Governments must boost spending on primary health care by at least an additional 1 percent of their gross domestic product to widen coverage and stop impoverishing patients, the World Health Organization (WHO) said on Sunday. Despite some progress, more people are having to pay out-of-pocket for often costly medicines and treatment, the U.N. agency said in a report compiled with the OECD and World Bank. Public investment in primary health care close to home, including immunisation, is key to extending coverage and saving lives, it said. “We believe it is achievable and affordable,” Dr. Peter Salama, WHO executive director of universal health coverage, told a news conference. It would cost an additional $200 billion per year to scale up primary health care in low- and middle-income countries, he said. “Even though it seems like a large sum, we know most countries can actually afford to do this based on their domestic resources. It is only a handful of countries that requires international aid to scale up their primary health care,” Salama said. Some $7.5 trillion is spent on health globally each year, according to the report, issued on the eve of a health summit at the U.N. General Assembly. Barely half of the world’s 7.7 billion people is covered by essential health services, the report said, calling for doubling that figure. Yet if current trends continue, allowing for population growth, up to 5 billion people will miss out on health care in 2030, the target for universal health coverage set by world leaders in 2015, it said. About 925 million people spend more than 10% of their household income on healthcare, including 200 million people who spend more than 25%, the report said. “It is quite shocking to see the increasing number of people which are at risk of poverty due to health spending,” said Francesca Colombo, who heads the health division at the Organisation for Economic Cooperation and Development (OECD). “Even in high-income countries … there has been growth in the share and in the number of people who spend large proportions of their household budgets on health,” she said. Primary health care must cover access to essential drugs including for diseases such as diabetes and malaria, said Muhammad Pate, global health director at the World Bank. “Because we know that the cost of essential drugs is a key driver of catastrophic out-of-pocket costs,” he said. Agnes Soucat, a WHO health systems expert, said that high-income countries must seek efficiencies. “We are at a crossroads in the health sector in which we see declining marginal returns on investment with new technologies that are expensive but don’t necessarily always get a lot of health benefits,” she said.