Finance, investment, and the health governance model are closely intertwined and require transparent and appropriate budgetary policies. Policies that enhance trust between decision makers, caregivers and citizens. To this end, independence and accountability are essential, both on the part of the government and on the part of the administrative and institutional management bodies.
The financing model, as an allocation of resources, can be a powerful factor for modifying the health system and bringing about significant changes in it, indicating three implications:
Financing and investing in health should be seen as an investment in the economic and social development and well-being of societies. This requires a new budgetary logic aimed at luxury;
The financing model must be focused and oriented towards health and well-being outcomes, promoting integration of care and, at the same time, preventing the induction and proliferation of unnecessary, redundant or inadequate care;
An organized integration strategy with all public or private actors whose action affects health, such as education, the social sector, the environment or transportation, is necessary, in an integrated and horizontal systematic view, to provide appropriate responses to the health needs of the population.
Where are we and where are we going?
The unpredictability of current global conditions imposes the need for adaptive change on economies and health systems.
The dimensions that contribute to these changes are, among others: the interdependence of services, finance and governance; patient-centered care and empowerment; Medical and informatics technology. Demographic aging, the phenomenon of migration. and public health emergencies (particularly related to epidemics, economic and social disruptions and climate change).
The change in the financing model has begun in some countries, and has had an impact on the definition of health policies, as health is a critical component of well-being. Thus, this change in policies, from traditional economic metrics to self-perceived well-being, must translate into a change in the way resources are allocated to improve population health, focusing on health systems and all the actors that affect them. the health .
How do others think about the future
Several authors highlight the importance of health equity for improving the overall well-being of society. Equity is a fundamental value, both in access, use and outcomes of health care. Equality of well-being and health are the hallmarks of systems that provide better outcomes for citizens and better value for money. Thus, it is important to think about what it takes to create economies that respond to these goals, as well as what metrics, ultimately, reflect what value creation is in health. This question involves rethinking the concept of value in health, and reshaping and reorienting the economy based on new health metrics.
Countries such as New Zealand and the United Kingdom are some of those that have already started implementing budget programs that focus on wellbeing, focus on people, employment, education, health and the environment, and seek to balance the needs of current generations with long-term challenges.
How can we make progress?
Based on this new model, and in accordance with current trends at the international level, some methods began to appear in Portugal, in order to provide the population with tools that provide them with greater well-being.
The long-felt deficiencies of the SNS, highlighted by the epidemic, highlight the urgent need to change the health management model in Portugal, with transversal measures aimed at improving the social determinants of health, appropriate planning and efficiency. Health Care Administration SNS, which, in 2021, spent more than 12,500 million euros. These expenses are presented either according to the entities that are distributed among them (for example, 7,000 million euros for EPE hospitals), or according to the types of spending (for example, 5,000 million euros for human resources). But the purpose of these expenditures was not made clear, since we all, as citizens, contributed to the financing and what goals were achieved.
Necessary changes should be monitored and evaluated, with particular attention to explicit linking of budgetary allocations to strategic priorities for health and well-being, from a systemic and integrated perspective, moving away from the logic of “isolated” funding, for specific institutions or sectors. Thus, funding for the welfare of the population should be shared, initially between the Ministries of Health and Social Security, and later expanded to include the education and environment sectors, among others.
The investment plan must be explicitly aligned with current and future health and well-being priorities, with a primary focus on the infrastructure, means and equipment of primary and nearby health care, as basic pillars and underpinnings of the entire health system. A key step will also be the implementation of a multi-year budget, in line with the Basic Law on Health (Base 23).
Hopefully, in October, in the upcoming budget, at least part of the spending planned for 2023 will have a well-being sign, cross-sectional with organizations and spending types, with clear, transparent and consensual goals we can all follow.
* In collaboration with Anna Livio and Karma Gouvia (Portuguese Association for the Development of Hospitals – APDH).
Anna Escoval (ENSP/CHRC/CISP) and Julian Perlman (ENSP/UNL)
