Navigating how to finance individual and public health services to enable progress towards universal health coverage remains a key issue for governments around the world as health systems are confronted with new pressures and demands. These challenges are complex and difficult and include the following examples: climate change has direct health consequences and is a cause of migration and conflict, which in turn have health implications; the health and socioeconomic effects of COVID-19 slowed growth, widened inequality and increased poverty, and the protective responses by governments in 2020 and 2021, while laudable, were funded mainly through deficit spending, which brings increases in debt service obligations; violent conflicts have directly harmful impacts on people’s physical and mental health, and health facilities and health workers have also been explicitly targeted; redressing the chronic underinvestment in the training and employment of health workers remains a major challenge in much of the world; novel technologies for health, in addition to the promise they hold, pose many social and ethical implications, given the need to prioritize within finite resources; and the rise of antimicrobial resistance is not only a health threat but also a financial challenge.
In one sense, these challenges are not new; the need for both individual and public health services is growing faster than the available financial resources, and thus health systems face difficult trade-offs, even as they advocate for much-needed increases in spending. Reforms to improve efficiency can lessen the severity of these trade-offs, but they will always be with us.
However, the specific manifestations of the current challenges are new, and so too are the aspects of the global context noted above, plus the pressures arising from the approach of 2030 and the desire for quick fixes to reach the Sustainable Development Goals targets. From the perspective of health financing, and of health systems more generally, we need to be vigilant and not let the urgency of the moment lead countries to act out of desperation. The calls, even if well-intentioned, for what might be deemed “zombie policies” – those bad ideas which keep coming back even though they have been shown not to work – may actually divert systems away from rather than towards universal health coverage.
This is why this book comes at such a crucial time. A multiyear effort by leading health policy analysts, this volume serves as a response to the need for evidence on how to organize and adapt health finance mechanisms to enable affordable, accessible and high-quality health services, even in the face of tight fiscal constraints. While publications on health financing exist, this is a unique and comprehensive resource that systematically examines each health financing function and investigates what the main issues are, why these arise, what the literature says about them and what country experience can tell us. This book takes a pedagogical approach that can serve policy-makers, practitioners and students alike. By unravelling the intricacies of why certain financing mechanisms persist while others waver, and highlighting country examples along the way, the book equips readers with the essential tools to comprehend, analyse and identify realistic and practical health financing reforms to support progress towards universal health coverage.
This endeavour has been undertaken under the auspices of the European Observatory on Health Systems and Policies, with which I have had the privilege to cooperate with for nearly 30 years, even before it was formally established. As with all Observatory products, it is deeply rooted in the ethos of evidence-based practice and knowledge brokering. The European Observatory was established late in the 20th century to support health policy-makers and advisors in Europe with the evidence needed to design and implement the best policies for their countries. In 2002, the Observatory published a seminal volume entitled, Funding health care: options for Europe. More than 20 years later, this new book provides an updated analysis of recent experiences with health financing reforms enriched by global, and not merely European, evidence. Its organization reflects the core functions and policies of health financing: revenue raising; pooling of funds and policies on benefits and their rationing; and commissioning and purchasing of services. The book takes the reader into next-generation issues – that in fact must be addressed now – such as paying for integrated care, financing pandemic preparedness and the funding of global public goods. It is sure to remain relevant and influential for years to come, as was the case with its predecessor.
In essence, this textbook epitomizes a convergence of theory and practice, equipping readers with knowledge tools to push for good policy-making practice, while concurrently arming them against the rise of zombie ideas. We hope that scholars, practitioners, decision-makers and their advisors can take the lessons from the text back to their contexts and continue to improve their health financing systems to better meet the challenges of tomorrow.
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