Health care policy should not focus on finance, says research

Focusing on finance could jeopardize the long-term survival of our health care systems, according to a study published in Value in Health. The researchers, from Bocconi University, Milan, Italy, urge policy makers to consider social and political sustainability when building universal health care systems.

Their work has been selected by an international scientific committee to be given the Atlas award. The Co-Editor of Value in Health, Professor Michael Drummond, said the following about the research, "Apart from being cost-effective, health care systems need to be equitable, diverse, democratic and interconnected. There also needs to be the political will to sustain a major policy direction in healthcare. The journal was pleased to publish this paper, which was part of a special issue called Sustainability of Universal Health Coverage: Five Continents, Four Perspectives."

Universal health care gives all people equal access to health care, regardless of how much money they have. The authors of the study say this is a human right, and governments need to shift their focus away from finances to provide it.

"Until now, discussions about universal health care have focused on economic sustainability; policy makers are concerned about how they're going to pay for care," said Professor Elio Borgonovi, lead author of the study from Bocconi University, Milan, Italy.

"We think there's a problem with looking at it this way: what about the issue of getting political consensus, or making sure that all people – rich and poor – have equal access?"

For the study, the researchers looked at the current discussions around universal health care. They summarized and analyzed arguments about the economic, political and social factors affecting the development of universal health care, and looked at case studies around the world.

They concluded that considering financial sustainability alone is not enough to provide universal health care; social and political sustainability is just as important.

"There has been a real focus on economics in recent decades," said Prof.. Borgonovi. "Policy makers assume that getting the finances right means they will automatically reach political consensus and social equality, but we don't agree. The three factors – economic, political and social – are connected, but they're also independent, and they all need to be considered."

Traditionally, health care systems have been managed using financial budgets as a basis for decisions about new hospitals, free services and treatments to offer. One of the challenges universal health care faces is an aging population: as more people have access to health care, they will live longer, requiring more treatment and therefore costing more.

However, the researchers say it's not so simple: countries with universal health care, like the UK, often spend less on the system than countries without universal health care. Rather than focusing on the money, policy makers should think about the social aspect by involving patients in planning, and build political consensus without finance being a factor.

"I'm afraid that in this period of economic pressure, policy makers will miss out on the opportunity to create universal health care systems that survive in the long term," said Prof. Borgonovi.

"Health care is an industry based on knowledge, which has the potential to provide thousands of new jobs, and a much-needed boost to the economy. But that will only happen if policy takes a longer view," continued Prof. Borgonovi.

"A strong health care system can provide new jobs and boost so many industries – pharma, biotechnology and informatics, for example – but we'll miss out on this if policy makers continue to focus on the money."