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Summary
Background and recommendations
Financing is at the centre of efforts to improve health and health systems. It is only when resources are adequately, efficiently and equitably mobilised, pooled and spent that all people can enjoy sustained progress towards universal health coverage (UHC) and the full benefits of global public goods for health (GPGHs).
The articles in this special issue have demonstrated how unprecedented transitions and new and persisting challenges shared by all countries put such progress at risk, and do so particularly for low- and middle-income countries. These transitions include profound changes in the global economy, changes in health and risk factors for disease, and transformations of the institutional landscape of global health. Despite important advances, persisting challenges include poor health outcomes, poor access to health services and financial risks to patients stemming from out-of-pocket health service payments. These are compounded by profound inequalities both between and within countries and by uneven distribution of recent improvements.
Health financing is central to meeting these grand challenges. But to do so effectively, shortcomings in today's approach to health financing must be addressed. As shown in Table 1, we believe the current approach must be revised with respect to the domestic financing of national health systems, the joint financing of GPGHs, and the external financing of national health systems where domestic capacity is inadequate.
Table 1
Shortcomings in today's approach to health financing
Domestic financing of national health systems | Joint financing of global public goods for health | External financing for national health systems |
Insufficient total funds Over-reliance on out-of-pocket payments Inadequate mechanisms to raise public finance through effective tax and revenue systemsaRudimentary mechanisms for mandatory prepayment with pooling of funds Problematic priorities and inefficient health spending Inadequate accountability | Insufficient total funds Inadequate focus among countries Inadequate institutions and mechanisms for collective action | Insufficient total funds Unsettled contribution norms Volatility and uncertainty Fungibility Inadequate priority setting Inadequate coordination Inadequate accountability Unclear rationale |
a. Added to the list presented in the original report.
Recent and ongoing transitions also come with unprecedented opportunities to improve health financing. Economic growth in many countries expands the fiscal space for domestic spending on health. Projections up to 2035 forecast real gross domestic product (GDP)-growth per year at 4-5, 4.3 and 4.2%...