Dissertation On Sustainability Of Private Healthcare composition. Our experts proofread and edit your project with a detailed eye and with Dissertation On Sustainability Of Private Healthcare complete knowledge of all writing and style conventions. Proofreading sets any writing apart from “acceptable” and makes it exceptional/10() Sep 15, · The OECD Meeting, held on 24–25 April in Paris, aimed to identify and disseminate good practices in managing health care budgets 4, and a publication on the fiscal sustainability of health systems is under development. This shall examine drivers of health expenditure, policies to manage spending and improve value for money services. We Dissertation On Sustainability Of Private Healthcare will not breach university or college academic Dissertation On Sustainability Of Private Healthcare integrity policies. Disclaimer: nascent-minds is dedicated Dissertation On Sustainability Of Private Healthcare to providing an ethical tutoring service. We don't/10()
Health care financing and the sustainability of health systems
Try out PMC Labs and tell us what you think. Learn More. Center for Health Services Management and Evaluation, Faculty of Nursing, University of Athens, Papadiamantopoulou Street, Athens, Greece. Health Economics Unit, Public Health Building, University of Birmingham, Birmingham, B15 2TT UK. The economic crisis brought an unprecedented attention to the issue of health system sustainability in the developed world.
Not enough attention has yet been paid to the issue of who pays and, more importantly, to the sustainability of financing. This fundamental concept in the economics of health policy needs to be reconsidered carefully. In a globalized economy, as the share of labor decreases relative to that of capital, wage income is increasingly insufficient to cover the rising cost of care. At the same time, as the cost of Social Health Insurance through employment contributions rises with medical costs, it imperils the competitiveness of the economy.
These reasons explain why spreading health care cost to all factors of production through comprehensive National Health Insurance financed by progressive taxation of income from all sources, instead of employer-employee contributions, protects health system objectives, especially during economic recessions, and ensures health system sustainability. Health systems appeared afteras Europe was healing from the 2 nd World War. With a political shift to the left dissertation on sustainability of private healthcare 1 ], governments responded to public demands for affordable health services accessible to all.
Two major types of public health systems emerged, named after their political instigators:. Bismarck systems based on social insurance, with a multitude of public insurance funds, financed by employer-employee contributions, independent of health care provision. Examples are Belgium, France and Germany. Beveridge systemswhere public financing and health care delivery are handled within one tax-financed structure, such as the National Health Service NHS in the UK and in some Nordic states.
Since then, there has been intense debate over the two generic types of systems, with the discussion centered on access, quality and cost. In both WHO definitions, the main concern was about raising adequate funds, sidestepping the implications for payers and for the economy. With recent recessions, however, universal coverage, a main pillar of social cohesion and welfare is endangered, with profound implications on equity 1 and financial protection.
The willingness of society to disburse the necessary funds in developing countries has been discussed since the s [ 4 ], and sustainable development remains pertinent in light of social, demographic and epidemiological changes [ 5 ]. The incidence of financing and health system viability has only recently become a major topic of health policy [ 6 ], not only in Europe [ 7 ] and the UK [ 8 ] but also in the US [ 9 ] and Canada [ 10 ].
The OECD Meeting, dissertation on sustainability of private healthcare, held on 24—25 April in Paris, aimed to identify and disseminate good dissertation on sustainability of private healthcare in managing health care budgets 4and a publication on the fiscal sustainability of health systems is under development. This shall examine drivers of health expenditure, policies to manage spending and improve value for money. This fundamental, but rather overlooked, concept in the economics of health policy needs to be actively debated as sustainable development goals gain traction in post policy agenda.
This paper discusses the implications of the way health care resources are raised, pooled and spent. Financial sustainability as a major health care issue in the 21 st century world is also discussed. The evolution of health financing during the last half century reveals a fundamental shift in core issues. Afterhealth systems were designed for populations expected to live for an average of 65—70 years, dissertation on sustainability of private healthcare.
With retirement at 60—65 and near full employment, lifetime earnings and savings were more or less sufficient to finance a decent health system, while rising health expenditure meant welfare gains for all. In the 21 st century, average life expectancy rose above the age of 80, and health science and technology improved quality of life even at a very old age. Although desirable, dissertation on sustainability of private healthcare, the prolongation of life in good health costs, a reality that no democratic society can ignore for long.
The real political, dissertation on sustainability of private healthcare, economic and ethical question is the source of the required financing. Very rich countries 5 can still afford to rely largely on private health insurance despite the serious equity issues involved. Most developed and developing countries, however, finance their more or less developed welfare state through taxation and labor contributions. It is in these countries that globalization is bringing increasing economic inequality and economic uncertainty has caused a major debate on the sustainability of health financing.
Globalization has profoundly affected the distribution of income both among and within countries. The seminal work of Thomas Piketty in [ 12 ] showed that globalization favors capital relative to other sources of income, such as labor and rents. Increased capital mobility pulled many countries out of poverty, but the benefits favor the rich capital owning countries [ 13 ]. Globalization also increased income inequality within countries with top income brackets absorbing a larger share of national GDP [ 14 ].
Besides being a moral and political question, growing inequality is also an economic one since, beyond a certain point, it can be a source of significant economic ills [ 15 ].
For example, the failure to tax income reduces the effectiveness of welfare and safety nets and undermines the competitiveness of the economy [ 16 ]. This point is particularly important for developing countries now developing their health systems, dissertation on sustainability of private healthcare.
Another phenomenon that makes this century different is frequent recessions as income inequality causes a drop in demand [ 15 ]. Unemployment and economic distress put a strain on public budgets, increase the demand for public health services, and limit access to private services [ 17 ], dissertation on sustainability of private healthcare.
Such extreme pressures, as after the economic crisis, introduced financial sustainability in the health policy debate. Although the debate is still centered on funding and value for money, it now includes the ability of a society to fulfill its implicit or explicit promise to satisfy need-based demand for health care [ 18 ]. The answer to the question of who must pay for health care and how lies in the moral fabric and the value system of a society.
It is a deeply ideological and political question with undertones of social involvement, personal responsibility, and freedom of choice. Big changes in health care financing happen rarely, usually after major events 6and are more likely to take place in countries with social cohesion high on their value scale dissertation on sustainability of private healthcare. One, dissertation on sustainability of private healthcare reliance on out-of-pocket expenditure is not acceptable on equity and financial protection grounds.
Two, that only some kind of income transfer, such as taxation, dissertation on sustainability of private healthcare, can cover dissertation on sustainability of private healthcare increasing cost of health care. The question therefore should now focus, not only on whether society as a whole will bear the cost but also on how to obtain and manage the needed savings, and on the efficiency and competitiveness of the dissertation on sustainability of private healthcare which must produce them.
Life expectancy indeed rose significantly in the last fifty years together with total lifetime cost [ 20 ]. The average retirement age, however, remained more or less the same at around People of working age today must finance the health needs of their children, themselves and, mainly, the 3 rd and 4 th generation.
Therefore, only savings in the form of taxes on all incomes produced by society, including wealth and capital, appear to be a sustainable source of funding in the long-term. In addition, cyclical fluctuations are now common events rather than rare occurrences.
Health financing may determine how pressures on health systems are weathered without loss of equity, quality and financial protection.
Social Health Insurance has been found to have negative labor market effects [ 21 ] and to hurt competitiveness [ 7 ] due to higher labor costs. This is crucial in monetary unions where devaluation during economic crises is not an option and competitiveness gains are the only way for the economy to adjust to pre-crisis levels.
In addition, as unemployment increases, incomes decline and pressures on health budget and public infrastructure are pushed to extremes, evidence has indicated that public health systems financed through taxation can be more responsive to economic pressures and more effective in health expenditure consolidation [ 22 ].
Although conclusive evidence is lacking, the experiences of Canada and Greece may be indicative. Evidence from Canada, where health is financed mainly through taxation, suggests that patient satisfaction, hospital performance and health outcomes were maintained despite the financial strain [ 23 ].
Concerns that reliance on taxation may be associated with higher private payments, especially during economic downturns [ 22 ], or that corruption may inhibit administrative capacity to collect taxes [ 24 ], may be put to rest by the fact that during economic turmoil individuals become more price-sensitive and administrative capacity tends to improve.
Between and9 Social Insurance expenditure declined by Greece is now a country where the need of re-orientation of health care financing is pressing [ 2527 ]. In conclusion, employment contributions as a source of health financing are incompatible with universal coverage, quality of services, and rising life expectancy.
A move towards general taxation to meet health care dissertation on sustainability of private healthcare can boost economic growth through increased competitiveness, and achieve major non-health objectives, like equity, financial protection, quality and responsiveness even during economic downturns. Health system sustainability, as a system objective, must turn to financing through progressive taxation of all types of income. Political concerns associated with economic imperatives as well as moral considerations may force changes in health services financing in both the developed and developing world.
National health insurance financed through taxation should gain momentum in the quest for more sustainable and responsive health systems. The full Report will be submitted to the European Parliament in early Even so, it has become the main issue in the ideological and political warfare in the US.
Competing interests. LL conceived the idea for the paper. Both authors contributed to the write up of the manuscript and approved the final version. Lycourgos Liaropoulos, Email: dissertation on sustainability of private healthcare. srun oporaill.
Ilias Goranitis, Email: ku. mahb sitinarog. National Center for Biotechnology Informationdissertation on sustainability of private healthcare, U.
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Journal List Int J Equity Health v. Int J Equity Health. Published online Sep doi: PMCID: PMC Lycourgos Liaropoulos and Ilias Goranitis. Lycourgos Liaropoulos Center for Health Services Management and Evaluation, Faculty of Nursing, University of Athens, Papadiamantopoulou Street, Athens, Greece Find articles by Lycourgos Liaropoulos.
Ilias Goranitis Health Economics Unit, Public Health Building, University of Birmingham, Birmingham, B15 2TT UK Find articles by Ilias Goranitis. Author information Article notes Copyright and License information Disclaimer. Corresponding author.
Received Dec 17; Accepted Aug Copyright © Liaropoulos and Goranitis. Open Access This article is distributed under the terms of the Creative Commons Attribution 4. This article has been cited by other articles in PMC.
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