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The Long-Term Sustainability Of European Health Care Systems

Author

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  • Vincenzo Rebba

    (University of Padova)

Abstract
Over the past thirty years, health expenditure has grown at a faster rate than the economy in almost every OECD country. The main drivers of public health spending are income growth, insurance coverage, demographics, and, above all, technological change. According to the projections of the major international institutions (European Commission, OECD, International Monetary Fund), public health spending for the of EU-15 countries could significantly increase by 2050. These projections vary in an extremely wide range, between +27% and +84%, depending on the assumptions made. However, the big challenge will be the growth of public spending on long-term care which could more than double over the 2010-2050 period, owing to the sharp rise of frailty and disability at older ages, especially amongst the very old (aged 80+) which will be the fastest growing segment of the EU population in the decades to come. The European countries are facing a common challenge: the need to secure the economic and financial sustainability of their health care systems without undermining the values of universal coverage and solidarity in financing. Command and control policies aimed at expenditure restraints and largely operating through regulatory controls (controls over inputs and wages, budget caps, etc.) are widely used during periods of recession. They can hold expenditures down in the short term. However, they do little or nothing to moderate the underlying pressures which push health spending up over the long-run. Other policies to guarantee both economic and financial sustainability in the long-run should be explored: 1) the adoption of new regulation tools on supply and demand side; 2) a new balanced mix of public and private financing, strengthening the role of supplementary private health insurance, to allow investment and innovation, without imposing unsustainable burdens on public budgets and without denying care to the disadvantaged. The former policies focus on economic sustainability, improving the way health systems address the rise in chronic disease and seek to incentive and reward patients, providers and buyers for healthy behaviour, quality and efficiency of care. The latter policies could ensure long-term financial stability of the health care systems but may determine negative effects in terms of equity and, therefore, they must be carefully designed.

Suggested Citation

  • Vincenzo Rebba, 2014. "The Long-Term Sustainability Of European Health Care Systems," "Marco Fanno" Working Papers 0191, Dipartimento di Scienze Economiche "Marco Fanno".
    • Handle: RePEc:pad:wpaper:0191
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    References listed on IDEAS

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    Cited by:

    1. S.N. Yashin & N.I. Yashina & E.V. Poyushcheva & E.S. Malysheva & N.N. Pronchatova-Rubtsova & O.I. Kashina, 2018. "Evaluating the Effectiveness of Public Health Financing Based on Financial and Non-Financial Indicators in Terms of the Knowledge Economy," European Research Studies Journal, European Research Studies Journal, vol. 0(Special 2), pages 112-123.
    2. Sanandaji, Tino & Lakomaa, Erik, 2016. "Care, Commons and Entrepreneurship," SSE Working Paper Series in Economic History 2016:2, Stockholm School of Economics.
    3. Lakomaa, Erik & Sanandaji, Tino, 2017. "Can Community Driven Care be integrated in the European Welfare System? Institutional Challenges and Historical Lessons," SSE Working Paper Series in Economic History 2017:3, Stockholm School of Economics.
    4. Marenzi, Anna & Rizzi, Dino & Zanette, Michele, 2021. "Incentives for voluntary health insurance in a national health system: Evidence from Italy," Health Policy, Elsevier, vol. 125(6), pages 685-692.

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    Keywords

    health care expenditure; health care systems; projection models; sustainability; health care policy.;
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