What level of domestic government health expenditure should we aspire to for universal health coverage?

Abstract

Global discussions on universal health coverage (UHC) have focussed attention on the need for increased government funding for health care in many low-and middle-income countries. The objective of this paper is to explore potential targets for government spending on health to progress towards UHC. An explicit target for government expenditure on health care relative to gross domestic product (GDP) is a potentially powerful tool for holding governments to account in progressing to UHC, particularly in the context of UHC's inclusion in the Sustainable Development Goals. It is likely to be more influential than the Abuja target, which requires decreases in budget allocations to other sectors and is opposed by finance ministries for undermining their autonomy in making sectoral budget allocation decisions. International Monetary Fund and World Health Organisation data sets were used to analyse the relationship between government health expenditure and proxy indicators for the UHC goals of financial protection and access to quality health care, and triangulated with available country case studies estimating the resource requirements for a universal health system. Our analyses point towards a target of government spending on health of at least 5% of GDP for progressing towards UHC. This can be supplemented by

The Global Burden of Surgical Disease: An Analysis on Inaccessible Surgical Care in Low and Middle Income Countries

“…Catastrophic payments are the OOP spending that exceeds the household's income, leading individuals to suffer the burden of disease (WHO, 2012). If there is a 1% increase in health expenditure by OOP payments, a proportion of households will face a 2.2% increase in catastrophic payments (McIntyre, Meheus, & Røttingen, 2017;Xu et al, 2003). Therefore, OOP is one of the factors that can significantly impact health care expenditure.…”

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“…Increasing the share of government expenditure going to health is politically complex, illustrated by the fact that in the 10 years after the Abuja Declaration was signed, almost as many African Union countries moved away from the target of 15% as moved closer to it (WHO Regional Office for Africa, 2011;McIntyre et al, 2017). Yet, a number of low-and middle-income countries have shown that it is possible to increase the share of GGE going to health.…”

“…In the first article of this series, McIntyre et al (2017) have made the arguments of setting government health expenditure targets at 5% of gross domestic product (GDP) and at US$86 per capita. These targets emerge from several sources, including from the HLTF calculations.…”

Distributing development assistance for health: simulating the implications of 11 criteria

“…According to the criterion linked to conditional GHEpc gap from $86 (5% gap), DAH increases with the shortfall of GHEpc from $86 that would exist if GHE in the country represented 5% of GNI. A GHE/GNI 2 ratio of at least 5% has been suggested as a useful target for government health expenditure (McIntyre et al, 2017). The 5% gap can be seen as a indication of the lack of capacity to meet health needs, since any such gap suggests that countries are unable to reach the $86 target even if they spent 5% of GNI on publicly financed health services.…”