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By 2040, people in developing countries will continue to spend a greater proportion of their own money on healthcare than those in the developed world as national health spending is failing to keep up with demand, a Lancet study warns.

The researchers say that low-income countries only spend around 3 US cents on health for each dollar that rich countries spend. This is unlikely to change in the next 25 years despite growing wealth, according to the paper.

This means people living in these countries will have to spend a larger share of their own income on private healthcare than those in rich countries — or forego important health treatments, the authors say.

In 2040, the proportion of health spending coming from government is expected to be lowest in South Asia, where it will meet just 33 per cent of demand. Countries in Sub-Saharan Africa are forecast to pay for 36 per cent of health costs, while governments in all other regions are likely to meet at least half the costs of their citizen’s healthcare, according to lead author Joseph Dieleman.

By comparison, Western European countries are expected to pay for close to 90 per cent of healthcare costs by that time, according to the 13 April study. The research also found that donor money for health services in developing countries is levelling off after tripling between 2000 and 2010. Funding for maternal and child health is growing, but money to care for people with health problems such as HIV/AIDS tuberculosis and malaria is decreasing, the study says.

“We have seen an overall stagnation in donor funding for global health,” says Dieleman, a researcher at the Institute for Health Metrics and Evaluation in the United States. “The slowdown comes just after the global financial crisis that impacted many donor countries.”
But to address the situation, countries need more detail on local disparities in healthcare access and spending, which the study’s use of national spending per person does not provide, says Divya Parmar, a public health researcher at City University London, United Kingdom.
Parmar also notes that countries may start taxing unhealthy food and substances, such as tobacco and sugar, using the money to improve healthcare. Better infrastructure could further reduce the health burden in the poorest countries, she says.
“[These countries] need to improve the cost-effectiveness of healthcare services by expanding access to primary healthcare, safe water and sanitation,” she explains. 


Joseph L. Dieleman and others National spending on health by source for 184 countries between 2013 and 2040 (The Lancet, 13 April 2016)

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