Journal Article

Basic patterns in national health expenditure

Zeramdini, Riadh, Carrin, Guy, Musgrove, Philip

2002

Overview

Analysed in this paper are national health accounts estimates for 191 WHO Member States for 1997, using simple comparisons and linear regressions to describe spending on health and how it is financed. The data cover all sources - out-of-pocket spending, social insurance contributions, financing from government general revenues and voluntary and employment-related private insurance - classified according to their completeness and reliability. Total health spending rises from around 2-3% of gross domestic product (GDP) at low incomes (< 1000 US dollars per capita) to typically 8-9% at high incomes (> 7000 US dollars). Surprisingly, there is as much relative variation in the share for poor countries as for rich ones, and even more relative variation in amounts in US dollars. Poor countries and poor people that most need protection from financial catastrophe are the least protected by any form of prepayment or risk-sharing. At low incomes, out-of-pocket spending is high on average and varies from 20-80% of the total; at high incomes that share drops sharply and the variation narrows. Absolute out-of-pocket expenditure nonetheless increases with income. Public financing increases faster, and as a share of GDP, and converges at high incomes. Health takes an increasing share of total public expenditure as income rises, from 5-6% to around 10%. This is arguably the opposite of the relation between total health needs and need for public spending, for any given combination of services. Within public spending, there is no convergence in the type of finance - general revenue versus social insurance. Private insurance is usually insignificant except in some rich countries.

• Publisher: World Health Organization,The World Health Organization
• Subject: Convergence / Developed Countries - economics / Developing Countries - economics / Economic development / Employment / Estimates / Financing / Financing, organized / Financing, Organized - statistics & numerical data / Financing, personal / Financing, Personal - statistics & numerical data / GDP / Government spending / Gross Domestic Product / Health care expenditures / Health care sector / Health Care Sector - statistics & numerical data / Health Expenditures - statistics & numerical data / Health Expenditures - trends / Health expenditures/statistics / Health insurance / Health needs / Health Policy & Services / Health services / Health Services Needs and Demand - economics / Humans / Income - classification / Inflation, Economic / Insurance / International aspects / Linear Models / Low income groups / Medical care / Medical care, Cost of / Needs assessment / Per capita / Personal expenditure / Prepayments / Public finance / Purchasing power parity / Reimbursement Mechanisms / Reliability / Research Article / Revenue / Risk sharing / Social security / Statistics as Topic / World Health Organization