ArticleBMJ global health2021
Trends and outcomes in primary health care expenditures in low-income and middle-income countries, 2000-2017.
Article in BMJ global health, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers.
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Who cites it
14 citing papers in PubMed.
- Globalization in the Healthcare Industry: Drivers, Risks, and Adaptation.Healthcare (Basel, Switzerland) · 2026Review
- Evaluating the use of the consolidated framework for implementation research in primary care settings: a systematic review.Implementation science communications · 2026Review
- Progress towards universal health coverage in South Asia, 2000-2030: an examination of the twin elements of primary healthcare provision and financial protection.BMJ global health · 2025Article
- Evaluating quality and utilisation of primary care among older adults in Hong Kong: a mixed-methods study protocol.BMC primary care · 2025Article
- Estimating mechanisms linking relative income to self-rated health by multilevel modeling: the moderating role of healthcare access and quality index.BMC public health · 2025Article
- Strengthening primary health care service competency: a scoping review of challenges, influencing factors, and enhancement strategies.Frontiers in public health · 2025Article
- Estimating the Direct Medical Costs of Smoking-Attributable Non-communicable Diseases in Northeastern Iran From 2015 to 2023.Tobacco use insights · 2025Article
- Food insecurity, environment, institutional quality, and health outcomes: evidence from South Asia.Globalization and health · 2024Article
- Epidemiology of neonatal disorders attributable to low birthweight-global burden of disease research, 1990-2021.Frontiers in pediatrics · 2024Article
- Observational
- An assessment of primary health care costs and resource requirements in Kaduna and Kano, Nigeria.Frontiers in public health · 2023Article
- Costs and resource needs for primary health care in Ethiopia: evidence to inform planning and budgeting for universal health coverage.Frontiers in public health · 2023Article
- Horizontal Integration and Financing Reform of Rural Primary Care in China: A Model for Low-Resource and Remote Settings.International journal of environmental research and public health · 2022Article
- Impact of Tobacco Smoking on Health Care Utilization and Medical Costs in Chronic Obstructive Pulmonary Disease, Coronary Heart Disease and Diabetes.Current medical science · 2022Article
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Authors and funding
12 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionAs the world responds to COVID-19 and aims for the Sustainable Development Goals, the potential for primary healthcare (PHC) is substantial, although the trends and effectiveness of PHC expenditure are unknown. We estimate PHC expenditure for each low-income and middle-income country between 2000 and 2017 and test which health outputs and outcomes were associated with PHC expenditure.
methodsWe used three data sources to estimate PHC expenditures: recently published health expenditure estimates for each low-income and middle-income country, which were constructed using 1662 country-reported National Health Accounts; proprietary data from IQVIA to estimate expenditure of prescribed pharmaceuticals for PHC; and household surveys and costing estimates to estimate inpatient vaginal delivery expenditures. We employed regression analyses to measure the association between PHC expenditures and 15 health outcomes and intermediate health outputs.
resultsPHC expenditures in low-income and middle-income countries increased between 2000 and 2017, from $41 per capita (95% uncertainty interval $33-$49) to $90 ($73-$105). Expenditures for low-income countries plateaued since 2014 at $17 per capita ($15-$19). As national income increased, the proportion of health expenditures on PHC generally decrease; however, the fraction of PHC expenditures spent via ambulatory care providers grew. Increases in the fraction of health expenditures on PHC was associated with lower maternal mortality rate (p value≤0.001), improved coverage of antenatal care visits (p value≤0.001), measles vaccination (p value≤0.001) and an increase in the Health Access and Quality index (p value≤0.05). PHC expenditure was not systematically associated with all-age mortality, communicable and non-communicable disease (NCD) burden.
conclusionPHC expenditures were associated with maternal and child health but were not associated with reduction in health burden for other key causes of disability, such as NCDs. To combat changing disease burdens, policy-makers and health professionals need to adapt primary healthcare to ensure continued impact on emerging health challenges.
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