The 2024 Global Heath Expenditure Report

The 2024 Global Heath Expenditure Report by the World Health Organization (WHO) shows that the average per capita government spending on health in all country income groups fell in 2022 from 2021 after a surge in the early pandemic years. Government spending on health is crucial to delivering UHC. Its deprioritization can have dire consequences in a context where 4.5 billion people worldwide lack access to basic health services and 2 billion people face financial hardship due to health costs.

Key facts

The pandemic surge in health spending—will it continue?

After surging early in the COVID-19 pandemic, aggregate global health spending fell in 2022, to US$ 9.8 trillion, or 9.9% of global gross domestic product (GDP), the first decline in global health spending in real terms since 2000.

Across all country income groups, except lower-middle income countries, average health spending per capita in 2022 fell in real terms from 2021.

• Domestic public spending on health per capita declined in all income groups in 2022. In most income groups, this occurred against a backdrop of rising government spending, implying that health’s share of general government spending—a measure of health priority — fell.
• The exception was in high income countries, where health priority remained close to 2021 levels, but general government spending declined.
• External aid for health continued to rise in low and lower-middle income countries in 2022 following a sharp increase in 2021. Aid is particularly important in low income countries, accounting for a larger share (31%) of total health spending than domestic public spending (22%).

Across all income groups, health spending per capita in 2022 was above 2019 levels in real terms and close to long-term rising trends from 2000 to 2019.

• In 2022, average out-of-pocket spending (OOPS) on health per capita remained close to its 2021 level in all income groups, except in lower-middle income countries, where it increased.
• Domestic public spending on health remained 6%–7% above prepandemic levels in most income groups and 11% higher in upper-middle income countries. In upper-middle and high income countries, health priority in 2022 remained above prepandemic levels, whereas in low and lower-middle income countries, it was at prepandemic levels.
• OOPS per capita was 3%–4% higher than before the pandemic in low and upper-middle income countries and 11% higher in lower-middle income countries but remained close to the pre-pandemic level in high income countries.
• It is still too early to assess whether the COVID-19 pandemic has continued (or altered) the long-term trends in health spending. In particular, it remains unclear whether governments can sustain elevated health spending per capita amid such economic headwinds as slowing economic growth and rising debt service costs as well as competing priorities.

The evolution of health financing systems

• Between 2000 and 2019, the share of health spending channelled through government schemes (mainly health budgets) and compulsory health insurance (mainly social health insurance) to health financing systems increased steadily, except in low income countries, where it remained mostly unchanged.
• The number of countries with out-of-pocket spending (OOPS) as the main health financing mechanism declined. However, in 2022, OOPS was still the main financing scheme in 30 low and lower-middle income countries; in 20 of these, OOPS accounted for more than half of total health spending.
• In a majority of countries, financing schemes with automatic or compulsory participation accounted for the largest share of health spending, primarily because of government schemes. But the number of countries with social health insurance (SHI) schemes rose—particularly middle income countries.
• The increase in the share of total health spending flowing through SHI schemes between 2000 and 2019 was driven mainly by government budget transfers, even when insurance contributions were the main funding source.
• During the COVID-19 pandemic, public spending on health channelled through government schemes responded to the emergency faster than other schemes. The rise of budget transfers in funding SHI schemes appears to have continued.
• Most countries had voluntary health insurance (VHI) but on a small scale, at less than 5% of total health spending, on average, in 2022, and only 20 countries had it financing more than 10%.

Financing health services during the COVID-19 pandemic

• Government schemes were more flexible than social health insurance (SHI) in scaling up financing and adapting to the higher demand for preventive care during the COVID-19 pandemic, regardless of the country’s main health financing scheme.
• Most countries boosted spending on outpatient care and inpatient care during the pandemic, with the changes financed mainly by a country’s main health financing scheme.
• Out-of-pocket spending (OOPS) on medical goods increased during the pandemic in most countries where SHI dominated health financing but mostly declined where government schemes dominated.
• Government schemes were crucial in increasing primary health care (PHC) spending, regardless of whether government schemes or SHI dominated financing during the pandemic. In 27 of 35 high and middle income countries with data, PHC spending financed by government schemes rose from 2019 to 2022, making it the primary driver of growth in PHC spending.

Better data for better policy

• Milestone achievement: Celebrating 25 years, the World Health Organization’s (WHO) Health Expenditure Tracking programme has been pivotal in setting global standards for health accounting. It maintains the Global Health Expenditure Database (GHED), with annual updates since 2000 for more than 190 countries, and produces the annual Global Health Expenditure Report (GHER). These global public goods drive informed policy-making, transparency and accountability worldwide.
• Institutionalization for sustainability: Institutionalizing health accounts is vital for generating reliable and timely health spending data. This requires stable funding, routine data access and skilled staff. WHO, in collaboration with partners, has supported countries in building capacity, enhancing data quality and promoting the use of data for effective policy-making.
• The path forward: The programme will address emerging data needs, leverage digital tools for data production and management and strengthen institutional support to ensure reliable health spending data, enabling better policies to build resilient health systems for universal health coverage and health security.