Making the case for investment in health – but what is investment?
The Thursday plenary Talking so you’re heard – making the case for investment in health focused on the question of how to ensure we get more resources to be spent on health for improved health outcomes and wellbeing of the population. As Hans Kluge from the WHO Regional Office for Europe said in his opening address, improved health systems and spending in health systems do not only lead to better individual health and wellbeing, but also to inclusive economic growth. So, how hard can it be to get what we as health sector want – a bigger piece of the budget cake?
Throughout the debate, however, it became clear that behind this question, there are certain implicit assumptions that should be acknowledged and re-examined. A diverse mix of speakers ensured that we heard both the financial and the health perspective, and figure out where they differ. Let’s look at some of those assumptions.
You are successful if you get more money to spend. Wilhelm Molterer, Managing Director at the European Fund for Strategic Investment and former Minister of Finance and Agriculture in Austria, urged us to rethink whether it could also be a success that we spend equally or less. However, the question remains how much room for efficiency there is if the original amount of resources is low in the first place.
We need to increase the share of resources for health in the public budget. Additionally, Mr. Molterer pointed out that the health sector too often just aims at increasing their share of the budget in the public sector, but does not think about alternative forms of financing – for example by turning to the private sector and adopting a more entrepreneurial approach.
We have not been successful in achieving investment in healthcare. Jennifer Dixon from The Health Foundation challenged us by saying that perhaps we have been too successful in achieving investment in healthcare, but not in the areas such as public health, social care and wider social determinants of health. More leadership is needed, though, in order to shift the focus away from mere treatment towards targeting factors that will promote health.
We just have to make the case about the return on investment to the finance sector. While the finance perspective (besides Mr. Molterer also Matti Hetemaki from the Finnish Ministry of Finance,) emphasized that in order to be willing to provide the resources, a clear case has to be made on return on investment. Josep Figueras, Director of the European Observatory on Health Systems and Policies and Head of the WHO European Centre on Health Policy, pointed out that often the measures of efficiency in healthcare, as set by the ministries of finance, are too simplified and not nuanced enough to capture the actual outcomes.
Health and finance sectors are speaking the same language. Despite using the same terms, during the panel it became clear that representatives from finance and health sectors did not always mean the same thing when they said, for example, “investment” or “healthcare” or even “health”. These issues should be considered when having a conversation with people from different backgrounds. If we want to have a common understanding of our objectives and targets, we first have to make sure we are talking about the same basic concepts.
It is definitely true that it is important to think about win-win strategies for all the sides and that we have to overcome the silo thinking, as it was pointed out throughout the plenary. At the same time however, the discussion showed that we have to make sure to keep on reconsidering and rethinking the assumptions behind our reasoning, or we will not keep up with the rapidly changing circumstances.
Written by a Young Gasteiner Daša Kokole