World government spend is rising but people still pay out of pocket for healthcare


The global trends in government healthcare spending could be transforming, with countries spending more money on health.

But a significant portion of people are still paying for healthcare out of pocket.

But that too is improving – albeit slowly – according to a new report by the World Health Organisation (WHO) titled, Public Spending on Health: A Closer Look at Global Trends.

The report posits that total health spending is increasing more rapidly in low- and middle-income countries, growing on average by 6% a year, and by 4% in high-income countries.

Health spending is made up of government expenditure, out-of-pocket payments (people paying for their own care) and sources such as voluntary health insurance, employer-provided health programmes, and activities by NGOs.


The health sector has become one of the main sectors of the global economy, linked to economic growth, demographic change and technological change.

However, the distribution of health globally remains “highly unequal”.

“Despite gross domestic product and health spending growing fastest in low- and middle-income countries, a large gap persists between rich and poor countries,” the report said.

“In 2016 the median per capita [per person] health spending was more than $2 000 (more than R28 000) in high-income countries but just a fifth of that, $400 (about R5 600), in upper-middle income and one-20th of that $100 (about R1 400) in low- and lower-middle income countries,” it said.

Governments provide an average of 51% of a country’s health spending but more than 35% of health spending per country comes from out-of-pocket expenses.

The report contends that reliance on out of pocket is slowly declining in most regions globally.

“The transformation of health spending is the increasing reliance on public funding (taxes, typically).

“This is observable regionally and in middle- and high-income countries, in particular. This trend is a positive development because public funding sources enable revenues to be pooled and spent more equitably and efficiently to meet health needs and reduce the reliance on out-of-pocket spending,” it said.

Out-of-pocket spending dropped in the African region – which includes 47 countries – from 46% to 37% (of the share in total health expenditure).

However, the report stated that the declines were driven by the faster relative increase in spending from other sources rather than by a decline in out-of-pocket spending per person.

The report pointed to ways that policymakers, health professionals and citizens could continue to strengthen health systems.

“Health is a human right and all countries need to prioritise efficient, cost-effective primary healthcare as the path to achieving universal health coverage and the [UN] sustainable development goals,” said Agnès Soucat, WHO director for health systems, governance and financing.

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