Domestic resources for surgical care financing: a descriptive analysis of global health expenditure trends and illustrative case studies on fiscal mechanisms in LMICs
Ramya Reddy, Gabriella Yael Hyman, Simon Fabry, Walter D Johnson, Hao Yi Tan, Roman Macaya, Noor Hisham Abdullah, Lia Tadesse Gebremedhin, Kee B ParkIntroduction
Surgical care is essential to achieving universal health coverage (UHC) and addressing 30% of the global disease burden, including non-communicable diseases (NCDs), maternal health and injuries. However, low and middle-income countries (LMICs) face significant challenges providing equitable access to surgical services, with 5 billion people lacking access and US$20 trillion in associated global economic losses, emphasising the need for sustainable domestic financing strategies.
Methods
A multifaceted approach combined quantitative analysis of domestic health spending trends (2000–2021) using the WHO Global Health Expenditure Database with illustrative case studies examining fiscal mechanisms. The quantitative analysis assessed government health expenditure (GHE), current health expenditure (CHE) and resource allocation. Illustrative case studies examined fiscal mechanisms, including taxes, subsidies, levies and public health insurance, drawn from published literature and policy reports in selected LMICs. A surgical expenditure surrogate (SES), defined as the proportion of health expenditure allocated to NCDs, reproductive, maternal, neonatal, child and adolescent health and trauma and injuries, was used as a proxy to estimate spending on surgical care.
Results
In 2021, global CHE totalled US$9.84 trillion, with GHE contributing a global median of 53.66%. LMICs allocated only 34.88% of CHE to domestic resources, relying heavily on external funding and out-of-pocket payments. Using the SES as a proxy for surgical spending, spending on communicable diseases (CDs) outpaced SES in LMICs (median SES: 40.17% vs CD: 49.38% of CHE). Mechanisms like taxes, subsidies and public health insurance show potential to expand fiscal space but face challenges such as inequities, sustainability concerns and limited allocation to surgical care.
Conclusion
Strengthening domestic financing through targeted fiscal policies and improved resource allocation can enhance access to surgical care and health system independence in LMICs. National surgical plans and better reporting metrics are critical to integrating surgical care into UHC strategies.