Cross posted from: EQUIDAD@listserv.paho.org
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
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: http://www.euro.who.int/Document/E93058.pdf
“………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
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?
Ruggiero, Mrs. Ana Lucia (WDC)