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Figure 3.3. Health coverage and per capita GDP, latest available data
Source: ILO, based on ILO, LABORSTA and UN; UNDATA, 2013.
Gaps in health coverage are particularly concentrated in developing countries. In particular, they frequently affect vulnerable groups such as the poor, workers in the
informal sector, migrants and women ILO, 2012b. They are frequently an indication of fragmented legislation and rights-based approaches on health systems that are
characterized by inadequate coordination of various financing mechanisms such as microinsurance, social insurance, private insurance and others.
3.1.2. Funding and financing
National levels of health expenditure define the availability of quality services, medicines, infrastructure and other elements. Health care will be delivered only at low quality if at
all where funding is insufficient. Inadequate financing mechanisms that impose large amounts of expenditure on private households also impact negatively on the accessibility
of necessary health care by creating financial barriers. Thus, minimum requirements for health funding and financing include meeting at least the key principles of providing
access to at least essential health-care services, and fairness in health financing. What is the situation at the global level?
National health expenditure varies widely across countries. Those that spend the most on health care are situated in the Americas and Europe. In 2012, the United States spent more
than 18 per cent of its GDP on health, while the Netherlands spent 12 per cent figure 3.4. Those countries that spend the least on health are largely situated in sub-Saharan Africa:
for instance, health expenditure in the Congo amounts to about 3 per cent of GDP.
5 000 10 000
15 000 20 000
25 000 30 000
35 000 40 000
20 40
60 80
100
G D
P p
e r
cap it
a in
c u
rr e
n t
U S
Population coverage
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Figure 3.4. Health expenditure as a percentage of GDP, selected countries, 2012
Source: ILO, based on WHO Global Health Observatory, 2014.
The level of wealth measured through a country’s GDP is closely related to its overall level of health spending. Figure 3.5 shows this positive correlation: the higher per capita GDP,
the higher per capita expenditure on health. However, levels of health expenditure are not a fixed percentage of GDP levels: some countries with relatively low GDP manage to spend
considerably more on health care than others with an equal level of wealth, indicating that all countries to a certain extent have the freedom to choose their own levels of health
expenditure.
2 4
6 8
10 12
14 16
18 20
Congo India
Philippines Peru
Egypt Russian Federation
Zambia Colombia
Poland Kyrgyzstan
Namibia Afghanistan
South Africa Finland
Brazil Australia
Greece Japan
Netherlands United States
