Estimating primary health care expenditures: trends and associations with health outcomes and outputs in low- and middle-income countries

Thesis (Ph.D.)--University of Washington, 2020As the world responds to the novel coronavirus and aims for the Sustainable Development Goals, the potential for primary health care (PHC) is substantial, although the trends and effectiveness of PHC expenditure are largely unknown. The first aim of this dissertation compiled all available National Health Accounts and used these data of country-reported health expenditures to estimate a complete set of health expenditures across 195 countries between 1995 and 2017. Aim 2 built upon the outputs of aim 1 to improve upon previous estimates of PHC expenditures and produce a complete set of PHC expenditures for low- and middle-income countries between 2000 and 2017. Lastly, aim 3 used regression analyses to test which health outputs and outcomes were associated with PHC expenditure. PHC expenditures in low- 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). PHC expenditures were associated with maternal and child health outcomes and outputs, but were not associated with reduction in health burden for other key causes of disability, such as NCDs. Primary health care is touted as foundational to reaching the global goal of universal health coverage and the health-related Sustainable Development Goals. Based upon this research, for PHC to reach these goals policy-makers and health professionals need to adapt PHC to ensure the impact is broader and not only associated with improvements in maternal and child health outcomes and outputs