Year : 2021 | Volume
: 10 | Issue : 3 | Page : 61--62
Financing health in the new normal: issues and opportunities
School of Public Health, Seoul National University, Republic of Korea
Professor Soonman Kwon
School of Public Health, Seoul National University
Republic of Korea
|How to cite this article:|
Kwon S. Financing health in the new normal: issues and opportunities.WHO South-East Asia J Public Health 2021;10:61-62
|How to cite this URL:|
Kwon S. Financing health in the new normal: issues and opportunities. WHO South-East Asia J Public Health [serial online] 2021 [cited 2022 Jan 24 ];10:61-62
Available from: http://www.who-seajph.org/text.asp?2021/10/3/61/309875
Pandemics and universal health coverage
Coronavirus disease 2019 (COVID-19) has disrupted all aspects of society, including progress towards universal health coverage (UHC). Countries now have an urgent need to increase government spending on health; as is always emphasized, public investment plays a key role in mixed financing mechanisms in World Health Organization South-East Asia Region countries. This is the only feasible way forward for adequate, sustainable and equitable financing for health. The pandemic crisis has provided an opportunity to appreciate the clear interconnectedness of health and the economy: failures in health systems have devastating economic effects. Because of the immediate effects of COVID-19 on fiscal deficits, however, countries still cannot afford to invest substantially in health systems, and the long-term effect is a deterioration in the population’s health.
UHC with functioning health systems has the capacity to protect a country’s economy from a pandemic such as COVID-19, and primary health care (PHC) is a cornerstone of UHC. Sufficient funding and effective service delivery for pandemic preparedness and response as part of UHC reduce the risk of an outbreak, enable quick response and protect the vulnerable, increasing social stability and prosperity. Countries need to mobilize more financial resources, such as health taxes, increase flexibility in purchasing mechanisms and public financial management (PFM) with swift reprioritization, improve fiscal space through effectiveness in spending, and strengthen PHC. To make health systems more resilient to shocks and crises, it is critical for governments to invest in core health system functions, such as financing, service delivery and governance. In particular, funding and integration of these functions at the primary level – including infection prevention and control, surveillance, and information systems – are fundamental to ensure that health systems are prepared for and respond better to health emergencies.
Sustainable financing and purchasing for universal health coverage and health system resilience
Health financing should provide comprehensive coverage and access to essential medicines and health services, including preparedness for outbreaks and pandemics. Key public health functions, tests, diagnostics and personal protective equipment related to pandemic response should be available as an entitlement without financial barriers. PFM systems need to include special arrangements and procedures that enable fast and transparent flexibility to reallocate funds or purchase goods and services to adjust to changing needs in response to an emergency, including the needs of the poor and vulnerable. Purchasing arrangements need to be made to ensure that during a pandemic there is minimal disruption in the provision of essential health care, such as vaccinations and care for mental health, noncommunicable diseases, reproductive health, and maternal and child health.
Quick and flexible purchasing in times of outbreak or pandemics includes making additional public resources available to frontline health care providers in a timely manner. Resilient health systems can quickly adjust PFM rules and procedures, and fiscal arrangements such as advance payments or direct budget transfers aimed at accelerating release of funds to providers. Temporary compensation to providers for unexpected changes in cash flow is needed to enable smooth and effective adaptation.
In a pandemic, a surge in patients requires the mobilization of both public and private providers for a whole-of-country approach. Having a contracting system in place for private providers, based on quality and performance, is fundamental for pandemic preparedness. Incentive and payment systems for private (and public) providers, together with laws, accreditation and regulation to ensure the quality of health care providers, form part of pandemic preparedness. A country can introduce a law to allow mandatory mobilization of private providers in a health emergency. The role of the private sector is also critical to rapidly expand the supply of personal protective equipment, diagnostic tests and medicines.
PHC needs to play a key role in prevention, detection, treatment and referrals, and can also help ensure access to essential services without disruption. Digital health has been shown to improve access to care during the COVID-19 pandemic in many countries because social distancing and lockdowns are barriers to health care access, and health care providers are also concerned about potential infection resulting from a patient visit. Adequate payments and incentives for both providers and patients as well as a system to ensure quality, safety and privacy in digital health should be considered.
The COVID-19 pandemic has underscored the importance of sufficient investment in the health sector and the interconnectedness of health and the economy. Investment in strengthening health systems – primary care and public health in particular – is a fundamental solution for preparedness and response to a pandemic. Effective targeting and protection of elderly, poor and vulnerable people, including migrant workers and those who live in vulnerable environments, such as urban slums, is key to successfully addressing a pandemic, as well as achieving UHC. Multisectoral cooperation of public and private sectors, central and local governments, and different ministries and sectors, particularly ministries of health and of finance, is critical.
When countries make progress towards UHC, they need to make sure that people are entitled not only to individual services but also to population and public health services, including prevention, preparedness and treatment of infectious diseases and pandemics. In an effective response to a pandemic, resilience and adaptability of service delivery and purchasing are crucial in terms of provider payment methods/ rates, coverage of medicines and services, and contracting mechanisms. Government budgets and PFM need to be flexible as well as accountable to ensure that they can reprioritize and mobilize financial resources and increase spending to the health sector during a pandemic crisis.
The pandemic has shown that health systems protect lives and improve prosperity, and without them economic recovery is not possible. All countries gained valuable lessons in how to strengthen their health systems to become more resilient and how to protect vulnerable people as part of a wider societal effort to improve lives and well-being, including access to essential services for all, without financial hardship.
Source of support: None.
Conflict of interest: None declared.
Authorship: SK conceptualized and wrote the manuscript.
|1||Kwon S, Lee H, Ki M, Chung DW, Baris E. Republic of Korea’s COVID-19 preparedness and response. Discussion paper. Washington (DC): World Bank; 2020.|