Fiscal rules, powerful levers for controlling the health budget? Evidence from 32 OECD countries

Analysis of Centralized Efficiency Improvement Practices in Australian Public Health Systems

Aim

Analysis of centralized efficiency improvement practices in Australian public health systems.

Introduction

Public health systems seek to maximize outcomes generated for resources used through efficiency improvement (EI) in response to funding and demand pressures. Despite this focus, evidence for EI approaches at the whole-of-system level is lacking in the literature. There is an urgent need for evidence-based approaches to centralized EI to address these pressures. This study aims to address this gap by answering the research question "How is EI conceptualized and managed by central public health system management entities in Australia?".

Material and Methods

Document analysis was selected due to its suitability for systematically searching and appraising health system documentation, with this study following Altheide's approach focusing on whole-of-system strategic plan and management framework documents originating from Australian public health organizations.

Results

Conceptualization of efficiency varied substantially with no consistent definition identified, however common attributes included resource use, management, service and delivery. Forty-two of 43 documents contained approaches associated with improving efficiency at the whole of system level.

Discussion

While no comprehensive framework for centralized EI was evident, we identified nine core approaches which together characterize centralized EI. Together these approaches represent a comprehensive evidence-based approach to EI at the whole of system level.

Conclusion

The approaches to whole-of-system EI identified in this study are likely to be highly transferable across health systems internationally with approaches including strategic priority setting, incentivization, performance support, use of EI evidence, digital enablement and workforce capability development.

COVID-19 resilience index in European Union countries based on their risk and readiness scale

Addressing risks and pandemics at a country level is a complex task that requires transdisciplinary approaches. The paper aims to identify groups of the European Union countries characterized by a similar COVID-19 Resilience Index (CRI). Developed in the paper CRI index reflects the countries' COVID-19 risk and their readiness for a crisis situation, including a pandemic. Moreover, the study detects the factors that significantly differentiate the distinguished groups. According to our research, Bulgaria, Hungary, Malta, and Poland have the lowest COVID-19 Resilience Index score, with Croatia, Greece, Czechia, and Slovakia following close. At the same time, Ireland and Scandinavian countries occupy the top of the leader board, followed by Luxemburg. The Kruskal-Wallis test results indicate four COVID-19 risk indicators that significantly differentiate the countries in the first year of the COVID-19 pandemic. Among the significant factors are not only COVID-19-related factors, i.e., the changes in residential human mobility, the stringency of anti-COVID-19 policy, but also strictly environmental factors, namely pollution and material footprint. It indicates that the most critical global environmental issues might be crucial in the phase of a future pandemic. Moreover, we detect eight readiness factors that significantly differentiate the analysed country groups. Among the significant factors are the economic indicators such as GDP per capita and labour markets, the governance indicators such as Rule of Law, Access to Information, Implementation and Adaptability measures, and social indicators such as Tertiary Attainment and Research, Innovation, and Infrastructure.

Population ageing and health financing: A method for forecasting two sides of the same coin

There is a perception that population ageing will have deleterious effects on future health financing sustainability. We propose a new method-the Population Ageing financial Sustainability gap for Health systems (or alternatively, the PASH)-to explore how changes in the population age mix will affect health expenditures and revenues. Using a set of six anonymized country scenarios that are based on data from countries in Europe and the Western Pacific representing a diverse range of health financing systems, we forecast the size of the ageing-attributable gap between health revenues and expenditures from 2020 to 2100 under current health financing arrangements. In the country with the largest financing gap in 2100 (country S6) the majority (87.1%) is caused by growth in health expenditures. However in countries that are heavily reliant on labour-market related social contributions to finance health care, a sizeable share of the financing gap is due to reductions in health revenues. We argue that analyses giving equal attention to both health expenditures and revenues steers decision makers towards a more balanced set of policy options to address the challenges of population ageing, ranging from targeting expenditures and utilization of services to diversifying revenue.

A review of the sustainability of vaccine funding across Europe and implications for post-COVID policymaking

BACKGROUND

Approaches to routine vaccine funding and the underlying budget-setting process vary greatly across European countries. The ongoing COVID-19 pandemic has put enormous pressure on healthcare systems, affecting resilience of the overall vaccine ecosystem.

METHODS

This article reviews how vaccine budgets are structured across 8 European countries (England, Finland, France, Germany, Italy, Norway, Romania, and Spain). First a literature review of the landscape was undertaken, followed by expert interviews to review the findings and consider policy principles to secure prioritisation and sustainability of routine vaccination budgets post-COVID.

RESULTS

The organisation of budgets and vaccine spending varies greatly across Europe. In 2/8 countries (France and Germany) vaccine spending is subsumed into a wider healthcare budget. In 2/8 countries (Italy and Romania) the budget differentiates public health and prevention spending from other areas of healthcare, though there is no standalone vaccine budget. In 4/8 countries (England, Finland, Norway and Spain) there is a standalone vaccine budget, however this may not cover all elements needed for immunisation delivery and is not always transparent.

CONCLUSION

Ensuring adequate and dynamic country vaccine budgets, with horizon scanning approaches like in England and Finland, or flexible vaccines expenditures like Germany, would greatly help the timely availability of public funding for new vaccines and strengthen vaccines supply security in Europe through a more virtuous European vaccine ecosystem.

Supporting efficiency improvement in public health systems: a rapid evidence synthesis

Background

Public health systems internationally are under pressure to meet increasing demand for healthcare in the context of increasing financial resource constraint. There is therefore a need to maximise health outcomes achieved with public healthcare expenditure. This paper aims to establish and synthesize the contemporary evidence base for approaches taken at a system management level to improve efficiency.

Methods

Rapid Evidence Assessment (REA) methodology was employed. A search strategy was developed and applied (PUBMED, MEDLINE) returning 5,377 unique titles. 172 full-text articles were screened to determine relevance with 82 publications included in the final review. Data regarding country, study design, key findings and approaches to efficiency improvement were extracted and a narrative synthesis produced. Publications covering health systems from developed countries were included.

Results

Identified study designs included policy reviews, qualitative reviews, mixed methods reviews, systematic reviews, literature reviews, retrospective analyses, scoping reviews, narrative papers, regression analyses and opinion papers. While findings revealed no comprehensive frameworks for system-wide efficiency improvement, a range of specific centrally led improvement approaches were identified. Elements associated with success in current approaches included dedicated central functions to drive system-wide efficiency improvement, managing efficiency in tandem with quality and value, and inclusive stakeholder engagement.

Conclusions

The requirement for public health systems to improve efficiency is likely to continue to increase. Reactive cost-cutting measures and short-term initiatives aimed only at reducing expenditure are unlikely to deliver sustainable efficiency improvement. By providing dedicated central system-wide efficiency improvement support, public health system management entities can deliver improved financial, health service and stakeholder outcomes.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-07694-z.

Hardening subnational budget constraints via administrative subordination: The Italian experience of recovery plans in regional health services

Since 2007, Italian regions running large deficits underwent recovery plans (Piani di Rientro) imposed by the central government. The goal was twofold: regions were asked (i) to restore a balanced budget and (ii) to continue supply the set of services defined by the constitution. We investigate whether recovery plans have reached their objectives. Our evidence suggests that recovery plans have proved to be an effective mechanism to eliminate subnational governments deficits. We also do not find any significant effects on health care utilization and on citizens' health. Overall, spending efficiency has likely improved.

Crise econômica, austeridade e seus efeitos sobre o financiamento e acesso a serviços públicos e privados de saúde bucal

Resumo O presente estudo analisou os efeitos da austeridade e crise econômica sobre o financiamento da saúde bucal, oferta e utilização de serviços públicos e acesso a planos exclusivamente odontológicos no Brasil, no período de 2003 a 2018. Foi realizado um estudo retrospectivo, descritivo, com abordagem quantitativa. Foram coletados dados da base do Fundo Nacional de Saúde, da Agência Nacional de Saúde Suplementar, da Sala de Apoio à Gestão Estratégica, do Sistema e-gestor. Observou-se que o repasse federal fundo a fundo apresentou tendência crescente de 2003 a 2010 e estável de 2011 a 2018. A oferta decresceu ao final do período com redução da cobertura da primeira consulta odontológica programática, média da escovação dental supervisionada e número de tratamentos endodônticos. Na contramão da crise financeira pública, as empresas de planos exclusivamente odontológicos expandiram o mercado de 2,6 milhões de usuários em 2000 para 24,3 milhões em 2018, com lucro de mais de R$240 milhões. A austeridade fiscal tem forte influência sobre a utilização de serviços públicos odontológicos no Brasil, que pode beneficiar o mercado privado e ampliar as desigualdades.