Health Economics, Policy and Law
Volume 12 – Issue 2 – April 2017
Special Issue: Towards a Global Framework for Health Financing
Global health financing towards 2030 and beyond
Trygve Ottersen, David B. Evans, Elias Mossialos, John-Arne Røttingen
Published online: 23 March 2017, pp. 105-111
Universal health coverage and healthy lives for all are now widely shared goals and central to the 2030 Agenda for Sustainable Development. Despite significant progress over the last decades, the world is still far from reaching these goals. Billions of people lack basic coverage of health services, live with unnecessary pain and disability, or have their lives cut short by avoidable or treatable conditions (Jamison et al., 2013; Murray et al., 2015; World Health Organization, World Bank, 2015). At the same time, millions are pushed into poverty simply because they need to use health services and must pay for them out-of-pocket. Fundamental to this situation is the way health interventions and the health system are financed. Numerous countries spend less than is required to ensure even the most essential health services, scarce funds are wasted, out-of-pocket payments remain high and disadvantaged groups get the least public resources despite having the greatest needs.
It is clear that today’s global and national arrangements for health financing need to change, and this is a multifaceted endeavour. It is about domestic financing of health systems, joint financing of global public goods and external financing of health systems. It is about resource mobilisation, pooling and effective use. And it is about economics, politics, public health, human rights, law and ethics. To get health financing right, these areas, functions and perspectives must all be integrated and aligned.
Chatham House Working Group
The need for a broad and fresh look at global health financing was the starting premise for the Chatham House Centre on Global Health Security Working Group on Health Financing. The Group was established in 2011, following a conference at the Centre marking the 10th anniversary of the Commission on Macroeconomics and Health (Commission on Macroeconomics and Health, 2001). The mandate was to revisit the central themes addressed by the Commission and develop updated recommendations in light of new knowledge and developments since 2001. The Working Group would also build on the insights of three other landmark reports: the World Development Report 1993 Investing in Health (World Bank, 1993), the 2009 final report of the Taskforce on Innovative International Financing for Health Systems (HLTF, 2009), and the 2010 World Health Report Health Systems Financing: The Path to Universal Coverage (World Health Organization, 2010).
To facilitate a broad view on health financing, the Working Group brought together members with diverse backgrounds and perspectives from 15 countries. This included policy makers, researchers in multiple fields, representatives of civil society, and representatives of national and international institutions. The group met three times, and multiple working papers were prepared to form the basis for the final report, entitled Shared Responsibilities for Health: A Coherent Global Framework for Health Financing (Røttingen et al., 2014), which was launched during the World Health Assembly in 2014.
The report characterises key economic, epidemiological and institutional transitions and describe how these come with both challenges and opportunities for health financing. Against that background, a set of policy responses is offered, encapsulated in 20 recommendations for making progress towards a coherent global framework for health financing. These recommendations pertain to domestic financing of health systems, joint financing of global public goods for health, external financing of health systems and the cross-cutting issues of accountability and agreement on a new framework.
This special issue addresses all these questions and does so more broadly and more in depth than the Working Group’s Report could do. Health Economics, Policy and Law serves as an ideal platform for such a wide-ranging health policy issue, where economics, politics and legal considerations need to converge. While most contributions are in the form of academic articles, the close link to practical policy has been sought maintained throughout…