Global Spending On Health 2020

The results of the report clearly show that in 2020, a year dominated by the emergence of COVID-19 and its associated health and economic crises, governments around the world rose to the challenge. Sharp increases in government spending on health at all country income levels underpinned the rise in health spending to a new high of US $9 trillion (approximately 11% of global GDP). Government health spending generally increased and offset declines in out-of-pocket spending. Importantly, the rise in government health spending was part of a much broader fiscal response to the pandemic. In high income and upper-middle income countries social protection spending also increased sharply in as governments attempted to cushion populations from the economic impacts of COVID-19. In contrast to health and social protection, growth in education spending was relatively subdued. Countries face the further challenge of sustaining increased public spending on health and other social sectors in the face of deteriorating macroeconomic conditions and rising debt servicing. This also includes the challenge of sustaining external support for low income countries, which is essential for reducing ensuring poverty, ensuring access to health services and strengthening pandemic preparedness.

The report shows that global spending on health continued to increase in 2021, the second year of the pandemic, to US$ 9.8 trillion (10.3% of global GDP). The increase in spending was driven by higher government spending and out-of-pocket spending. In low income countries, external aid for health played an important role in supporting government spending. Sustaining government spending and external aid at 2021 levels could, however, prove challenging given the deterioration in global economic conditions, rising inflation and increased debt servicing obligations. The report also capitalizes on disaggregated spending information to provide new insights into the dynamics of increased global spending on health through the pandemic. Using data disaggregated by health service providers it shows some of the ways that health service delivery systems coped with the COVID-19 pandemic. Hospitals, ambulatory care providers, and pharmacies accounted for most health spending. Shifts were observed, however, in the composition of services within provider types, reflecting the new and evolving demands through the pandemic. Disaggregated spending data by disease and condition also shows a delicate balance between spending on COVID-19 and other diseases was maintained. The report also examines countries’ health capital investment, which shape current operational capacity and are essential for forging a path toward effective and resilient health systems.

This technical note provides supplementary explanations for the Global Health Expenditure Database (GHED) data. The purpose of this document is to summarize the main methods and practices established and provide a technical description of the process implemented by the WHO Health Accounts team for the annual publication of GHED. The target audience are the users of the GHED data, who can find in this document a useful resource. It provides supplementary information to the indicators and aggregates published on the database, since it explains how the data collection and consultation process is performed, it describes the estimation methods implemented on the different SHA classifications, and provides details on the macroeconomic variables used, as well as the metadata information. As the COVID-19 pandemic has a significant impact on health spending since 2020, this document also provides a brief description of Covid-related expenditure categories and data collected and published on the GHED.