Institute for Heath Metrics and Evaluation, Seattle, WA, USA.
Institute for Heath Metrics and Evaluation, Seattle, WA, USA.
Lancet. 2016 Jun 18;387(10037):2521-35. doi: 10.1016/S0140-6736(16)30167-2. Epub 2016 Apr 13.
A general consensus exists that as a country develops economically, health spending per capita rises and the share of that spending that is prepaid through government or private mechanisms also rises. However, the speed and magnitude of these changes vary substantially across countries, even at similar levels of development. In this study, we use past trends and relationships to estimate future health spending, disaggregated by the source of those funds, to identify the financing trajectories that are likely to occur if current policies and trajectories evolve as expected.
We extracted data from WHO's Health Spending Observatory and the Institute for Health Metrics and Evaluation's Financing Global Health 2015 report. We converted these data to a common purchasing power-adjusted and inflation-adjusted currency. We used a series of ensemble models and observed empirical norms to estimate future government out-of-pocket private prepaid health spending and development assistance for health. We aggregated each country's estimates to generate total health spending from 2013 to 2040 for 184 countries. We compared these estimates with each other and internationally recognised benchmarks.
Global spending on health is expected to increase from US$7·83 trillion in 2013 to $18·28 (uncertainty interval 14·42-22·24) trillion in 2040 (in 2010 purchasing power parity-adjusted dollars). We expect per-capita health spending to increase annually by 2·7% (1·9-3·4) in high-income countries, 3·4% (2·4-4·2) in upper-middle-income countries, 3·0% (2·3-3·6) in lower-middle-income countries, and 2·4% (1·6-3·1) in low-income countries. Given the gaps in current health spending, these rates provide no evidence of increasing parity in health spending. In 1995 and 2015, low-income countries spent $0·03 for every dollar spent in high-income countries, even after adjusting for purchasing power, and the same is projected for 2040. Most importantly, health spending in many low-income countries is expected to remain low. Estimates suggest that, by 2040, only one (3%) of 34 low-income countries and 36 (37%) of 98 middle-income countries will reach the Chatham House goal of 5% of gross domestic product consisting of government health spending.
Despite remarkable health gains, past health financing trends and relationships suggest that many low-income and lower-middle-income countries will not meet internationally set health spending targets and that spending gaps between low-income and high-income countries are unlikely to narrow unless substantive policy interventions occur. Although gains in health system efficiency can be used to make progress, current trends suggest that meaningful increases in health system resources will require concerted action.
Bill & Melinda Gates Foundation.
人们普遍认为，随着一个国家经济的发展，人均卫生支出会增加，通过政府或私人机制预付的卫生支出份额也会增加。然而，即使在发展水平相似的情况下，这些变化的速度和幅度在各国之间也有很大差异。在这项研究中，我们利用过去的趋势和关系来估计未来的卫生支出，按资金来源对其进行细分，以确定如果当前政策和趋势按预期发展，可能出现的融资轨迹。
我们从世卫组织卫生支出观察站和健康计量与评估研究所的《2015 年全球卫生筹资》报告中提取数据。我们将这些数据转换为采用相同购买力平价和经通胀调整的货币。我们使用一系列集成模型和观察到的经验规范来估计未来政府自付的私人预付款和卫生发展援助支出。我们将每个国家的估计值汇总，以生成 184 个国家 2013 年至 2040 年的总卫生支出。我们将这些估计值与彼此以及国际公认的基准进行了比较。
预计全球卫生支出将从 2013 年的 7.83 万亿美元增加到 2040 年的 18.28 万亿美元（不确定区间为 14.42-22.24 万亿美元）（按 2010 年购买力平价调整后的美元计算）。我们预计，高收入国家的人均卫生支出每年将增长 2.7%（1.9-3.4），中上收入国家将增长 3.4%（2.4-4.2），中下收入国家将增长 3.0%（2.3-3.6），低收入国家将增长 2.4%（1.6-3.1）。鉴于当前卫生支出存在差距，这些增长率表明卫生支出的均等化程度没有提高。在 1995 年和 2015 年，即使经过购买力调整，低收入国家的卫生支出也仅为高收入国家的三分之一，预计到 2040 年仍将如此。最重要的是，许多低收入国家的卫生支出预计仍将保持较低水平。估计表明，到 2040 年，只有 34 个低收入国家中的 1 个（3%）和 98 个中等收入国家中的 36 个（37%）将达到国际设定的政府卫生支出占国内生产总值 5%的目标。
尽管取得了显著的健康进步，但过去的卫生筹资趋势和关系表明，许多低收入和中低收入国家将无法实现国际设定的卫生支出目标，除非采取实质性的政策干预措施，否则低收入国家和高收入国家之间的支出差距不太可能缩小。尽管提高卫生系统效率可以取得进展，但目前的趋势表明，需要采取协调一致的行动才能增加有意义的卫生系统资源。
比尔及梅琳达·盖茨基金会。
