Public Expenditure on Health in the Post-2015 Agenda: Let's Think About it Again

It seems that the proposal to make universal health coverage (UHC) an umbrella goal in the post-2015 development agenda is gaining more support every day, despite its conceptual and empirical limitations.

However, once we have agreed on what we want to do, we will need to agree on who will pay and how much. A recent report drawn up by an expert panel set up by the United Nations is proposing that high-income countries should allocate at least 5% of their GDP to public spending on health and a further 0.1% to funding international aid in the same field.

In Spain, public expenditure on health has declined significantly over a short period, but in 2011, the last year for which data are available, health spending still accounted for 6.8% of GDP, an amount that exceeds by no less than €18,000 million the minimum expenditure proposed by our international experts. So those who believe that the Spanish public health system is carrying too much fat and needs to be slimmed down can now brandish these figures endorsed by the highly respected defenders of a proposal to reduce inequality by the expedient method of lowering the standards of those at the upper end of the scale. Of course—if we were to abide by the letter of the UN proposal—we would at the same time be obliged to contribute as our share at least €1,000 million every year in international cooperation for health, a proposal not likely to be easy to explain to our long-suffering fellow citizens.

And this is not the only surprising aspect of this proposal—as the average public expenditure on health in OEDC countries is currently 6% of GDP, setting a minimum of 5% would be logical if the standard deviation was large. But that is not the case: of the 34 members of the club of richest countries, only seven (South Korea, Mexico, Turkey, Chile, Estonia, Poland and Israel) come in under the magic threshold of 5%, and the last three of those by only a few tenths. This means that only 20% of high-income countries should strive to increase their public spending on health.

What is the point, one might ask, of establishing a minimum target for public investment in health in 2015 which 80% of the countries affected have already surpassed today? We hope that the authors of the proposal, which is still open to public discussion, will think again and set new percentage targets. Otherwise, they may meet with scant sympathy from the societies who contribute to international solidarity.