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  • Methods We extracted data from the WHO Health

    2019-05-05

    Methods We extracted data from the WHO Health Expenditure Observatory and the Institute for Health Metrics and Evaluation\'s Financing Global Health 2015 report. We then adjusted these data by converting to a common, inflation-adjusted currency, and completed the series using multiple imputation. We used a series of ensemble models and observed empirical norms to make our forecast. We aggregated the data to generate a forecast for the total amount of health spending in these 184 countries. Findings We estimate that global spending on health will increase from $7·71 trillion in 2013 to $21·25 trillion in 2040. In per person terms, we expect health spending to increase annually by 4·28% in South Asia, 3·07% in Latin America, 2·98% in high-income countries, and 1·93% in sub-Saharan Africa. The largest portion of health expenditure is expected to be from governments. In 2040, we expect the median government input to health spending will be 60%. We also expect a transition from out-of-pocket spending to pre-paid private spending, with out-of-pocket expenditure reducing by 11% by 2040. Despite remarkable progress, we expect that tremendous inequality in health spending between low-income and high-income countries will persist. Interpretation Estimates of future spending on health provides planners, funders, and advocates with insight into where more resources are needed to reach important health goals. Funding Bill & Melinda Gates Foundation. Declaration of interests
    Abstract Background Social franchising programmes are financed mostly by international donor agencies; however, because such funding lacks certainty in the long term, social franchises need to think about how to continue provision of services for their targeted populations. Corporate management analysts argue that for-profit companies face a similar challenge of uncertain funds, causing us to examine whether social franchises can learn from the business literature. In K03861 this K03861 systematic review of studies of sustainability in organisations from the business and public health sector, we aim to find common themes and lessons pacemaker are applicable to social franchising. Methods We included english-language articles from the Business Source Complete Database of the University of California, San Francisco, USA, and from PubMed, without any time restrictions, that hypothesised a cause or a clearly defined driver of sustainability. From the included studies, we compiled a list of the definitions of sustainability that we subsequently categorised into focus themes. Findings Our search yielded 1255, articles from which 26 met inclusion criteria. We found 13 sustainability definitions and categorised these into four groups: (1) financial/operational independence; (2) mission and social value creation; (3) ensuring resources for future generations; and (4) adaptability. We also identified sustainability themes across articles. 21 articles addressed adaptability, nine of which emphasised learning as important for sustainability. The concept of the environment appeared in 15 articles. Other themes were organisational structure (ten articles), mission/social value creation (nine articles), organisational culture (eight articles), and monitoring and metrics (nine articles). Surprisingly, the least identified theme was financial viability (four articles). Interpretation The lesson from the studies of business and social service provision is that institutional sustainability relies, to a great extent, on an organisation\'s adaptability, internal systems for learning, and ongoing awareness of its larger environment. The analytic studies included in our search echo the findings of the corporate management literature, confirming the importance of leadership, organisational mission, and value creation to society when predicting sustainability. These process-focused predictors of institutional sustainability have not, until now, been reviewed in social franchising programmes, but may merit more research and attention in the future.