Financing for health system transformation: Spending more or spending better (or both)? [Internet]

Excerpt

To transform their health systems, most countries will need to continue to dedicate more public funds to health, as well as use the funds they have more efficiently and effectively.

1. Governments often have major (but typically unsubstantiated) concerns that public spending on health is growing uncontrollably and, as a result, they may question the long-term sustainability of health financing. Amidst this rhetoric and within the context of price growth, demographic shifts and other pressures, health policy-makers across the WHO European Region are finding it increasingly challenging to make the case for sufficient health budgets.

2. Health systems and services need to transform to meet their objectives and to improve their resilience in the face of future challenges. The COVID-19 pandemic laid bare not just the inadequacy of many countries’ emergency preparedness plans, but also drew attention to the challenges facing health systems more broadly and the need to make fundamental changes.

3. Transformation requires a mix of more efficient (better) and increased (more) public spending on health. Health systems can spend their resources better by focusing on priorities that demonstrably provide value-for-money.

4. Some “good” investments to consider include:

   1. ◦

      primary health care and prevention, which reduce the need for more expensive and intensive treatments later on;

   2. ◦

      steps to strengthen and sustain the health care workforce to ensure there are enough staff in the appropriate geographic and care areas with working conditions that enable the delivery of high-quality, accessible services;

   3. ◦

      carefully selected and integrated digital innovations that can enhance efficiency, access and quality of care;

   4. ◦

      improved access to high-quality, affordable mental health care to address population and societal needs, including those that have historically been overlooked;

   5. ◦

      ongoing evaluation of pharmaceutical pricing and reimbursement models to ensure that prices paid reflect good value; and

   6. ◦

      coverage policies that provide better financial protection and access to needed services.

5. Although there is scope for resources to be spent better in all countries, additional public expenditure on health is also essential. Institutional rigidities and political economy factors may limit the potential for efficiency gains and reallocation of funding from one priority area to another in practice. Even where reallocation is feasible, it is unlikely to be enough on its own to deliver on strategic goals such as high-quality, affordable and accessible care. More spending will almost always be necessary.

6. While health systems will need to make strong arguments in favour of additional spending, there is no one-size-fits-all solution to negotiating for additional resources for health. A strategic approach based on evidence-informed narratives and effective fiscal governance arrangements can help.