Research in context
Evidence before this study
Substantial effort by researchers and government agencies has been dedicated to estimation of future health spending. Forecasting inputs and methods vary dramatically from country to country, and study to study. These studies tend to focus on a single country or small set of countries. On Jan 8, 2016, and April 4, 2016, we searched Google, Google Scholar, and MEDLINE for articles published in English with the search terms “health expenditure” and “health spending forecast”. The two endeavours that focus on a broad set of countries are led by the Organisation for Economic Co-operation and Development and the International Monetary Fund. The Organisation for Economic Co-operation and Development has estimated government spending on health and total spending on long-term care in high-income countries and four major middle-income countries up to 2060. The International Monetary Fund has estimated the annual percentage change in government health spending for all countries up to 2020. Both assess only government spending, report spending estimates only as a share of gross domestic product, and do not provide uncertainty intervals.
Added value of this study
This is the first study to estimate total health spending for a large set of countries. We estimate health spending for 184 countries from 2013 to 2040. We disaggregate our estimates by source, providing annual estimates for government health spending, prepaid private health spending, out-of-pocket health spending, and development assistance for health received, for each country. One important contribution of this study is that these four sources of health spending can be combined to measure total health spending. Previous studies focused on government health spending, excluding private spending and development assistance, which are crucial means to finance health spending for many countries, particularly low-income and middle-income countries. We report annual estimates as a share of gross domestic product and in purchasing power-adjusted, inflation-adjusted dollars, so that we can compare against notable health spending benchmarks. Furthermore, we compare the amount of health spending across income classifications and regions, assess progress in the health financing transition, and measure health financing inequality.
Implications of all the available evidence
This research highlights the persistence of health financing gaps and continued reliance on out-of-pocket health spending in some countries into the future. Even in 2040, 111 (60%) of the 184 countries are not meeting an international health financing target that 5% of gross domestic product be government health spending. Additionally, this research highlights global health spending inequality. These estimates indicate where change is most needed to bend health financing trajectories. In many cases, these countries are the world's poorest, with the largest disease burdens. This research emphasises that policy makers and global leaders need to work together to assess where more resources can be raised for health than at present and where existing resources can be squeezed to ensure essential health services are affordable for those most in need.