Abstract

Objectives: Rapid growth of Health Care Expenditures (HCE) has become one of the main challenges for the sustainability of public finances worldwide. The persistent growth of HCE and concerns about its long-term fiscal sustainability highlight the necessity for policymakers to formulate effective cost con-tainment strategies. To this end, identifying the factors that determine the growth of HCE and their size of impact is the first and most important step in curbing HCE growth. The purpose of this systematic review was to identify the factors considered as determinants of HCE at the national level and to report their significance. Methods: This study reviewed the empirical literature on determinants of HCE. Electronic databases in-cluding Scopus (Elsevier), PubMed/Medline, and ISI (Web of Science) were searched to retrieve articles published until November 2017. Results: Thirty six primary articles met the eligibility criteria and were included in this review. Based on the findings, a wide range of factors explaining HCE growth including socio-demographic, economic, tech-nological, environmental and lifestyle factors, factors associated with the epidemiological transition and changing patterns of diseases, factors related to the provision for health services, and factors concerning the administration and design of the health sector. Conclusions: The review suggests the need for considering a wider range of issues while investigating HCE drivers, thereby shifting from factors traditionally considered as drivers of HCE to other explaining elements that their effects on HCE growth has been rarely examined. Although the trends and deter-minants of HCE have been widely examined in high-income countries, limited number of studies have investigated the issue at the aggregate level in developing countries. (c) 2021 Fellowship of Postgraduate Medicine. Published by Elsevier Ltd. All rights reserved.