Investment Rating - The report does not explicitly provide an investment rating for the health sector in low- and lower middle-income countries (LLMICs) but emphasizes the need for increased government health spending to achieve Universal Health Coverage (UHC) and Sustainable Development Goals (SDGs) [8]. Core Insights - The report outlines pathways for LLMICs to expand government health spending amidst fiscal constraints, declining external support, and rising competition for public resources [8]. - It highlights that government health expenditure (GHE) per capita in LLMICs doubled in real terms from US$24 in 2000 to US$46 in 2022, but growth has significantly slowed since 2009 [30][31]. - The report identifies institutional, technical, and operational challenges that hinder the mobilization of government financing for health [40][41]. Summary by Sections Part A: Heed the Signs - Government health spending per capita in LLMICs has slowed markedly, with annual increases dropping from nearly 6% (2000-2009) to just 2% (2009-2019) [64]. - In 2022, average government health spending was US$16 per capita in low-income countries (LICs) and US$60 in LLMICs, falling short of the US$70 and US$90 benchmarks needed for UHC [67]. - Nearly half of LLMICs are projected to face stagnation or declines in government health spending due to high debt obligations and competition for resources [68]. Part B: Mind the Returns - The report emphasizes the economic, social, and political returns of investing in health, which are often overlooked due to their complexity and preventive nature [33][35]. - It discusses how government decision-making is centralized, limiting the role of health ministries and leading to fragmented health sectors [34]. Part C: Raise the Game - The report suggests that countries can elevate health as a political priority through policy reforms and institutional changes [41][42]. - It outlines the importance of collaboration between ministries of health and finance to improve budget formulation and execution [41][44]. Part D: Shift the Course - The fiscal pivot pathways proposed in the report include political economy strategies and technical measures to enhance government health spending [40][48]. - The report stresses the need for sustained commitment to health investments despite the challenges posed by external pressures and internal constraints [48].

Investment Rating - The report does not explicitly provide an investment rating for the Palestinian health system, but it highlights significant challenges and inefficiencies that could impact investment decisions. Core Insights - The Palestinian health system faces structural barriers to equitable service provision due to political fragmentation and movement restrictions, particularly affecting access to health services in Gaza and the West Bank [24][30]. - Health outcomes in the region are mixed, with a high burden of non-communicable diseases (NCDs) and rising maternal and infant mortality rates, indicating a need for improved health policies and interventions [28][40]. - The health financing system is characterized by high out-of-pocket expenditures, significant arrears, and a reliance on external financing, which complicates sustainability and efficiency [31][32]. Summary by Sections Health Outcomes - The Palestinian population is predominantly young, with a high total fertility rate and a declining dependency ratio, indicating potential for a demographic dividend [38]. - Life expectancy has declined from 74 in 2022 to 65 in 2024 due to the ongoing conflict, with maternal and infant mortality rates showing an upward trend [28][40]. - NCDs account for 72% of the disease burden, with high rates of risk factors such as smoking and obesity contributing to this trend [29][44]. Physical and Human Resources, Health System Capacity and Quality - The health service delivery system is fragmented, with a reliance on public facilities and significant shortages of medical equipment and essential medicines, particularly in Gaza [30][52]. - There is a need for improved management of chronic diseases and a more comprehensive approach to service provision, including better training for healthcare providers [52][53]. Overview of Health Financing Flows - In 2022, health spending in West Bank and Gaza was US$1.9 billion, representing 10.5% of GDP, significantly higher than regional averages [31]. - Out-of-pocket spending has increased, highlighting gaps in financial risk protection, with 14% of general government expenditures allocated to health [31][34]. Revenue Raising and Health Expenditures - The government health budget is heavily weighted towards wages and outside medical referrals, limiting resources for investments in primary health care [31][32]. - Health sector arrears exceeded US$900 million in 2024, with financing constraints leading to high unit costs and medicine stockouts [32]. Pooling Arrangements - The Government Health Insurance (GHI) scheme covers approximately 64% of the population, but low contribution rates limit its effectiveness as a risk-pooling mechanism [33]. - Out-of-pocket expenditures have risen significantly, with catastrophic health expenditures affecting 10% of households in 2023 [34]. Purchasing Arrangements - The PMOH is the sole purchaser of health services, relying on passive purchasing modalities, which constrains the ability to improve service quality and efficiency [35][36]. - Outside medical referrals (OMR) are a significant fiscal burden, with high costs and inefficiencies in purchasing arrangements [35][36]. Policy Recommendations - The report suggests a four-step plan to address the challenges in the Palestinian health financing system, focusing on improving purchasing arrangements, expanding coverage, and enhancing governance [37].

Healthcare Coverage & Subsidies - Approximately 22 million Americans face potential loss of healthcare subsidies initially established under the Affordable Care Act in 2014 and expanded in 2021 [1] - The Kaiser Family Foundation estimates that Obamacare recipients paid an average of $888 in premiums this year [1] - Without subsidies, average premiums are expected to jump 114%, from $888 to $1,94 [2] - The potential loss of subsidies could nearly double the number of uninsured Americans, adding to the existing 25 million uninsured [3] US Healthcare System & International Comparison - The United States stands out as the only high-income nation without universal healthcare coverage [4][5] - Between 60 and 73 countries have some form of universal healthcare [5][11] - The US healthcare system lags behind other wealthy nations in key health outcomes [6] Consequences of Lack of Coverage - Lack of affordable healthcare may lead to delayed care, increased reliance on community clinics and emergency rooms, and potentially fatal outcomes [3][15] - The US has the lowest life expectancy, highest death rates for avoidable conditions, highest maternal and infant mortality, and among the highest suicide rates compared to other wealthy nations [6] - Reduced insurance coverage leads to higher prices for those who remain insured [16] Economic Impact - The potential healthcare crisis could trigger an economic crisis, diverting resources from other vital sectors like infrastructure, education, and the environment [14][15] - High family premiums, averaging $27,000, strain employers and contribute to the economic burden [17]