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

Dieleman, Joseph L and Sadat, Nafis and Chang, Angela Y and Fullman, Nancy and Abbafati, Cristiana and Acharya, Pawan and Adou, Arsène Kouablan and Ahmad Kiadaliri, Aliasghar and Alam, Khurshid and Alizadeh-Navaei, Reza and Alkerwi, Ala'a and Ammar, Walid and Antonio, Carl Abelardo T and Aremu, Olatunde and Asgedom, Solomon Weldegebreal and Atey, Tesfay Mehari and Avila-Burgos, Leticia and Ayer, Rakesh and Badali, Hamid and Banach, Maciej and Banstola, Amrit and Barac, Aleksandra and Belachew, Abate Bekele and Birungi, Charles and Bragazzi, Nicola L and Breitborde, Nicholas J K and Cahuana-Hurtado, Lucero and Car, Josip and Catalá-López, Ferrán and Chapin, Abigail and Chen, Catherine S and Dandona, Lalit and Dandona, Rakhi and Daryani, Ahmad and Dharmaratne, Samath D and Dubey, Manisha and Edessa, Dumessa and Eldrenkamp, Erika and Eshrati, Babak and Faro, André and Feigl, Andrea B and Fenny, Ama P and Fischer, Florian and Foigt, Nataliya and Foreman, Kyle J and Ghimire, Mamata and Goli, Srinivas and Hailu, Alemayehu Desalegne and Hamidi, Samer and Harb, Hilda L and Hay, Simon I and Hendrie, Delia and Ikilezi, Gloria and Javanbakht, Mehdi and John, Denny and Jonas, Jost B and Kaldjian, Alexander and Kasaeian, Amir and Kasahun, Yawukal Chane and Khalil, Ibrahim A and Khang, Young-Ho and Khubchandani, Jagdish and Kim, Yun Jin and Kinge, Jonas M and Kosen, Soewarta and Krohn, Kristopher J and Kumar, G Anil and Lafranconi, Alessandra and Lam, Hilton and Listl, Stefan and Magdy Abd El Razek, Hassan and Magdy Abd El Razek, Mohammed and Majeed, Azeem and Malekzadeh, Reza and Malta, Deborah Carvalho and Martinez, Gabriel and Mensah, George A and Meretoja, Atte and Micah, Angela and Miller, Ted R and Mirrakhimov, Erkin M and Mlashu, Fitsum Weldegebreal and Mohammed, Ebrahim and Mohammed, Shafiu and Moses, Mark and Mousavi, Seyyed Meysam and Naghavi, Mohsen and Nangia, Vinay and Ngalesoni, Frida Namnyak and Nguyen, Cuong Tat and Nguyen, Trang Huyen and Niriayo, Yirga and Noroozi, Mehdi and Owolabi, Mayowa O and Patel, Tejas and Pereira, David M and Polinder, Suzanne and Qorbani, Mostafa and Rafay, Anwar and Rafiei, Alireza and Rahimi-Movaghar, Vafa and Rai, Rajesh Kumar and Ram, Usha and Ranabhat, Chhabi Lal and Ray, Sarah E and Reiner, Robert C and Sajadi, Haniye Sadat and Santoro, Rocco and Santos, João Vasco and Sarker, Abdur Razzaque and Sartorius, Benn and Satpathy, Maheswar and Sepanlou, Sadaf G and Shaikh, Masood Ali and Sharif, Mehdi and She, Jun and Sheikh, Aziz and Shrime, Mark G and Sisay, Mekonnen and Soneji, Samir and Soofi, Moslem and Sorensen, Reed J D and Tadesse, Henok and Tao, Tianchan and Templin, Tara and Tesema, Azeb Gebresilassie and Thapa, Subash and Tobe-Gai, Ruoyan and Topor-Madry, Roman and Tran, Bach Xuan and Tran, Khanh Bao and Tran, Tung Thanh and Undurraga, Eduardo A and Vasankari, Tommi and Violante, Francesco S and Werdecker, Andrea and Wijeratne, Tissa and Xu, Gelin and Yonemoto, Naohiro and Younis, Mustafa Z and Yu, Chuanhua and Zaki, Maysaa El Sayed and Zlavog, Bianca and Murray, Christopher J L (2018) Trends in future health financing and coverage: future health spending and universal health coverage in 188 countries, 2016–40. The Lancet, 391 (10132). pp. 1783-1798. ISSN 01406736

Trends in future health financing and coverage future health.pdf - Published Version
Available under License Creative Commons Attribution.

Download (7MB)


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.

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.

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.

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.

The Bill & Melinda Gates Foundation.

Item Type: Article
Subjects: B900 Others in Subjects allied to Medicine
G200 Operational Research
G300 Statistics
L100 Economics
Divisions: UoA Collections > REF2021 UoA 03: Allied Health Professions, Dentistry, Nursing & Pharmacy
Depositing User: Olatunde Aremu
Date Deposited: 06 Jun 2018 12:26
Last Modified: 06 Jun 2018 12:26

Actions (login required)

View Item View Item


In this section...