Fiscal Sustainability Of Health Systems How To Finance More Resilient Health Systems When Money Is Tight

This publication explores the policy options to finance more resilient health systems whilst maintaining fiscal sustainability. It finds that the scale of the additional health financing needs requires ambitious and transformative policy changes.

Norway’s economy is slowing as inflation and higher interest rates weigh on consumption and investment. The labour market is tight and wage growth robust, while labour shortages and job mismatches are high and rising. Inflation is falling but still way above the target of 2%. The fiscal stance is expansionary. It should become contractionary to support monetary policy. While Norway is one of the OECD’s most productive countries, productivity growth over the past decade has been weak. Making skills more relevant, notably by strengthening vocational education and training, could help raise productivity and ease tight labour markets. Higher and broader taxation of greenhouse gas emissions and investing in lower‐cost emission cuts would help achieve emission reductions more efficiently. Public spending as a share of GDP is the highest in the OECD, which brings important benefits in the form of high-quality public services. However, oil revenues are set to decline, and ageing costs to rise, foreshadowing strains on public finances in the future. Norway could benefit from applying a medium-term expenditure framework, introducing a spending rule, and establishing a full-fledged fiscal council. Reforming the very generous sickness and disability scheme could help reduce spending pressures and increase employment. Regional policy should become more cost-conscious. Infrastructure investment is very high, and imposing a minimum benefit-cost ratio on individual projects and strengthening ex-post evaluations could help improve its effectiveness. SPECIAL FEATURE: RAISING THE EFFECTIVENESS OF PUBLIC SPENDING

The health systems we enjoy today, and expected medical advances in the future, will be difficult to finance from public resources without major reforms. Public health spending in OECD countries has grown rapidly over most of the last half century. These spending increases have contributed to ...

Any analysis of health financing issues has to begin with sound estimates of the level and flow of resources in a health system, including total levels of spending, the sources of health expenditures, the uses of funds in terms of services purchased, and in terms of who purchases them. The analysis should also aim at understanding how these resource flows are correlated with health system outcomes, including those of improving health, reducing health inequalities, and reducing the incidence of catastrophic health expenditure. National Health Accounts (NHA) provide a framework to collect, compile, and analyze such data on all types of health spending in a country—and so create a robust evidence base for policy making. Although NHA data delineate the key financial metrics of a health system, the collection of these data have not been institutionalized in most developing countries. The root problems are often the same: insufficient resources to collect, collate, analyze and produce information on spending; poor development of health and other information systems; low levels of local capacity to interpret information to meet policy needs; and inadequate demand for data within countries. Furthermore, in many low- and middle-income countries, NHA activities have been conducted as ad hoc, donor-driven initiatives. Since 2008, the World Bank has been coordinating a global initiative to identify bottlenecks to the institutionalization of NHA, and to learn lessons in countries at different stages on the journey towards this institutionalization. The focus has been less on the production of NHA and more on its relevance as a tool to enable policy makers develop and implement evidence-based decisions, and better measure the impact of health reforms, especially those related to health financing. This report has been developed through a consultative process, involving experts and policy makers from more than fifty low-, middle- and high-income countries, large and small, in all corners of the world, development partners and World Bank staff globally. The report represents a synthesis of lessons learned from country experiences and is intended to serve as a strategic guide to countries and their development partners as they design and implement their strategy to develop nationally relevant and internationally comparable data, collected in a routine and cost-effective manner.

How can we improve health, wealth and societal well-being by investing in health systems? How can we ensure that health systems are sustained in the future? How can we monitor, manage and improve performance so that health systems are as effective and efficient as possible? This book looks at health systems from a new perspective. By reviewing the complex relationship between health systems, health and wealth, it argues that health systems need not be, as is often believed, simply a drag on resources but rather can be part and parcel of improving health and achieving better economic growth. Aiming to assist policy-makers as they assess the case for investing in health systems, Health Systems,Health, Wealth and Societal Well-being reviews the evidence on: The contribution of health systems to better health and to economic growth The ways that investment in better health can save future health costs as well as boosting economic growth How we can create equitable, sustainable health systems fit for the 21st century

Canada has a complex health delivery system which is a conglomeration of 13 public plans--10 provincial and three territorial as well as a number of federally administered plans serving special populations such as Aboriginals and Veterans--all providing full coverage for most hospital and physician services as well as partial coverage for many services that vary among plans. The importance of this study is that it examines how the public/private sector relationship in health care delivery--particularly that of the for-profit sector--has developed both historically and in recent years, in three subnational provincial jurisdictions within a federal system. The case study provinces are Ontario, Quebec, and Alberta. The study examines both similarities and differences in this development. These provinces are highly distinct in their political culture and political history affecting health care delivery. Ontario and Quebec are Canada's most populous provinces and Alberta is an increasingly populous prairie state. Alberta is unique in its long-time governance of the Progressive Conservative party and its predecessor the Social Credit Party. Ontario has had a more variable political history with periods of Progressive Conservative, New Democratic Party and Liberal leadership and in recent years Quebec governance has shifted between the Parti Qu becois and the Liberal Party. In this study, one dimension that the authors examine are political dispositions to act regarding public/private initiatives in health care delivery and how this affects health care delivery in these provinces. Provincial medical and hospital plans are constrained by the Canada Health Act of 1984. For necessary medical and hospital services, the provinces and territories must adhere to the five principles of the Act in order to receive federal funding. However for other extended health care and health care-related services, there are federal contributions that are not constrained by these principles--although subject to reporting obligations. Another factor providing some flexibility in provincial Medicare plans is that necessary hospital and medical services are not enumerated in the Canada Health Act. This has allowed some "delisting" of services which is discussed in the case studies. In the provincial case studies, the authors examine how the federal/provincial dynamic in the delivery of health care services has worked out in the three provinces, with respect to similarities and differences regarding the involvement of the for-profit sector both within and outside the respective Medicare systems. They also examine how the fiscal setting has affected both political and economic sustainability pressures with respect to inclusion of private commercial initiatives in these three provincial settings. The authors note that these initiatives occur both within and external to Canadian provincial Medicare systems and that there is a need to see that such initiatives are held publicly accountability to meet equity and access goals. The study utilizes government documents, press reports and personal interviews to draw a picture of health delivery developments within the Canadian federal context. This study adds to the comparative health policy literature by applying a comparative approach to subnational provincial cases. It is also noteworthy to note that globally, many nations' health insurance plans incorporate a mixed public and private health delivery system, albeit that the mixes of for-profit and not-for-profit organizations will vary with respect to the ideological, political, cultural and historical characteristics of various nations. This is an important book for collections in Canadian studies, political science, and public health.

"This World Health Report was produced under the overall direction of Carissa Etienne ... and Anarfi Asamoa Baah ... The principal writers were David B. Evans ... [et al] -- t.p. verso.