Health expenditures developing countries

National dmg expenditure as a proportion of total health expenditure currently ranges from 7% to 66% worldwide. The proportion is higher in developing countries (24%-66%) than in developed countries (7%-30%). In the former, at the individual and household level, drugs represent a major out-of-pocket health care cost (1). 

Centers for Disease Control and Prevention (CDC), which estimated a prevalence in 2001 of 7.9% in adults. This is equivalent to 16.7 million people. Because at least 30% of all prevalent cases are undiagnosed, the total number may have been almost 22 million. Note that in 1987, the prevalence of diagnosed diabetes was 6.8 million. This large increase in diabetes has been observed globally. The prevalence of diabetes in adults worldwide was estimated to be 4.0% in 1995 and anticipated to rise to 5.4% by the year 2025. The prediction is that in 2025 there will be 300 million adults with diabetes, greater than 75% of whom will live in developing countries. These statistics have led to diabetes being described as one of the main threats to human health in the twenty-first century. The prevalence of diabetes mellitus increases with age, and approximately half of all cases occur in people older than 55 years. In the United States, -20% of the population older than 65 years have diabetes. There is racial predilection, and by the age of 65, 33%, 25%, and 17% of Hispanics, blacks, and whites, respectively, in the United States have diabetes mellitus. In 2002 diabetes mellitus was estimated to be responsible for 132 billion in healthcare expenditures in the United States. The direct costs were 92 billion, with 50% of that incurred by those older than 65 years. An estimated 186,000 deaths annually are attributable to diabetes. In fact, American women are twice as likely to die from diabetes mellitus as from breast cancer. Approximately one in five American healthcare dollars spent in 2002 was for people with diabetes mellitus. 

Governmental and societal preoccupation with preparation for wars - often known as militarism - may lead to massive diversion and subversion of efforts to promote human welfare. This preoccupation and this diversion may be part of policies that lead to preemptive war (when an attack is allegedly imminent) and to preventive war (when an attack may be feared sometime in the future). Diversion of resources is a problem worldwide, but is especially acute in developing countries. Many developing conn tries spend substantially more on military expenditures than on health-related expenditnres for example, in 1990, Ethiopia spent 16 per capita for military expenditnres and only 1 per capita for health, and Sudan spent 25 per capita for military expenditures and only 1 per capita for health. 

In developed countries with low mortality rates, diet-related risks— mainly ovemutrition combined with physical inactivity— account for between one-tenth and one-third of the burden of disease. Major human health problems are arising from increasingly sedentary lifestyles. Engineering has contributed to this situation by focusing on the reduction of human energy expenditure through such technologies as cars, escalators, and power tools. 

The industry has diversified from its earlier focusing on infectious diseases to look for therapies in areas such as heart disease, gastric ulcers, mental disorders, fertility, arthritis, allergy and cancer. After a period of very rapid growth in the 1960s with many new product introductions, growth has slowed in many developed countries both in terms of new products and sales value, as a consequence of the difficulty in finding new improved medicines and the establishment of limits on public expenditure in the health-care field. 

Ovemutrition is difficult to define but is synonymous with excessive intake in the following discussions. Recent emphasis has been directed towards diets that contain excess energy in relation to expenditure, which result in obesity. This is a major problem in developed and increasingly in underdeveloped countries. There is particular concern about the marked increase in obesity in children, which can lead to major health problems in later life and will result in a massive increase in financial expenditure on health provision in the future some obese children are now developing type 2 diabetes as young as 12. The topics obesity and type 2 diabetes are discussed in Appendix 15.4. 

The effectiveness of various measures to contain expenditure on medicines in the UK can only be assessed in the context of the situation in other European Union countries. Table 21.1 gives data for the total expenditure on health care as a percentage of gross domestic product (GDP), expenditure on medicines as a percentage of total healthcare spend, the national pharmaceutical industry s research and development expenditure in euro-millions, the general price index and the medicines price index nationally compared to a European price of 100, and the national pharmaceutical consumption per capita expressed as defined daily doses (DDD). These comparisons are based on OECD Health Data 2000. 

Virtually all other industrialized countries have national health insurance programs that include prescription drug benefits. Good examples, later in this chapter, are Australia, Canada, France, Japan, and the United Kingdom, which illustrate what other nations are currently doing to control expenditures for prescription drugs and what these controls mean for revenues from new drugs yet to be developed. 

African governments are all grappling with the issue of high medicine prices. Coupled with the increasing momentum for developing local pharmaceutical industries, the issue of medicine prices and how to contain them will come into sharp focus for policy makers. African policy makers are also acutely aware of measures employed by other countries around the world to contain runaway health care costs, and specifically pharmaceutical expenditure. Although price controls are important policy instruments, they are very controversial. The South African experience with pharmaceutical price controls may therefore be a useful case study to inform other African coimtries interventions. 

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