from to

HEALTH FINANCING
A country’s health financing arrangement is an important determinant of the overall performance of the
health system, including a country’s progress towards UHC. 1 Over the past 20 years, many countries have
taken steps to improve their health financing systems in line with their available resources, but important
challenges remain. Several important lessons have been learnt about both promising directions for reform
as well as pitfalls to avoid.
TRENDS
Between 1995 and 2013, there has been a steady decline in the share
of total health expenditure in the form of out-of-pocket spending at
the time of use, particularly in low-income countries (Figure 3.5).
This is important because out-of-pocket spending is both a barrier
to needed service use for those unable to pay and pose a threat to
financial risk protection. 92
In general, the greater the level of health spending from public/
compulsory sources, the lower the dependence of systems on outof-pocket
spending. And indeed it appears that, as part of improved
health financing policies more generally, an important reason why
out-of-pocket spending has declined has been a growth in public
spending on health (Figure 3.6).
Globally, and especially in low-income countries, the data reveal
that behind this growth in public spending has been an increased
commitment to the health sector by governments (Figure 3.7), although
in many cases this has been strongly supported by external funds that
flow through government systems.
Despite this progress, out-of-pocket spending remains high, and
millions of people globally are at risk of financial harm (including
impoverishment) as a consequence of paying for health services.
Figure 3.6
Public expenditure on health as a percentage of GDP, a 1995–2013 18
(%)
Global
4.5
4.0
3.5
3.0
2.5
2.0
1.5
1.0
0.5
0
Low-income countries
1995–1999 2000–2004 2005–2009
a
Values are unweighted averages.
2010–2013
Figure 3.7
General government expenditure on health as a percentage of total general
government expenditure, 1995–2013 18
Global
Low-income countries
Figure 3.5
Out-of-pocket spending as a percentage of total health spending, a 1995–2013 18
Global
60
Low-income countries
(%)
15
10
5
(%)
50
40
30
20
10
0
1995–1999 2000–2004 2005–2009
a
Values are unweighted averages.
2010–2013
0
1995–1999 2000–2004 2005–2009
a
Values are unweighted averages.
2010–2013
52 HEALTH IN 2015: FROM MDGs TO SDGs