{
  "title": "Healing Public Health Care Finances: Budget Reforms That Work",
  "publication": "IMF Blog, February 8, 2011",
  "sourceUrl": "https://www.imf.org/en/blogs/articles/2011/02/08/healing-public-health-care",
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  "summary": "IMF Fiscal Affairs Department paper presents public health spending projections for fifty advanced and emerging countries and offers reform options.",
  "sections": [
    {
      "heading": "Summary and scope",
      "content": "- IMF Fiscal Affairs Department paper presents public health spending projections for fifty advanced and emerging countries and offers reform options.\n- Central question: how can governments maintain access to affordable health care without unsustainable pressure on public finances?"
    },
    {
      "heading": "Advanced economies: findings",
      "content": "- Health care spending accounted for about half of the rise in government budgets in the past 40 years.\n- Public health spending is projected to climb by 3 percentage points of GDP over the next 20 years in the advanced economies.\n- Drivers of rising health spending: population aging, technical progress, and availability of better and more expensive technologies.\n- Historical observation: countries with lower increases in public spending (examples cited: Italy, Japan, and Sweden) have a greater reliance on budget caps and central oversight."
    },
    {
      "heading": "Advanced economies: recommended reform strategies",
      "content": "- Combine top-down budget control with bottom-up efficiency reforms.\n  - Top-down: budget systems that cap total health expenditures and impose a high degree of central oversight to provide incentives for expenditure restraint.\n  - Bottom-up: reforms to enhance efficiency and deliver more and better services for a given amount of resources.\n- Specific bottom-up measures (examples cited):\n  - Strengthening market mechanisms: increase patient choice of insurers, allow greater competition between insurers and providers, rely more on private sector provision (examples: Germany and Japan).\n  - Change provider payment methods: move away from fee for service toward sophisticated management and contracting systems with incentives to minimize waste and improve services (examples: Germany and Italy).\n  - Greater reliance on private insurance can help slow growth of public health spending (examples: Australia, Canada, and France).\n- Equity constraint: reforms must protect universal access to basic health services and minimize adverse effects on the poor.\n- Contingency: if reforms are insufficient to prevent public health spending rising as a share of GDP in some countries, additional fiscal measures—deeper cuts in other spending areas or additional revenue increases—may be needed."
    },
    {
      "heading": "Emerging economies: findings",
      "content": "- Public health spending is expected to increase by about 1 percentage point of GDP over the next 20 years.\n- Health indicators (life expectancy and infant mortality) are substantially lower than in advanced economies in many emerging markets.\n- Two distinct challenges:\n  - For many countries (especially in Asia and Latin America): expand basic health care and the health safety net; scope exists to boost spending to cover more people at an affordable cost.\n  - For countries with already extensive access (notably in Eastern Europe): focus on making public spending more efficient to prevent future budget pressure."
    },
    {
      "heading": "Emerging economies: recommended reform strategies",
      "content": "- Prioritize preventive and primary care, fight infectious diseases, and enhance care in poorer rural areas.\n- Change financial incentives facing health care providers to emphasize primary and preventive services.\n- Focus public resources on providing the most essential health services first to maximize coverage at low fiscal cost (examples of success: Thailand and Chile).\n- Where access is already broad, prioritize efficiency improvements to avoid future fiscal strain."
    },
    {
      "heading": "Cross-cutting conclusion",
      "content": "- Both advanced and emerging economies need to get \"more bang for their buck\" from public health care spending by combining expenditure control with efficiency and equity-preserving reforms.\n\nSource: Healing Public Health Care Finances: Budget Reforms That Work — Benedict Clements, February 8, 2011.\n\n---\n\n Content in this bundle\n\n- iMFdirect 博客: 恢复公共医疗财政的健康状况, 行之有效的预算改革, 2011 年 2 月 8 日\n  - iMFdirect 博客: 恢复公共医疗财政的健康状况, 行之有效的预算改革, 2011 年 2 月 8 日 (Markdown version){rel=\"alternate\" type=\"text/markdown\"}\n  - iMFdirect 博客: 恢复公共医疗财政的健康状况, 行之有效的预算改革, 2011 年 2 月 8 日 (PDF){rel=\"external\" type=\"application/pdf\"}\n\n---\n\n References\n\n- recent paper\n\nSource: https://www.imf.org/en/blogs/articles/2011/02/08/healing-public-health-care"
    }
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    "Authors: Benedict Clements",
    "Published: February 8, 2011",
    "IMF Fiscal Affairs Department paper presents public health spending projections for fifty advanced and emerging countries and offers reform options.",
    "Central question: how can governments maintain access to affordable health care without unsustainable pressure on public finances?",
    "Health care spending accounted for about half of the rise in government budgets in the past 40 years.",
    "Public health spending is projected to climb by 3 percentage points of GDP over the next 20 years in the advanced economies.",
    "Drivers of rising health spending: population aging, technical progress, and availability of better and more expensive technologies.",
    "Historical observation: countries with lower increases in public spending (examples cited: Italy, Japan, and Sweden) have a greater reliance on budget caps and central oversight.",
    "Combine top-down budget control with bottom-up efficiency reforms.",
    "Specific bottom-up measures (examples cited):",
    "Equity constraint: reforms must protect universal access to basic health services and minimize adverse effects on the poor.",
    "Contingency: if reforms are insufficient to prevent public health spending rising as a share of GDP in some countries, additional fiscal measures—deeper cuts in other spending areas or additional revenue increases—may be needed.",
    "Public health spending is expected to increase by about 1 percentage point of GDP over the next 20 years.",
    "Health indicators (life expectancy and infant mortality) are substantially lower than in advanced economies in many emerging markets.",
    "Two distinct challenges:",
    "Prioritize preventive and primary care, fight infectious diseases, and enhance care in poorer rural areas.",
    "Change financial incentives facing health care providers to emphasize primary and preventive services.",
    "Focus public resources on providing the most essential health services first to maximize coverage at low fiscal cost (examples of success: Thailand and Chile).",
    "Where access is already broad, prioritize efficiency improvements to avoid future fiscal strain.",
    "Both advanced and emerging economies need to get \"more bang for their buck\" from public health care spending by combining expenditure control with efficiency and equity-preserving reforms.",
    "**iMFdirect 博客: 恢复公共医疗财政的健康状况, 行之有效的预算改革, 2011 年 2 月 8 日**",
    "[recent paper](http://www.imf.org/external/pp/longres.aspx?id=4521)"
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      "title": "iMFdirect 博客: 恢复公共医疗财政的健康状况, 行之有效的预算改革, 2011 年 2 月 8 日",
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