Lancet. 2018 May 5;391(10132):1783-1798. doi: 10.1016/S0140-6736(18)30697-4. Epub 2018 Apr 17.
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.
实现全民健康覆盖（UHC）需要有能够为关键卫生服务提供预付款池资源的卫生筹资体系，同时又不会给家庭带来过度的经济压力。了解当前和未来的卫生筹资轨迹对于实现 UHC 至关重要。我们利用 1995 年至 2015 年期间 188 个国家的历史卫生筹资数据，估算了截至 2040 年期间卫生支出和预付款池卫生支出的未来情景。
我们从 1995 年至 2015 年期间从 188 个国家提取了国内生产总值（GDP）和卫生支出的历史数据，并根据参考情景预测了 2015 年至 2040 年期间的 GDP 年增长率、卫生发展援助以及政府、自付和预付款私人卫生支出。这些估计数是使用各种关键人口和社会经济决定因素的模型集合生成的。我们根据历史卫生支出增长率的全球分布情况，生成了更好和更差的替代未来情景。最后，我们使用随机前沿分析来研究预付款池卫生资源与 UHC 指数之间的关联，UHC 指数是衡量一个国家 UHC 服务覆盖范围的指标。最后，我们估算了未来的 UHC 绩效以及三种未来情景下的覆盖人数。
在参考情景中，预计全球卫生支出将从 2015 年的 10 万亿美元（95%不确定性区间为 10 万亿美元至 10 万亿美元）增加到 2040 年的 20 万亿美元（18 万亿美元至 22 万亿美元）。人均卫生支出预计将以上中等收入国家增长最快，为每年 4.2%（3.4-5.1），其次是下中等收入国家（4.0%，3.6-4.5）和低收入国家（2.2%，1.7-2.8）。尽管全球卫生支出有所增长，但到 2040 年，低收入国家的人均卫生支出预计仅为 40 美元（24-65），下中等收入国家为 140 美元（90-200）。在全球范围内，预付款池资源覆盖的卫生支出份额差异很大，从尼日利亚的 19.8%（10.3-38.6）到塞舌尔的 97.9%（96.4-98.5）。UHC 指数的历史表现与预付款池人均资源显著相关。在所有替代情景中，我们估计 2030 年 UHC 将覆盖 51 亿（49 亿至 53 亿）至 56 亿（53 亿至 58 亿）人。
我们描绘了卫生支出及其与 UHC 关系的未来情景。确保所有国家都有可持续的预付款池卫生资源，这对于实现 UHC 至关重要。
比尔及梅林达·盖茨基金会。
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