Trends in future health financing and coverage: future health spending and universal health coverage in 188 countries, 2016–40
Authors: Joseph L Dieleman, Nafis Sadat, Angela Y Chang, Nancy Fullman, Cristiana Abbafati, Pawan Acharya, Arsène Kouablan Adou, Aliasghar Ahmad Kiadaliri, Khurshid Alam, Reza Alizadeh-Navaei, Ala'a Alkerwi, Walid Ammar, Carl Abelardo T Antonio, Olatunde Aremu, Solomon Weldegebreal Asgedom, Tesfay Mehari Atey, Leticia Avila-Burgos, Rakesh Ayer, Hamid Badali, Maciej Banach, Amrit Banstola, Aleksandra Barac, Abate Bekele Belachew, Charles Birungi, Nicola L Bragazzi, Nicholas J K Breitborde, Lucero Cahuana-Hurtado, Josip Car, Ferrán Catalá-López, Abigail Chapin, Catherine S Chen, Lalit Dandona, Rakhi Dandona, Ahmad Daryani, Samath D Dharmaratne, Manisha Dubey, Dumessa Edessa, Erika Eldrenkamp, Babak Eshrati, André Faro, Andrea B Feigl, Ama P Fenny, Florian Fischer, Nataliya Foigt, Kyle J Foreman, Mamata Ghimire, Srinivas Goli, Alemayehu Desalegne Hailu, Samer Hamidi, Hilda L Harb, Simon I Hay, Delia Hendrie, Gloria Ikilezi, Mehdi Javanbakht, Denny John, Jost B Jonas, Alexander Kaldjian, Amir Kasaeian, Yawukal Chane Kasahun, Ibrahim A Khalil, Young-Ho Khang, Jagdish Khubchandani, Yun Jin Kim, Jonas M Kinge, Soewarta Kosen, Kristopher J Krohn, G Anil Kumar, Alessandra Lafranconi, Hilton Lam, Stefan Listl, Hassan Magdy Abd El Razek, Mohammed Magdy Abd El Razek, Azeem Majeed, Reza Malekzadeh, Deborah Carvalho Malta, Gabriel Martinez, George A Mensah, Atte Meretoja, Angela Micah, Ted R Miller, Erkin M Mirrakhimov, Fitsum Weldegebreal Mlashu, Ebrahim Mohammed, Shafiu Mohammed, Mark Moses, Seyyed Meysam Mousavi, Mohsen Naghavi, Vinay Nangia, Frida Namnyak Ngalesoni, Cuong Tat Nguyen, Trang Huyen Nguyen, Yirga Niriayo, Mehdi Noroozi, Mayowa O Owolabi, Tejas Patel, David M Pereira, Suzanne Polinder, Mostafa Qorbani, Anwar Rafay, Alireza Rafiei, Vafa Rahimi-Movaghar, Rajesh Kumar Rai, Usha Ram, 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
Journal: The Lancet (2018)

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.