Finding sufficient funds to pay for more resilient health systems is challenging in the current economic context. 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. Robust actions to encourage healthier populations and policies can put future health expenditure on a far gentler upward trajectory. These would enable spending to reach a more sustainable 10.6% of GDP in 2040 (as compared with health spending reaching 11.8% of GDP in the absence of major policy change).

Better budgetary governance is critical. It improves how public funds for health are determined, executed and evaluated. Findings of this report are targeted at health and finance policy makers. Improved dialogue between health and finance ministries is especially important when governments are operating in a constrained fiscal setting.

This report would not have been possible without the government officials and other participants of the OECD Joint Network of Senior Budget and Health Officials. Many of the findings build upon insights from these participants during meetings and workshops, who also provided a thorough review of the chapters contained in this report.

The report was prepared by the OECD Health Division and Public Management and Budgeting Division, under the co-ordination of Chris James and Camila Vammalle. Chapter 1 was written by Chris James, David Morgan, Michael Mueller, Caroline Penn and Camila Vammalle; Chapter 2 by Michael Mueller, Caroline Penn and David Morgan; Chapter 3 by Luca Lorenzoni, Pietrangelo De Biase and Sean Dougherty; Chapter 4 by Camila Vammalle, Caroline Penn, Laura Cordoba Reyes and Chris James; Chapter 5 by Caroline Penn, Chris James and Camila Vammalle; and Chapter 6 by Chris James, Caroline Penn, Ivor Beazley, Camila Vammalle and Andrew Blazey.

Chapter 4 is based on work funded by “Le Haut conseil pour l’avenir de l’assurance maladie (HCAAM)”. Nathalie Fourcade and Renaud Legal (HCAAM), and David Bernstein from the ‘Ministère des Solidarités et de la Santé’ provided important inputs. Findings in this chapter draw from a series of in-depth discussions with officials from ministries of health, finance and other non-governmental health policy experts from Belgium (Jo de Cock, Joanna Geerts, Anika Meskens, Johan Peetermans, Karen Raeymaekers, Brieuc Van Damme, and Dirk Wouters); Israel (Noa Heymann, Haim Hoffert, Daniel Padon, Ran Ridnik, and Nadav Ben Yosef); New Zealand (Jess Hewat, Jess Jenkins, Niki Lomax, Simon McLoughlin, and Cara Palmer-Oldcorn) and the United Kingdom (Anita Charlesworth, Becky Henderson, Dylan Kirkland, Peter Lilford, Peter Smith, and Amelia Tudor-Beamish). Chapter 6 builds on earlier work funded by the World Health Organization, with the country case studies done in close collaboration with government officials and other partners from Chile, Latvia and New Zealand. In particular, we would like to thank Hélène Barroy, Svetlana Batare, Cristian Herrera, Alejandro Pino, Klinta Stafecka and Erick Vargas. The opinions expressed and arguments employed herein do not necessarily reflect the official views of the OECD member countries or other organisations mentioned above.

This publication benefitted from comments by Andrew Blazey, Jón Blöndal, Francesca Colombo, Mark Pearson and Stefano Scarpetta. Editorial assistance was provided by Lucy Hulett.

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