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Fiscal Sustainability of Health Systems

Bridging Health and Finance Perspectives

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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 important progress in population health: for example, life expectancy at birth has increased, rising on average by ten years since 1970. The challenge now is to sustain and enhance these achievements in a context of tight fiscal constraints in many countries combined with upward pressure on health spending from factors such as new technological advances and demographic changes. Finding policies that can make health spending more sustainable without compromising important achievements in access and quality requires effective co-operation between health and finance ministries. Sound governance and co-ordination mechanisms are therefore essential to ensure effective policy choices. Prepared by both public finance and health experts, this report provides a unique detailed overview of institutional frameworks for financing health care in OECD countries. One of the main features of this book is a comprehensive mapping of budgeting practices and governance structure in health across OECD countries.

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Country experiences in dealing with fiscal constraint following the 2008 crisis

This chapter presents a synthesis of OECD and non-OECD countries’ experiences in responding to the global financial crisis, on what concerns the health sector. Many countries initially followed counter-cyclical fiscal policies and tried to sustain social sector expenditure, in particular in health. However, many countries were also soon forced to develop and implement strategies to control or reduce spending, and the health sector was often a target. The country responses to the crisis presented in this chapter provide important examples to other countries facing similar challenges, as well as interesting insights into how longer-term fiscal sustainability of the health sector might be enhanced.

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