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The rapid aging of the population presents great challenges in terms of China’s social security expenditure and economic growth. This paper uses the entropy method to comprehensively measure the provincial population aging index in 2008–2019 and constructs an intermediary effect model with it as the core explanatory variable. The results show that the population aging has a significant positive impact on economic growth and on the promotion of the economic growth of more developed areas; it also has a positive impact on the endowment insurance expenditure and medical and health expenditure and on the promotion of economically backward areas. Endowment spending and health spending fully mediate the relationship between population aging and economic growth.

Achieving universal health coverage (UHC) involves all people receiving the health services they need, of high quality, without experiencing financial hardship. Making progress towards UHC is a policy priority for both countries and global institutions, as highlighted by the agenda of the UN Sustainable Development Goals (SDGs) and WHO's Thirteenth General Programme of Work (GPW13). Measuring effective coverage at the health-system level is important for understanding whether health services are aligned with countries' health profiles and are of sufficient quality to produce health gains for populations of all ages. Based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we assessed UHC effective coverage for 204 countries and territories from 1990 to 2019. Drawing from a measurement framework developed through WHO's GPW13 consultation, we mapped 23 effective coverage indicators to a matrix representing health service types (eg, promotion, prevention, and treatment) and five population-age groups spanning from reproductive and newborn to older adults (≥65 years). Effective coverage indicators were based on intervention coverage or outcome-based measures such as mortality-to-incidence ratios to approximate access to quality care; outcome-based measures were transformed to values on a scale of 0–100 based on the 2·5th and 97·5th percentile of location-year values. We constructed the UHC effective coverage index by weighting each effective coverage indicator relative to its associated potential health gains, as measured by disability-adjusted life-years for each location-year and population-age group. For three tests of validity (content, known-groups, and convergent), UHC effective coverage index performance was generally better than that of other UHC service coverage indices from WHO (ie, the current metric for SDG indicator 3.8.1 on UHC service coverage), the World Bank, and GBD 2017. We quantified frontiers of UHC effective coverage performance on the basis of pooled health spending per capita, representing UHC effective coverage index levels achieved in 2019 relative to country-level government health spending, prepaid private expenditures, and development assistance for health. To assess current trajectories towards the GPW13 UHC billion target—1 billion more people benefiting from UHC by 2023—we estimated additional population equivalents with UHC effective coverage from 2018 to 2023. Globally, performance on the UHC effective coverage index improved from 45·8 (95% uncertainty interval 44·2–47·5) in 1990 to 60·3 (58·7–61·9) in 2019, yet country-level UHC effective coverage in 2019 still spanned from 95 or higher in Japan and Iceland to lower than 25 in Somalia and the Central African Republic. Since 2010, sub-Saharan Africa showed accelerated gains on the UHC effective coverage index (at an average increase of 2·6% [1·9–3·3] per year up to 2019); by contrast, most other GBD super-regions had slowed rates of progress in 2010–2019 relative to 1990–2010. Many countries showed lagging performance on effective coverage indicators for non-communicable diseases relative to those for communicable diseases and maternal and child health, despite non-communicable diseases accounting for a greater proportion of potential health gains in 2019, suggesting that many health systems are not keeping pace with the rising non-communicable disease burden and associated population health needs. In 2019, the UHC effective coverage index was associated with pooled health spending per capita (r=0·79), although countries across the development spectrum had much lower UHC effective coverage than is potentially achievable relative to their health spending. Under maximum efficiency of translating health spending into UHC effective coverage performance, countries would need to reach $1398 pooled health spending per capita (US$ adjusted for purchasing power parity) in order to achieve 80 on the UHC effective coverage index. From 2018 to 2023, an estimated 388·9 million (358·6–421·3) more population equivalents would have UHC effective coverage, falling well short of the GPW13 target of 1 billion more people benefiting from UHC during this time. Current projections point to an estimated 3·1 billion (3·0–3·2) population equivalents still lacking UHC effective coverage in 2023, with nearly a third (968·1 million [903·5–1040·3]) residing in south Asia. The present study demonstrates the utility of measuring effective coverage and its role in supporting improved health outcomes for all people—the ultimate goal of UHC and its achievement. Global ambitions to accelerate progress on UHC service coverage are increasingly unlikely unless concerted action on non-communicable diseases occurs and countries can better translate health spending into improved performance. Focusing on effective coverage and accounting for the world's evolving health needs lays the groundwork for better understanding how close—or how far—all populations are in benefiting from UHC. Bill & Melinda Gates Foundation.

The development challenges of addressing health problems in low- and middle-income countries are daunting but not insurmountable. There are now known and affordable interventions to deal with many aspects of the HIV/AIDS crisis as well as the continued challenge posed by malaria and other major infectious diseases. Three major development objectives of health insurance in low- and middle income countries are highlighted in this volume: securing sustainable financing for health care providers that serve the health needs of vulnerable populations; providing financial protection against the impoverishing cost of illness; and reducing social exclusion from organized health financing and delivery systems. Private health insurance schemes can address the needs of the poor and other vulnerable populations with appropriate combinations of subsidies, risk pooling, household savings, and user charges. The authors of this book argue in favor of a multipillar approach to health care financing in low- and middle-income countries that combines these instruments in addressing the underlying development objectives described above, while putting a strong emphasis on private voluntary health insurance. In this way, private means can make a significant contribution to public ends.

Private voluntary health insurance already plays an important role in the health sector of many low and middle income countries.The book reviews the context under which private insurance could contribute to an improvement in the financial sustainability of the health sector, financial protection against the costs of illness, household income.

Background Although cardiovascular disease (CVD) has been the major contributor to global mortality and disability especially in undeveloped and developing countries/areas with severer air pollutions, studies are quite limited and evidence is insufficient of short-term main air pollutants exposure on health burden of CVD hospital admissions in those regions particularly through direct costs. Method Based on an analysis of 30,959 CVD hospital admissions among suburban farmers from 2018 to 2019 through multiple linear regression (MLR), our study evaluated the impact of main air pollutants (PM 2.5 , PM 10 , SO 2 , CO, NO 2 and O 3 ) exposure on number of cases, length of stay (LOS) and costs of CVD hospital admissions in Pingliang, China. Results Concentration of SO 2 and O 3 rising from a low level was found to lower the costs, LOS and daily cases of CVD hospital admissions and PM 2.5 , PM 10 , CO and NO 2 were found to aggravate the burden. Besides, the NO 2 could put more economic stress on those CVD patients in Pingliang (China) which implies that some improvements could be done on public medical insurance policy and benefit local suburban farmers by strengthening the supports on specific drugs and therapies. Conclusions More efforts should be made to lower the concentration of air pollution by coordinated control managements even in a low-level scenario. Concentration levels and interactions between main air pollutants may play an important role in air pollution-induced CVD health burden. Future research is needed to explore more evidence in different areas, especially with low-level SO 2 effects.

Despite clear evidence of correlations between financial and medical statuses and decisions, most models treat financial and health-related choices separately. This article bridges this gap by proposing a tractable dynamic framework for the joint determination of optimal consumption, portfolio holdings, health investment, and health insurance. We solve for the optimal rules in closed form and capitalize on this tractability to gain a better understanding of the conditions under which separation between financial and health-related decisions is sensible, and of the pathways through which wealth and health determine allocations, welfare and other variables of interest such as expected longevity or the value of health. Furthermore we show that the model is consistent with the observed patterns of individual allocations and provide realistic estimates of the parameters that confirm the relevance of all the main characteristics of the model.

Growing healthcare expenditure is of major concern for the sustainability of public finances. In order to better explore the fiscal sustainability challenge and to inform the debate, we draw up a new set of healthcare expenditure projections for the particularly interesting case of Switzerland. According to our projections up to 2045, population ageing exerts a growing pressure on public budgets and mandatory healthcare insurance. However, healthcare expenditure is not only driven by demographic change but also by non-demographic drivers such as the increasing national income, medical advances and Baumol's cost disease. We find that long-term care is more severely affected than healthcare excluding long-term care. This finding implies that population ageing affects public finances to a greater extent than the mandatory healthcare insurance. Our sensitivity analysis suggests that the strongest cost pressure comes from alternative assumptions about the future state of health and Baumol's cost disease. Accordingly, measures aiming at prevention and efficiency would help most to ease the pressure on public finances and mandatory healthcare insurance.