12 December 2017 marks five years since the United Nations unanimously endorsed universal health coverage. As a result, this year’s global day of action calls for individuals and organisations to ‘rise for our right’ to health for all and drive courageous political action in every nation.
Universal Health Coverage (UHC) exists when all people have access to needed health services of adequate quality to be effective, and are protected against financial hardship from using these services. Universal health coverage has significant health and economic benefits and promotes equity and human rights.
Global discussions on UHC often focus on how to raise more money for health, and recent research confirms the importance of increasing domestic government health spending, in particular tax funding, in improving countries’ health status. Pertinent to these discussions is the question of how much governments in pursuit of UHC should aim to spend on health.
A 2017 publication by Professor Di McIntyre and colleagues from Chatham House working group on Sustainable Health Financing, addresses this question and suggests a target of government spending on health of at least 5% of GDP for progressing towards UHC.
The target of government spending on health of at least 5% of GDP is derived from a wide range of evidence and comparisons across countries. Several factors support the 5%+ figure:
- According to data from the 2010 World Health Report, public spending of about 6% of GDP on health will limit out-of-pocket payments to an amount that makes the incidence of financial catastrophe negligible.
- Government spending on health of more than 5% of GDP is required to achieve a conservative target of 90% coverage of maternal and child health services.
- A range of studies projecting the financial resource requirements to achieve universal health systems, using detailed health service cost data and modelling techniques, indicate that public health expenditure should be 6-7% of GDP.
Given the variation in wealth across countries, the relative target of 5% of GDP translates into very different amounts in absolute monetary terms. Most low-income counties will continue to require external assistance – an absolute (per capita) target would be a useful complement to the relative target of 5% of GDP. Such a target can be developed by costing a set of core PHC services, for example the High Level Task Force estimate of $86 (based on 2012 AER).
Although absolute targets have deficiencies, when used alongside relative targets, they can play an important role in advocating for domestic government and international assistance funds that are truly additional to move towards universal primary healthcare services.
Further resources
- What level of domestic government health expenditure should we aspire to for universal health coverage?
- Fiscal space for domestic funding of health and other social services
- RESYST UHC resource page
