A new report from the WHO Barcelona Office for Health Systems Financing has highlighted the need for governments to maintain a higher level of public spending on health for the wider benefit of society despite expected budgetary pressures following the pandemic.
The report, “Spending on health in Europe: entering a new era”, is the first in-depth analysis of health spending across all 53 Member States of the WHO European Region over nearly 2 decades.
In a foreword to the report, WHO Regional Director for Europe Dr Hans Henri P. Kluge and Director of WHO/Europe’s Division of Country Health Policies and Systems Dr Natasha Azzopardi-Muscat write: “To avoid the mistakes of the past, governments will need to invest more public funding in health now and in the years ahead – even as they face growing budgetary pressure – to address the backlog created by disruption to health services, mitigate the negative health effects of foregone care, unemployment and poverty, and strengthen preparedness for future shocks.”
Dr Kluge and Dr Azzopardi-Muscat add, “Governments also need to pay attention to how health system resources are used, to avoid any further widening of inequalities.”
Health spending as a political choice
Analysing countries across the Region, the report finds that spending on health grew prior to the 2008 financial crisis. However, a significant shift away from public spending on health in response to the crisis was not reversed in later years.
Between 2013 and 2018, out-of-pocket payments grew faster than public spending on health in most of the lower-middle-income countries in the Region, and in around half of the upper-middle-income and high-income countries.
Austerity in the health sector – budget cuts and coverage restrictions – has undermined national and regional progress towards universal health coverage. This has pushed health-care costs onto households, increased out-of-pocket payments, led to unmet need and financial hardship, and exacerbated socioeconomic inequalities within and across countries.
Health spending as an investment
COVID-19 has shown the importance of robust health systems and the long-term benefits of investing in the health of the population. Countries were quick to mobilize additional funds for the health system in response to the pandemic, but treating and preventing COVID-19 and addressing the impact of disruption to services will require continued investment in the years ahead.
Sustained increases in public spending on health coupled with well designed public policy can mitigate the negative effects of COVID-19 while also building health system resilience.
The report also highlights that spending on primary health care accounts for less than half of all health spending, despite being a cost-effective way to deliver health care to communities. WHO has called for an additional 1% of gross domestic product (GDP) in public funding to be spent on primary health care.
European Programme of Work
Reductions in public spending on health following the financial crisis damaged health systems. Increased public investment in health is needed in most countries to make progress towards universal health coverage and to improve health, well-being and protection from health emergencies – goals that are central to the European Programme of Work 2020–2025 – “United Action for Better Health in Europe”.