A publication released by the WHO shows how the response to the economic crisis across the European Region varies across health systems.
The Study highlights the three main challenges facing policy-makers:
Health systems require predictable sources of revenue. Sudden interruptions to public revenue streams can make it difficult to maintain necessary levels of health care.
Cuts to public spending on health made in response to an economic shock typically come at a time when health systems may require more, not fewer, resources – for example, to address the adverse health effects of unemployment.
Arbitrary cuts to essential services may further destabilise health systems if they erode financial protection, the equitable access to care and the quality of care provided - which would increase costs in the longer term. In addition to introducing new inefficiencies, widescale cuts are not only unlikely to address existing inefficiencies, but could also potentially exacerbate the fiscal constraint.
Policy responses have differed across the European Region: For some countries the crisis is an opportunity to increase efficiency. In other cases, measures aimed at reducing budget deficits by increasing user charges for essential services is a cause for concern. The WHO study also notes that little has been done to increase efficiency through policies to improve public health.
Some of the policy responses that help with both fiscal consolidations and promote better health outcomes are: risk pooling; strategic purchasing; health technology assessment; controlled investment; public health measures; price reductions for pharmaceuticals combined with rational prescribing and dispensing; shifting from inpatient to day case or ambulatory care; integration and coordination of primary care and secondary care, and of health and social care; reducing administrative costs while maintaining capacity to manage the health system; fiscal policies to expand the public revenue base; and counter-cyclical measures, including subsidies to protect access and financial protection, especially among poorer people and regular users of health care.
On the other hand, there are policy options that risk undermining health system goals, such as: reducing the scope of essential services covered; reducing population coverage; increasing waiting times for essential services; charging users for essential services; and reducing salaries of health workers.
The conclusion is that “the policy emphasis should be on cutting wisely to minimize adverse effects on health system performance, enhancing value and facilitating efficiency-enhancing reforms in the longer run.”
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