2024-11-17-世界银行-政府卫生支出展望——2029年预测_财政压力分散_制约因素不均衡（英）_42页_1mb

This report outlines government health expenditure (GHE) projections for 170 countries through 2029, representing 95% of the global population, using IMF macro-fiscal forecasts from April 2024. Key findings include:

1. Fiscal Divergence: While average general government expenditure per capita is expected to grow slowly overall, it is projected to decline in real per capita terms for 29 low- and middle-income countries (among 170) between 2019 and 2029 due to fiscal pressures and potentially sluggish growth or decline in another 67 countries.

2. Uneven Constraints on Health Spending: Scenarios exploring different GHE growth paths (linked to general government expenditure projections or historical trends) consistently show that real GHE per capita will be significantly lower by 2029 in countries with contracting or stagnant general government expenditure compared to historical trends, posing a major challenge for achieving health-related Sustainable Development Goals (SDGs).

3. Challenges for Low-Income Countries (LICs) and Lower-Middle-Income Countries (LMICs): These nations face the most significant hurdles, often experiencing declines or stagnation in the share of GHE within general government expenditure and being disproportionately affected by rising interest payments on public debt, limiting fiscal space for health.

4. Shortfall to 2030 Goals: Expected spending trajectories, even under favorable macro-fiscal conditions, are generally insufficient to reach the estimated annual minimum per capita government health spending levels (around US$80 in LICs, US$100 in LMICs, in 2023 USD terms).

5. Need for Action: The study recommends policymakers prioritize health spending, increase domestic revenues through fiscal reforms, manage public debt, and improve spending efficiency (e.g., eliminating ineffective subsidies, combating corruption) to address funding shortfalls and meet the 2030 health goals. International partners should also adjust support based on country needs.

In essence, the outlook is grim for meeting health spending targets required for the Sustainable Development Goals unless decisive policy actions are taken to improve fiscal space, prioritize health, and enhance efficiency.