation
Santos, João Vasco
Unknown Affiliation
Sarker, Abdur Razzaque
Unknown Affiliation
Sartorius, Benn
Unknown Affiliation
Satpathy, M.
Unknown Affiliation
Sepanlou, Sadaf G.
Unknown Affiliation
Shaikh, Masood Ali A.
Unknown Affiliation
Sharif, Mehdi
Unknown Affiliation
Sheikh, Aziz
Unknown Affiliation
Shrime, Mark G.
Unknown Affiliation
Sisay, Mekonnen
Unknown Affiliation
Soofi, Moslem
Unknown Affiliation
Sorensen, Reed J.D.
Unknown Affiliation
Tadesse, Henok
Unknown Affiliation
Tao, Tianchan
Unknown Affiliation
Templin, Tara
Unknown Affiliation
Tesema, Azeb Gebresilassie
Unknown Affiliation
Thapa, Subash
Unknown Affiliation
Tobe-Gai, Ruoyan Gai
Unknown Affiliation
Topoŕ-Ma̧dry, Roman
Poland, Krakow
Jagiellonian University Medical College
Poland, Wroclaw
Wroclaw Medical University
Tran, Bach Xuan
Unknown Affiliation
Tran, Khanh Bao
Unknown Affiliation
Undurraga, Eduardo A.
Unknown Affiliation
Vasankari, Tommi Juhani
Unknown Affiliation
Violante, Francesco Saverio
Unknown Affiliation
Werdecker, Andrea
Unknown Affiliation
Wijeratne, Tissa
Unknown Affiliation
Yonemoto, Naohiro
Unknown Affiliation
Younis, Mustafa Zeedan
Unknown Affiliation
Yu, Chuanhua
Unknown Affiliation
Zaki, Maysaa El S.
Unknown Affiliation
Zlavog, Bianca S.
Unknown Affiliation
Murray, Christopher J.L.
Unknown Affiliation
Statistics
Citations: 103
Authors: 136
Affiliations: 2
Identifiers
Doi:
10.1016/S0140-6736(18)30697-4
ISSN:
01406736
Research Areas
Health System And Policy
Study Locations
Nigeria
Seychelles