Since the onset of the economic crisis in Europe in 2008, WHO/Europe has worked with countries to support policy decisions that protect health and reduce health inequalities. WHO’s work is based on Health 2020, the European policy framework for health and wellbeing, which strongly emphasizes improved health outcomes, solidarity and equity. Needing to achieve fiscal balance in the health sector, policy-makers have three broad options:
to lower spending to match available resources through budgets cuts and reduced health coverage;
to meet spending commitments by maximizing available resources;
to raise additional resources so that spending commitments can be met.
In times of economic crisis with acute fiscal constraints, lowering spending can seem the simplest solution, but it carries the risk of reducing a health system’s ability to meet goals such as:
improving population health;
securing financial protection;
ensuring equitable access to high-quality health services;
using resources efficiently;
and promoting transparency and accountability.
These goals are necessarily part of the challenge of ensuring financial sustainability while seeking fiscal balance, but they are harder to achieve when fiscal balance is treated as a goal in itself or as independent of other goals.