Global status, trends, and cross-country inequality of total health spending, 1995–2021

This study describes global, regional, and national health spending in 2021 and its trends and inequality during 1995–2021. Data were extracted from the Global Health Data Exchange. Estimates and 95% uncertainty intervals (UI) are reported in constant 2022 United States Dollars, constant 2022 purchasing power parity adjusted dollars, and as a percent of gross domestic product. The temporal trends were examined using Joinpoint analysis and average annual percentage changes (AAPC). To assess the cross-country inequality, the slope index of inequality (SII) was used. In 2021, global THS across all countries/territories was $14.01 (95% UI: 13.89 to 14.16) trillion, and global THS per person was $1778 (95% UI: 1762 to 1796), meanwhile, health spending accounted for 10.4% (10.3% to 10.5%) of total gross domestic product(GDP). Between 1995 and 2021, the global THS, THS per person, and THS per GDP exhibited a consistent increase. Among 204 countries/territories, lower-income countries showed remarkable increasing rates. Liberia had the highest AAPC of THS (12.15 [95% CI: 7.28 to 17.25]). Similar increasing trends in lower-income countries could be found at THS per person and THS per GDP. Global THS increased continuously from 1995 to 2021, while the absolute spending gap between high- and low-income countries continued to widen. Persistent cross-country inequality in health spending highlights the need for sustained attention to the equity of global health financing.