The health financing transition: a conceptual framework and empirical evidence

Soc Sci Med. 2014 Mar:105:112-21. doi: 10.1016/j.socscimed.2014.01.014. Epub 2014 Jan 22.


Almost every country exhibits two important health financing trends: health spending per person rises and the share of out-of-pocket spending on health services declines. We describe these trends as a "health financing transition" to provide a conceptual framework for understanding health markets and public policy. Using data over 1995-2009 from 126 countries, we examine the various explanations for changes in health spending and its composition with regressions in levels and first differences. We estimate that the income elasticity of health spending is about 0.7, consistent with recent comparable studies. Our analysis also shows a significant trend in health spending - rising about 1 per cent annually - which is associated with a combination of changing technology and medical practices, cost pressures and institutions that finance and manage healthcare. The out-of-pocket share of total health spending is not related to income, but is influenced by a country's capacity to raise general revenues. These results support the existence of a health financing transition and characterize how public policy influences these trends.

Keywords: Health care economics and organizations; Health expenditures; Insurance; Major medical; Out-of-pocket health expenditures; Politics.

MeSH terms

  • Developed Countries / economics
  • Developing Countries / economics
  • Empirical Research
  • Financing, Personal / trends*
  • Health Care Sector
  • Health Expenditures / trends*
  • Humans
  • Public Policy