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To gain a better understanding of the financial sustainability of health systems, the OECD has produced a new set of health spending projections up to 2030 for all its member countries. Estimates are produced across a range of policy situations. Policy situations analysed include a “base” scenario – estimates of health spending growth in the absence of major policy changes – and a number of alternative scenarios that model the effect on health spending of policies that increase productivity or contribute to better lifestyles; or conversely, ineffective policies that contribute to additional cost pressures on health systems.
The size, structure and growth of health and pension programmes have, in recent years, been matters of concern to all OECD governments and societies. At issue are not only currently important social and economic questions, but also future difficulties which are likely to arise with the ageing of OECD population structures.
Japan has the fastest ageing population structure in the OECD. In 1960 the proportion of the population aged 65 and over in Japan was 5 per cent. In 1985 this proportion was 10 per cent, and in 2000 it is projected to be 15 per cent. The resulting pressures on social programmes are well understood in Japan, and the way in which the Japanese government and people are approaching this issue is of interest to other countries which must soon face similar problems.
This paper analyses the budgetary and health governance responses to the COVID-19 pandemic in Latin American and Caribbean (LAC) countries during 2020 and 2021 to identify good practices which could support countries improve the resilience of their health financing systems for future crises.
At the onset of the COVID-19 pandemic many countries found that they lacked basic, timely data for decision making—such as information on health workforce, resources, hospitalisations, and mortality. Many policy makers have since leveraged COVID-19 related information system reforms in a way that may also address long-standing barriers in the structures, policies and institutions that have kept countries from fully utilising health related data. Health data governance reforms, in particular, have been an important aspect of countries responses. Improvements in the quality, coverage, completeness, and capacity for data sharing in regard to existing national personal health datasets were widely reported. Countries have also made significant investments in digital tools, systems for public health monitoring, assessments of resource use and availability, and data to monitor the status of non-COVID related health needs.
South Africa has made substantial progress in developing its health care system since 1994. Universal access is a fundamental principle of the Constitution and health sector policies, and health outcomes have improved on aggregate. However, health inequities remain an important challenge today. Focusing on public financial management and the budgeting process for health, South Africa has a clear, well-structured and transparent process to budget formulation from national to provincial governments. But this transparency does not fully transmit on allocation decisions to health from provincial treasuries. In terms of budget execution, up-to-date data reporting systems, strict enforcement of fiscal rules, and well-developed monitoring processes are good budgetary practices. However, despite good aggregate spending levels, there is great disparity in the way provinces execute their budget. Finally, South Africa has well-established monitoring processes. However, the link between performance indicators and the budget process remains limited and could be strengthened.
The Philippines has placed a strong emphasis on achieving Universal Health Coverage. In recent years, earmarked funds from new alcohol and tobacco taxes have substantially increased government funds available for health. This additional funding offers great potential to improve access and health outcomes, as long as the money is well spent. An important pre-requisite for effective spending is a strong budgetary process for health. In terms of budget formulation and planning, the Philippines government has – at the national level – introduced a comprehensive package of public financial management reforms that apply across all sectors.
In the 21st century care, the old paradigm “because the doctor said so” no longer holds. Individuals are now seeking ways to understand their health options and take more control over their health decisions. But this is not an easy task. Professionals continue to use medical jargon, drug instructions are not always clear, and health information in clinical settings continue to be complex and challenging to navigate. Widespread access to digital technologies offset some of these barriers by democratising access to health information, providing new ways to improve health knowledge and support self care. Nonetheless, when health information is misused or misinterpreted, it can wrongly influence individuals’ preferences and behaviour, jeopardise their health, or put unreasonable demands on health systems.
Overall, the health of the Irish population has improved substantially during recent decades and is quite good compared with other OECD countries. However, spending is elevated, partly reflecting a system that is strongly based on hospitals. Population ageing is exacerbating spending pressures. In addition, the health sector is dealing with past underspending, particularly in capital outlays in the years following the global financial crisis, that have constrained service delivery, contributing to substantial waiting lists and heavy pressure on staff. The government has initiated wide-ranging reforms, termed Sláintecare, with the aim of broadening the coverage of universal care, decentralising provision and enhancing the integration of primary, community and hospital care. The reforms are complicated, reflecting a healthcare system that is complex and at times opaque. This is particularly the case with the interaction of the public and private parts of the system in which private patients enjoy easier access to care, leading to concerns about a two-tier healthcare system. The creation of new regional health areas is set to support more decentralised decision-making, but information systems to track spending and reform implementation need an overhaul. The COVID-19 pandemic has diverted policy-making attention just as the reforms got underway, but stepping up the efforts to address legacy issues and move forward on the reforms is now key to meet the coming challenges while using resources effectively.
In 2018, the Inter-American Development Bank and the OECD launched a survey to collect information on key health systems characteristics in Latin American and Caribbean (LAC) countries. This paper presents the information provided by 21 of these countries. It describes country-specific arrangements to organise the population coverage against health risks and the financing of health spending. It depicts the organisation of health care delivery, focusing on the public/private mix of health care provision, provider payment schemes, user choice and competition among providers, as well as the regulation of health care supply and prices. Finally, this document provides information on governance and resource allocation in health systems (decentralisation in decision-making, nature of budget constraints and priority setting).
The economic crisis that started in 2008 has had a profound impact on the lives of citizens. Millions of people lost their job, saw their life-savings disappear and experienced prolonged financial hardship. The economic crisis has also led a number of OECD governments to introduce austerity measures to reduce public deficits. The health sector, like many other social welfare programmes, has witnessed extensive spending cuts and has also been the subject of substantial reforms. The combined effects of economic crisis, austerity and reforms have led many OECD health systems into unchartered territory.
This paper looks at the impact of economic crisis on health and health care. It summarises findings from the published literature on the effects of economic crisis that took place over the past few decades and also describes recent health policy reforms, focusing on those countries where the economic crisis has hit hardest. Finally, this paper analyses the empirical relationship between unemployment and health care use, quality and health outcomes, using data from OECD Health Statistics. In doing so, it investigates whether the effects of unemployment on health outcomes have been extenuated by austerity measures...
This study reviews health-system reforms in OECD countries over the past several decades and their impact on the following policy goals: ensuring access to services; improving the quality of care and its outcomes; allocating an “appropriate” level of resources to health care (macroeconomic efficiency); and ensuring microeconomic efficiency in service provision. While nearly all OECD countries have achieved universal insurance coverage, initiatives to address persistent disparities in access are now being undertaken in a number of countries. In light of new evidence of serious problems with health-care quality, many countries have recently introduced reforms, but it is too soon to generalise as to the relative effects of alternative approaches. Instruments aimed at cost control have succeeded in slowing the growth of (particularly public) health-care spending over the 1980s and 1990s but health-care spending continues to rise as a share of GDP in most countries. A few countries have ...
This paper is also published under OECD Health Working Papers Series.