As people become richer, they generally spend more money on health. However, as countries become richer, do they spend more or less (relative to their GDP per capita) on health care innovation?
A paper by Yu et al. (2026) looks at trends in willingness to pay thresholds between the US and countries in the most-favored nation (MFN) basket. The examine cost-effectiveness analyses and thresholds cited by payers across countries. They find that MFN countries have set funding thresholds for health innovations less generously in recent decades than in the past (1979-2023):
Among MFN studies, the proportion citing thresholds at or below 1 × GDP per capita benchmark increased over time and became the majority in the recent post-2020 period. In contrast, US studies consistently cited thresholds above the 1 × benchmark across all periods, with only a temporary rise in the share citing lower thresholds. Results restricted to pharmaceutical CEAs are consistent with the main findings
The authors also note that “Cancer-related CEAs and CEAs of pharmaceutical interventions were more likely to cite higher thresholds. “
In short, non-US countries are becoming stingier (relative to their economy) over the past ~45 years. You can read the full study here.
