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[Correspondence] Health economics – Authors’ reply

As Theodore Papaioannou and colleagues point out, projecting long-term health spending is challenging.1 Our Article2 and extensions of this research3 made health spending projections for 184 countries and extends through 2040. Many factors—environmental, epidemiological, demographic, cultural, political, economic, and scientific—influenced the creation and evolution of complex health systems, and have coalesced to determine current health spending levels. These same factors will undoubtedly also influence health spending in the future, although how these factors will interact and determine precise spending is difficult to predict.