Article Text
Abstract
Background Setting Millennium Development Goals and Sustainable Development Goals for health has largely focused on defining specific targets of mortality and morbidity reduction over given time periods. Yet, less attention has been devoted to setting targets for the systemic determinants of health delivery, such as access and financial risk protection (FRP)—prevention of medical impoverishment. We examined candidate targets for FRP among low and middle-income countries by 2040.
Methods We used a data set on estimates of incidence of catastrophic health expenditure (CHE)—medical expenditure exceeding 40% of household capacity to pay—among 110 countries over 1995–2007, augmented by estimates of the percentage of out-of-pocket expenditure out of total health expenditure (OOPEXP), the share of health expenditure as a percentage of gross domestic product (HEXGDP) and the gross domestic product per capita (GDPC). Using a simple model and 2040 estimates for OOPEXP, HEXGDP and GDPC from the World Bank, the International Monetary Fund and the Institute for Health Metrics and Evaluation, we projected CHE incidence by 2040 for four country income groups.
Results We predicted that the 2040 incidence of CHE among households would be: 2.13% (Uncertainty interval: 0.60-6.87) among low-income countries, 1.15% (0.32–3.81) among lower-middle-income countries and 0.65% (0.18–2.21) among upper-middle-income countries. By 2040, the probability of achieving CHE <1.00% would be: 0.1 for low-income countries, 0.4 for lower-middle-income countries and 0.7 for upper-middle-income countries; for CHE <0.50% , it would be 0 for low-income countries, 0.1 for lower-middle-income countries and 0.3 for upper-middle-income countries.
Conclusions Historical trends of CHE rates can help define post-2015 targets for FRP. The projected achievements suggest that elimination of medical impoverishment will not be achieved by 2040 and that countries must urgently enact dramatic changes in policy to ensure FRP to their populations.
- Sustainable Development Goals
- financial risk protection
- out-of-pocket costs
- poverty
- equity
- low and middle-income countries
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Footnotes
Contributors SV initiated and conceptualised the study. SV coordinated the research and did the analysis with MEK. WND pursued some of the preliminary analyses. SV wrote the first draft of the report. ATW drafted the box. All authors subsequently read, revised and approved the report.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement No additional data are available.