“In 2018, overall spending on health care in the United States was estimated to be the equivalent of more than 10,000 dollars for each US resident. This amount of expenditure (when adjusted for different purchasing power in countries) was higher than all other OECD countries by a considerable margin. Switzerland, the next highest spender in the OECD, spent less than 70% of this amount, while the overall average of all OECD countries was less than 40% of the US figure (USD 3,994) (Figure 7.1). Many high-income OECD countries, such as Germany, France, Canada and Japan spend only around a half or less of the US per capita spending on health, while the United Kingdom and Italy were around the OECD average. Lowest per capita spenders on health in the OECD were Mexico and Turkey with health expenditure at around a quarter of the OECD average, and levels similar to the key emerging economies such as the Russian Federation, South Africa and Brazil. Latest available figures show that China spent around 20% of the OECD per capita spending level, while both India and Indonesia spent less than 10%.”

Source: OECD (2019), Health at a Glance 2019: OECD Indicators, OECD Publishing, Paris, doi.org/10.1787/4dd50c09-en.

“In 2018, global spending on health reached US$8.3 trillion, about 10% of global GDP. Domestic public sources took the largest share, which at US$4.9 trillion accounted for 59% of global spending in 2018 (Figure 1.1).¹ Private health spending was US$3.4 trillion, or 41% of global spending, of which most was household out-of-pocket spending (OOPS). Health spending from external aid accounted for 0.2% of global spending, the same as in the previous year.

“More than 75% of global spending on health was in the World Health Organization (WHO) regions of the Americas and Europe. The countries of the Western Pacific region accounted for 19% of global spending, while those of the South-East Asian and Eastern Mediterranean regions each accounted for 2% of global spending, and the African region for 1%. In 2018, 40% of the world’s people lived in 51 countries with per capita health spending below US$100. Five countries (France, Germany, Japan, the United Kingdom and the United States), with 9% of the world’s people, accounted for more than 60% of global health spending, with the United States alone accounting for 42% (Figures 1.2 & 1.3).

“Thus, health spending remained unequal across countries (Figure 1.3). Globally, the cross-country average of health spending per capita was US$1,099 in 2018.² But in low income countries, the average was only US$40 a person that year, while in high income countries, it was US$3,313—more than 80 times larger (Figure 1.4).³ The difference has grown over time, with cross-country inequality in health spending rising. On average, health spending per capita was US$115 in lower middle income countries and US$ 466 in upper middle income countries in 2018.”

Source: Global spending on health 2020: weathering the storm. Geneva: World Health Organization; 2020. Licence: CC BY-NC-SA 3.0 IGO.

“Per capita health spending continued to rise in real terms, but growth recently slowed (Figure 1.5.a). The average annual growth of health spending has been consistently above 2% over the past two decades. Before the 2008–2009 economic crisis, health spending growth was above 3% a year. During the crisis, health spending grew more than 5% from 2008 to 2009, while GDP dropped more than 1% on average. This pattern was more pronounced in high income countries, where most governments implemented countercyclical fiscal policy to mitigate the impact of the economic shock (Figure 1.5.b). Due to short-term measures, public spending on health actually grew faster during the 2008–2009 economic crisis as compared with previous years. But following the economic recovery, overall government spending increased more slowly. Between 2014 and 2017, health spending per capita grew faster than GDP. But in 2018, the situation reversed, with GDP growth exceeding health spending growth.

“In general, the level of health spending depends on the level of country income, but there are variations within income groups. High income countries spent 8.2% of GDP on health on average in 2018 (Figure 1.6). Low income countries spent 6.4% of GDP on health, and upper middle income countries, 6.3%. The lowest share was in the lower middle income countries group—4.8%. Within every country income group, health spending as a share of GDP varies widely. Countries with a similar GDP per capita spent very different proportions of GDP on health. For example, Thailand and South Africa, with roughly equal GDPs per capita, spent vastly different shares of GDP on health, with South Africa spending much more (8.3%) than Thailand (3.8%). Generally, there is no clear correlation between income and share of health spending within any income group. The policy choices that each country makes in the organization of its health financing system, as well as differences in epidemiological patterns, have important implications for health spending levels and likely explain much of the observed variation.”

Source: Global spending on health 2020: weathering the storm. Geneva: World Health Organization; 2020. Licence: CC BY-NC-SA 3.0 IGO.

“In a number of European countries, there have been significant turnarounds in health spending. In Greece, the strong annual decreases in growth halted after 2013, even if growth in health spending has been close to zero overall since 2013 (-9.4% in the time period 2008‑13 vs. 0.2% in the time period 2013‑18), and real per capita spending in 2018 remained almost a third below the 2009 level. A similar if less dramatic picture can also be seen in Iceland (-3.0% vs. 4.0%). In other European countries, such as Germany and Norway, health spending remained relatively stable over the ten-year period, with annual growth of between 2.0-2.5%. Overall, health spending growth has picked up in the majority of European countries in most recent years.

“Outside of Europe, Korea and Chile have continued to report annual health spending increases above 5% in real terms since 2008. A provisional estimate for 2018 suggests further strong spending growth of 9.0% in Korea. In the United States, health spending is estimated to have grown by 1.4% in real terms in 2018, which along with similar growth in 2017 shows health spending in the United States growing slower than the overall economy.”

Source: OECD (2019), Health at a Glance 2019: OECD Indicators, OECD Publishing, Paris, doi.org/10.1787/4dd50c09-en.

“On average, OECD countries are estimated to have spent 8.8% of GDP on health care in 2018, a figure more or less unchanged since 2013 (Figure 7.3). The United States spent by far the most on health care, equivalent to 16.9% of its GDP – well above Switzerland, the next highest spending country, at 12.2% (Figure 7.3). After the United States and Switzerland, a group of high-income countries, including Germany, France, Sweden and Japan, all spent close to 11% of their GDP on health care. A large group of OECD countries spanning Europe, but also Australia, New Zealand, Chile and Korea, fit within a band of health spending of between 8-10% of GDP. Many of the Central and Eastern European OECD countries, such as Lithuania and Poland, as well as key partner countries, allocated between 6-8% of their GDP to health care. Finally, a few OECD countries spent less than 6% of their GDP on health care, including Mexico, Latvia, Luxembourg, and Turkey at 4.2%. Turkey’s health spending as a share of GDP sits between that of China and India.”

Source: OECD (2019), Health at a Glance 2019: OECD Indicators, OECD Publishing, Paris, doi.org/10.1787/4dd50c09-en.

“Drawing on publicly available national household budget survey data, the report provides up-to-date numbers on financial protection for 24 highand middle-income countries in Europe.

“• The incidence of impoverishing health spending in the study countries ranges from 0.3% to 9.0% of households. There is wide variation among European Union (EU) countries (from 0.3% to 5.9%) and among non-EU countries also (from 3.6% to 9.0%).

“• The incidence of catastrophic health spending ranges from 1% to 17% of households in the study countries. It varies widely among the 18 EU countries in the study, including wide variation among countries that joined the EU after 30 April 2004.

“• Catastrophic health spending is consistently heavily concentrated among the poorest fifth of the population.

“• Out-of-pocket payments incurred by households with catastrophic health spending are mainly due to outpatient medicines, followed by inpatient care and dental care.”

Source: Can people afford to pay for health care? New evidence on financial protection in Europe. Copenhagen: WHO Regional Office for Europe; 2019. Licence: CC BY-NC-SA 3.0 IGO.

“Financial protection indicators capture financial hardship arising from the use of health services, but do not indicate whether out-of-pocket payments create a barrier to access, resulting in unmet need. Bringing together for the first time data on financial hardship and unmet need across Europe reveals the following findings.

“• In countries where the incidence of catastrophic health spending is very low, unmet need also tends to be low and without significant income inequality.

“• In a few countries, the incidence of catastrophic health spending is relatively low, but there is a high level of unmet need, particularly among poor households, which suggests that health care is not as affordable as the financial protection indicators alone imply.

“• In many countries, the incidence of catastrophic health spending and levels of unmet need are both relatively high, and income inequality in unmet need is also significant, indicating that health services are not at all affordable, and that if everyone were able to use the services they needed, financial hardship would be even greater, particularly among
poorer households.

“• Some health services – notably dental care – are a much greater source of financial hardship for richer households than poorer households. This reflects higher levels of unmet need for dental care among poorer households than richer households in most countries.

“• Outpatient medicines are an important source of financial hardship in many countries and among the poorest quintile in most countries.

“• Unmet need for prescribed medicines is also generally higher in countries with a higher incidence of catastrophic health spending, which indicates that out-of-pocket payments for medicines lead to both financial hardship and unmet need for poorer people.”

Source: Can people afford to pay for health care? New evidence on financial protection in Europe. Copenhagen: WHO Regional Office for Europe; 2019. Licence: CC BY-NC-SA 3.0 IGO.

Health Systems Facts is a project of the Real Reporting Foundation. We provide reliable statistics and other data from authoritative sources regarding health systems in the US and several other nations.

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Page last updated Dec. 18, 2021 by Doug McVay, Editor.