Global spending on health: Weathering the storm

The 2020 Report analyses global health spending for 190 countries from 2000 to 2018 and provides insights into the health spending trajectory from the MDG era to the SDG era prior to the crisis of 2020. The report shows that global spending on health continually rose between 2000 and 2018 and reached US$ 8.3 trillion or 10% of global GDP. The data also show that out-of-pocket spending has remained high in low and lower-middle-income countries, representing greater than 40% of total health spending in 2018. We also report and summarize the data on expenditures for PHC, as well as by disease and intervention, including for immunization. The report also analyzes the available data on budget allocation in response to the COVID-19 crisis. In addition, we combine World Bank/IMF projections of the macroeconomic and fiscal impact of the crisis with an analysis of the historical determinants of health spending patterns and UHC indicators and based on this, we draw out the likely implications of 2020 for future health spending, highlighting key policy and monitoring concerns.

Before COVID-19 hit the world
GLOBAL SPENDING ON HEALTH WAS GROWING

KEY MESSAGES

Before the COVID-19 pandemic, global spending on health was continuing to rise, though at a slower rate in recent years.

• In 2018, global spending on health reached US$ 8.3 trillion, or 10% of global GDP, and it was the first time in the past five years that health spending grew slower than GDP.
• Government health spending per capita grew over the 2000–2018 period, but at a slower rate after the economic crises of 2008–2009.
• The share of out-of-pocket spending in total health spending remained above 40% in low and lower-middle-income countries.
• Health spending from external aid reached its peak in 2014 and has since fallen. The share of external aid absorbed by lower-middle-income countries has been increasing and in recent years surpassed that of low-income countries.
• The share of health spending devoted to primary health care varied widely across countries.

In 2018, global spending on health reached US$ 8.3 trillion, or 10% of global GDP, and it was the first time in the past five years that health spending grew slower than GDP

In 2018, global spending on health reached US$ 8.3 trillion, about 10% of global GDP. Domestic public sources took the largest share, which at US$ 4.9 trillion accounted for 59% of global spending in 2018. Private health spending was US$ 3.4 trillion, or 41% of global spending, of which most was household out-of-pocket spending (OOPS). Health spending from external aid accounted for 0.2% of global spending, the same as in the previous year.

More than 75% of global spending on health was in the World Health Organization (WHO) regions of the Americas and Europe. The countries of the Western Pacific region accounted for 19% of global spending, while those of the South-East Asian and Eastern Mediterranean regions each accounted for 2% of global spending, and the African region for 1%. In 2018, 40% of the world’s people lived in 51 countries with per capita health spending below US$ 100. Five countries (France, Germany, Japan, the United Kingdom, and the United States), with 9% of the world’s people, accounted for more than 60% of global health spending, with the United States alone accounting for 42%.

Thus, health spending remained unequal across countries. Globally, the cross-country average of health spending per capita was US$ 1,099 in 2018.2 But in low-income countries, the average was only US$ 40 a person that year, while in high-income countries, it was US$ 3,313—more than 80 times larger. The difference has grown over time, with cross-country inequality in health spending rising. On average, health spending per capita was US$ 115 in lower-middle-income countries and US$ 466 in upper-middle-income countries in 2018.