The World Bank has introduced the Atlas method to determine in an econometrically valid
way borderline thresholds for classifications of all national economies into low, middle, and
high-income categories in an objective and predictable manner. Although this approach may be
challenged to some extent, it has long served well in observation and predictions of long-term
trends in GDP growth and national health expenditures (1–3).
The contribution of low- and middle-income countries (LMICs) share in total health
expenditures as observed through the (4) Global Health Expenditure criteria has almost doubled in
terms of purchase power parity (PPP) basis from only 20% of the global share in 1995 up to almost
40% in 2013 (5, 6). These fiscal flows have been well-documented via WHO’s National Health
Accounts database. This lengthy and rocky road forward for the LMICs contains many difficulties.
A few core challenges include socioeconomic inequalities in medical care access and affordability,
large out-of-pocket expenses, and vulnerabilities against catastrophic household expenditures.
These challenges remain matters of grave concern in many LMICs (7).
Broad trends give far greater grounds for optimism, however, since networks of rural and
suburban health care facilities are growing and strengthening. Preventive lifestyle interventions,
provision of essential medicines, and spreading of cost-effective basic medical technologies,
designated in WHO policy as “best buys” interventions, all contributed to exceptionally improved
early childhood survival and extended life expectancy. Current circumstances in most LMICs
are characterized by aging populations, rapid urbanization, and increased citizen expectations in
terms of health insurance coverage. Prescription drugs consumption is still dominated by generic
medicines, with brand name originals gradually taking root. Hospital sectors are state or publicly
owned in most former and modern day centrally-planned socialist economies. By contrast, in
some regions like the Middle East and North African (MENA) Arabic nations, Latin America,
and free-market Far East Asian economies, hospital property structure is predominantly privately
owned (1).
The authors would like to hereby express gratitude to Grant No.175014 of the Ministry of Education, Science and Technological Development of the Republic of Serbia, out of which some underlying studies were partially financed. Publication of results was not contingent on Ministry’s censorship or approval.
