Our results further suggest a critical role for health care spending in determining a country's probability of detecting, confirming and reporting influenza cases in the early phases of a pandemic. The negative relationship between healthcare spending and detection of 2009 A/H1N1 influenza may be due to a delay in testing or in the collecting of specimens from individuals in countries lower healthcare resources. These countries likely have lower rates of health insurance, less healthcare infrastructure, lower self-reporting, and lower numbers of doctors per capita.