Domestic health spending and universal health coverage targets for 184 countries

Globally, there is large variation in how much countries spend on health. In high-income countries, total health spending ranges from $853 to $9237 per capita while in low income countries health spending ranges from $33 to $347 per capita (2017 purchasing power parity adjusted dollars). Nonetheless, the provision of quality and affordable health care for the population is an aspirational goal shared by many countries. This aspiration is affirmed by the inclusion of universal health coverage as one of the Sustainable Development Goals. Existing research has shown that progress towards Universal Health Coverage will require that countries increase the proportion of total health spending that is domestically financed especially as mandatory prepayment. This study examines domestic health spending in 184 countries in order to assess whether their level of spending makes universal health care coverage within reach by 2030, the target deadline for the Sustainable Development Goals.

We extracted health spending data from the Institute for Health Metrics and Evaluation’s Financing Global Health database. These data disaggregate total health spending into four mutually exclusive categories – domestic government spending, prepaid private spending, out of pocket spending and development assistance for health - for 184 countries from 1995 through 2015. We examined the level of domestic spending against two proposed targets for progress towards Universal Health Coverage - government spending of at least 5% of gross domestic product and $86 per capita. Additionally, we used stochastic frontier analyses to identify patterns between country’s that commit the most towards domestic spending on health and their progression towards universal health coverage (measured as a composite index).

Our preliminary results show that in 2015 of the 184 countries, only 44 had domestic government spending levels that met or were above the proposed target of 5% of the national economy. Twenty-six countries in Europe, 5 in North America and only four in Africa had spending levels above the target. The majority of countries (133) achieved the per capita proposed target. The frontier analyses show that countries that have dedicated the most to government health spending are farther along in achieving universal health coverage. The results highlight the nuance required in establishing targets since there are countries that by spending criteria should have achieved universal health coverage but have not. Monitoring progress towards universal health coverage for the sustainable development goals will require a concerted effort from all stakeholders. These proposed targets provide guidance on whether domestic governments are mobilizing the maximum available resources given their specific context to achieve universal health care coverage.