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[Correspondence] Health economics

Joseph L Dieleman and colleagues (June 18, p 2521)1 should be congratulated for their study on health spending prediction. However, this is a multifactorial and complex problem. The ongoing global financial crisis, rapid development of novel technologies that can increase or reduce total health expenditures, the emergence of often unexpected diseases such as the Zika virus, changing population genetics and epigenetics, and environmental changes and disasters are key parameters that impede the accuracy of spending prediction models.