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Universal health coverage (UHC) is a core part of the Sustainable Development Goals, aiming to ensure that everyone can access the health services they need without financial hardship.
Understanding the role and potential of health financing to achieve UHC in low- and middle-income countries (LMIC) is more important than ever. Many people still lack access to essential health services, and the incidence of catastrophic out-of-pocket payments has risen, particularly in LMICs. This growing burden has been exacerbated by the COVID-19 pandemic, rising refugee numbers, the increase of extreme weather events, and cuts in aid budgets. As a result, critical questions remain about how to sustainably, efficiently, and equitably finance UHC in the future.
This book brings together a team of authors, predominantly from LMICs, to identify and analyse priority health financing issues in their respective countries and regions. It lays out key concepts, offers practical guidance, and provides empirical examples from a range of LMICs. The book covers the core health financing functions, including revenue generation, pooling, allocation, and payment mechanisms. This includes monitoring and tracking health financing dimensions such as funding levels, equity, efficiency, and financial risk protection as well as exploring emerging challenges and opportunities, such as public financial management, fiscal space, governance, and political economy analysis.
This book is designed for students, researchers, and practitioners engaged in health financing, including those without a formal background in economics. It serves as a practical handbook, to equip readers with the tools to address health financing research and policy, and understand related challenges, in diverse LMIC contexts.
Ultimately, this book is intended for anyone interested in how health financing systems can be strengthened to support universal access, informed by the firsthand experiences – both good and bad – of LMICs.
Josephine Borghi is Principal Researcher at the International Institute for Applied Systems Analysis, leading the Health, Ageing and Health Systems research group. She is also Professor of Health Economics at the Department of Global Health and Development, London School of Hygiene & Tropical Medicine. Jo has many years experience evaluating health financing reforms in low- and middle-income countries in Africa and Latin America, including insurance and cash-based coverage mechanisms for the informal sector, and payment for performance schemes to improve quality and coverage of care. Jo also led the financing workstream of the Countdown2030 involving tracking aid flows to Reproductive, Maternal, Newborn and Child Health and analysing health financing equity and efficiency at the subnational levels.
Daniel Maceira is Professor at the Economics Department, National University of Buenos Aires (UBA), Argentina, Independent Researcher of the National Council of Scientific and Technological Research (CONICET), Senior Researcher at the Center for the Study of State and Society (CEDES), and Director of the MBA-Health of the University of San Andrés. He has also developed teaching activities in several Postgraduate Programs in Health Economics and Public Health Policy in Argentina and the Latin American Region. He has more than 25 year’s research experience in health financing in Latin America and the Caribbean, particularly in out-of-pocket and catastrophic health expenditure analysis, provider payment mechanisms and contracting, health program evaluation, equity and financial access to health services for disadvantage groups (aging, adolescents, original population), as well as comparative health care systems and pharmaceuticals. Between 2016 and 2024 he was a Board Member and Chair for the Americas of Health Systems Global, the international society in health systems research. Daniel is currently Chief Editor of the International Journal for Equity in Health.
Shankar Prinja is a Professor of Health Economics at the PGI Chandigarh. His research interests include methodological and applied research on methods of costing and cost-effectiveness analysis, as well as evaluation of health financing policies. He has contributed to various important methodological guidelines of India’s Health Technology Assessment (HTA) agency. He has formerly served as the Executive Director at India’s National Health Authority. At the NHA, he was responsible for designing policies for health benefit package, pricing, and quality assurance of India’s national insurance scheme – Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PMJAY), as well as set up the Health Financing and Technology Assessment unit.
Virginia Wiseman is Professor of Health Economics and Health Systems at the Kirby Institute, University of New South Wales, Sydney and at the Department of Global Health and Development, London School of Hygiene & Tropical Medicine. She has around 3 decades experience working with collaborators to evaluate public health policies and programs in low- and middle-income countries in Africa and the Asia-Pacific. Designing fair and equitable health financing systems to protect people from catastrophic and impoverishing health care spending has been a key focus of her research. Virginia has also led research on the economics of infectious diseases, particularly evaluating interventions to support health system integration and scale-up of new diagnostics and treatments. She is co editor-in-chief of the journal, Health Policy and Planning and current President of the International Health Economics Association/IHEA (2026-2027). Virginia is committed to supporting the next generation of health economists to produce high‑quality research with real policy impact.
David Parkin is Honorary Visiting Professor at City St George’s, University of London and Senior Visiting Fellow at the Office of Health Economics, London. Earlier posts include Professor of Health Economics at King’s College London, Chief Economist at a Strategic Health Authority within the UK’s National Health Service, Professor of Economics at City University London and academic posts at the Medical Schools of the Universities Newcastle, Aberdeen and Manchester. From 1998-2011, he organised and led the UK’s Health Economists’ Study Group. He is a member of the EuroQol group, the owner and developer of the EQ-5D. His research interests are broad, but he has special expertise in health measurement. He has published many articles, books and book chapters and is co-author of a popular textbook in health economics, ‘Economic Analysis in Health Care’.