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[afro-nets] Addressing financial sustainability in health systems

Cross posted from:

Addressing financial sustainability in health systems

Sarah Thomson, Research Fellow, European Observatory on Health Systems and 
Policies, and LSE Health, London

Tom Foubister, Research Officer, LSE Health, London

Josep Figueras, Director, European Observatory on Health Systems and Policies, 

Joseph Kutzin, Regional Adviser, Health Systems Financing, and Head of the WHO 
Office, Barcelona

Govin Permanand, Programme Manager/Technical Officer, Health Evidence Network, 
WHO Regional Office for Europe, Copenhagen

Lucie Bryndová, Adviser to the Minister of Health, Cabinet of the Minister, 

World Health Organization 2009 on behalf of the European Observatory on Health 
Systems and Policies 2009

Available online PDF [49p.] at:

“………The question as to whether health systems will be financially sustainable 
in the future is frequently raised in health policy debate. The problem is 
often phrased in terms of the ability of governments and others adequately to 
finance health care in the face of growing cost pressures, with population 
ageing, new technologies and consumer expectations around health care coverage 
and quality being the three most commonly cited challenges.

Although the notion of ‘financial sustainability’ appears to be central to 
health policy debate, it does not form part of most health system objectives, 
including those of the World Health Organization’s health system performance 
framework (1). Moreover, there is little clarity or consensus about the term's 
meaning, beyond it having something to do with ‘ability to pay’ or 
‘affordability’. Nevertheless, the underlying ‘sustainability’ issue – 
balancing rising cost pressures against limited resources – is a concern across 
countries, all the more so in the context of the current financial crisis. 
Inevitably, this means addressing trade-offs, both within the health sector 
itself and more broadly between the health sector and the rest of the economy.

This policy summary aims to shed light on the notion of financial 
sustainability and to examine its policy relevance in practical terms. Without 
a better understanding of what is meant by financial sustainability and, 
importantly, without explicitly linking the issue to questions such as 
willingness to pay for health care, the value of the benefits gained from 
health spending and how to improve the performance of the health system, policy 
responses to sustainability concerns may be misdirected and yield unintended 

This policy summary shows the limitations of adopting financial sustainability 
as a ‘policy goal’, arguing instead that it should be understood as a 'policy 
constraint', and translating this notion into three key policy-relevant 



1 Introduction

2 Understanding the challenge of financial sustainability in health

3 How much should we spend on health care?

4 What level of health care coverage should we provide?

5 How can we enhance value in the health system?

6 Conclusion


Ruggiero, Mrs. Ana Lucia (WDC)

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