Document Type : Systematic reviews


1 Department of Community Medicine, Preventive Medicine and Public Health Research Center, Psychosocial Health Research Institute, School of Medicine, Iran University of Medical Sciences, Tehran, Iran

2 School of Economics and Management, Tarbiat Modares University (TMU), Tehran, Iran

3 Economic Research Center (ERC), Tarbiat Modarres University (TMU), Tehran, Iran

4 Department of Economic Development and Planning, School of Economics and Management, Tarbiat Modares University (TMU), Tehran, Iran

5 Department of Health Policy and Management, Medical Information and Management School, Iran University of Medical Sciences (IUMS), Tehran, Iran

6 Deputy of Treatment, Shahid Beheshti University of Medical Sciences and Health Services (SBMU), Tehran, Iran


Context: Health expenditures in the world undergo increasing growth. According to the WHO Report (2000), health financing is one of the main functions of the health system that has a significant impact on its other functions.
Objectives: The aim of this study is the systematic review of the changes and shifting of health care financing models and cost burden risk-sharing mechanisms in health systems over the past three decades.
Data Sources: In this systematic review, data sources of studies on health financing realm in different countries were investigated using a series of keywords, including “health financing”, “health expenditure “, “model”, “financing mechanism/arrangement”, and “cost risk-sharing” from the most important databases such as Google Scholar, Web of Science, Scopus, PubMed, and the Iranian databases, such as Magiran, IranMedx, SID, in 1990 - 2019.
Study Selection: According to PRISMA Flow Diagram, with application of inclusion and exclusion criteria (time limitations, lan- guage restrictions, lack of related title abstract, full text), among 86,611 documents, 150 studies were selected. Two pairs of review author’s independently extracted data and assessed the risk of bias.
Results: The systematic review of different evidence suggests that with economic growth, since 2001 to 2014, global health expendi- ture trend was increased from $ 3.8 trillion (in 2001) to $ 9.2 trillion (in 2014) and is estimated to reach $ 24.2 trillion (in 2040). Also, all the evidence indicates a tangible change, a 10% increase in public and pre-payments health expenditures and a 16% reduction in private expenditures, in the global health financing model in the current period up to 2040.
Conclusions: The review of regional and global studies, across countries and during the time, shows that in the last three decades, health financing systems are in a transition towards pervasive (with high financial risk-sharing) public health policies in the world