Skip to main content
×
×
Home

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

  • Di Mcintyre (a1), Filip Meheus (a1) and John-Arne Røttingen (a2) (a3) (a4)
Abstract
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 a per capita target of $86 to promote universal access to primary care services in low-income countries.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      What level of domestic government health expenditure should we aspire to for universal health coverage?
      Available formats
      ×
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      What level of domestic government health expenditure should we aspire to for universal health coverage?
      Available formats
      ×
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      What level of domestic government health expenditure should we aspire to for universal health coverage?
      Available formats
      ×
Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Corresponding author
*Correspondence to: Professor Di McIntyre, Health Economics Unit, Department of Public Health and Family Medicine, University of Cape Town, Anzio Road, Observatory 7925, Cape Town, South Africa. Email: Diane.McIntyre@uct.ac.za
Footnotes
Hide All
a Present address: International Agency for Research on Cancer, World Health Organisation, 150 Cours Albert Thomas, 69372 Lyon, France.
Footnotes
References
Hide All
Balakrishnan R., Elson D., Heintz J. and Lusiani N. (2011), Maximum Available Resources and Human Rights, NJ: Center for Women’s Global Leadership, Rutgers, New Brunswick, NJ.
Boerma T., AbouZahr C., Evans D. and Evans T. (2014), ‘Monitoring intervention coverage in the context of universal health coverage’, PLoS Med, 11(9): e1001728.
Borghi J., Mtei G. and Ally M. (2012), ‘Modelling the implications of moving towards universal coverage in Tanzania’, Health Policy and Planning, 27(Supplement 1): i88i100.
Commission on Macroeconomics and Health (CMH) (2001), ‘Macroeconomics and Health: Investing in Health for Economic Development’, Report of the Commission on Macroeconomics and Health, World Health Organisation, Geneva.
Eloivano R. and Evans D. (2017), ‘Raising more domestic money for health: prospects for low and middle income countries’, Health Economics, Policy and Law, 12(2): 139157.
Farag M., Nandakumar A. K., Wallack S. S., Gaumer G. and Hodgkin D. (2009), ‘Does funding from donors displace government spending for health in developing countries?’, Health Affairs, 28(4): 10451055.
Govender V., McIntyre D. and Loewenson R. (2008), ‘Progress Towards the Abuja Target for Government Spending on Health Care in East and Southern Africa’. EQUINET Discussion Paper No. 60, Regional Network for Equity in Health in Southern Africa, Harare.
High-Level Taskforce (HLTF) (2009), ‘Constraints to Scaling Up and Costs. High Level Taskforce (HLTF) on Innovative International Financing for Health Systems’. Working Group 1 Technical Report, World Health Organisation, Geneva.
International Monetary Fund (2012), World Economic Outlook, October 2012, Washington, DC: IMF.
Mathauer I., Doetinchem O., Kirigia J. and Carrin G. (2007), Feasibility Assessment and Financial Projection Results for a Social Health Insurance Scheme in Lesotho: Exploring Possible Options, Geneva: World Health Organization.
Mathauer I., Musango L., Carrin G. and Mthethwa K. (2008), Feasibility Assessment and Financial Projection Results for a Social Health Insurance Scheme in Swaziland: Exploring Possible Options, Geneva: World Health Organization.
McCoy D., Chigudu S. and Tillmann T. (2017), ‘Framing the tax and health nexus: a neglected aspect of public health concern’, Health Economics, Policy and Law, 12(2): 179194.
McIntyre D. and Kutzin J. (2011), ‘Revenue collection and pooling arrangements in health system financing’, in R. Smith and K. Hanson (eds) Health Systems in Low- and Middle-Income Countries, Oxford: Oxford University Press, 77101.
McIntyre D. and Ataguba J. (2012), ‘Modelling the affordability and distributional implications of future health care financing options in South Africa’, Health Policy and Planning, 27(Supplement 1): i101i112.
Meheus F. and McIntyre D. (2017), ‘Fiscal space for domestic funding of health and other social services’, Health Economics, Policy and Law, 12(2): 159177.
Moreno-Serra R. and Smith P. (2015), ‘Broader health coverage is good for the nation’s health: evidence from country level panel data’, Journal of the Royal Statistical Society, 178(1): 101124.
Njora G. (2010), ‘African finance ministers dismiss development declarations’. FAHAMU, http://pambazuka.org/en/category/comment/63894 [25 May 2010].
Organisation of African Unity (2001), Abuja Declaration on HIV/AIDS, Tuberculosis and Other Related Infectious Diseases, Addis Ababa: Organisation of African Unity.
Reeves R., Gourtsoyannis Y., Basu S., McCoy D., McKee M. and Stuckler D. (2015), ‘Financing universal health coverage – effects of alternative tax structures on public health systems: cross-national modelling in 89 low-income and middle-income countries’, Lancet, 386(9990): 274280.
RESYST (2014), ‘What is Strategic Purchasing for Health?’, Resilient and Responsive Health Systems, London School of Hygiene and Tropical Medicine, London, http://resyst.lshtm.ac.uk/sites/resyst.lshtm.ac.uk/files/docs/reseources/Purchasing%20brief.pdf [13 October 2014].
Savedoff W. D. (2007), ‘What should a country spend on health care?’, Health Affairs, 26(4): 962970.
Scott A. and Lucci P. (2015), ‘Universality and ambition in the post-2015 development agenda: a comparison of global and national targets’, Journal of International Development, 27(6): 752775.
Taskforce on Innovative International Financing for Health Systems (2009), More Money for Health, and More Health for the Money: Report of the Taskforce, Geneva: International Health Partnership.
United Nations (UN) (2015), Report of the Third International Conference on Financing for Development, New York: United Nations.
UN System Task Team on the Post-2015 UN Development Agenda (2012), Realizing the Future we Want for All: Report to the Secretary-General, New York: United Nations.
World Health Organisation (WHO) (2010), ‘Health Systems Financing: The Path to Universal Coverage’. World Health Report 2010, WHO, Geneva.
World Health Organisation (WHO) (2011), World Health Statistics, 2011, Geneva: World Health Organisation.
World Health Organisation (WHO) (2012), Measuring Service Availability and Readiness: A Health Facility Assessment Methodology for Monitoring Health System Strengthening. Service Availability Indicators, Geneva: WHO.
Xu K., Evans D. B., Kawabata K., Zeramdini R., Klavus J. and Murray C. J. L. (2003), ‘Household catastrophic health expenditure: a multicountry analysis’, Lancet, 362(9378): 111117.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Health Economics, Policy and Law
  • ISSN: 1744-1331
  • EISSN: 1744-134X
  • URL: /core/journals/health-economics-policy-and-law
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 359
Total number of PDF views: 969 *
Loading metrics...

Abstract views

Total abstract views: 1215 *
Loading metrics...

* Views captured on Cambridge Core between 23rd March 2017 - 23rd February 2018. This data will be updated every 24 hours.