Health system sustainability

Health system sustainability

Do health systems have the capacity to keep generating the financial resources they need? Can a country’s economy support higher levels of spending on health? Conversely, does the health system continue to operate despite chronic underfunding? These are important challenges for sustainable health systems.

The question of how to achieve sustainable health systems is frequently raised in health policy debate. Defined broadly, sustainability is the capacity to keep generating the financial resources needed to fund health system inputs. As most health systems have considerable government funding, the financial sustainability of public spending on health care is often connected to wider policy concerns about revenue raising and the fiscal sustainability of the public sector as whole.

Aside from ‘affordability’ issues, another aspect of sustainability is the question of how the health system can maintain sufficient levels of infrastructure, technologies and human resources to deliver good quality services (system sustainability). Both types of sustainability involve an important temporal element. The policy aim is to secure health system stability, both in terms of financing and provision, in the medium and longer term — and this may not align to the short-term time horizons of government budget cycles. 

From a policy point of view, when looking at financial sustainability, it is instructive to distinguish between the challenge of addressing growing cost pressures and situations where a health system continues to operate despite low funding or chronic underfunding. Both contexts involve the issue of resource constraints and have a bearing on whether a health system is considered to be sustainable. In the first case, the main concern is whether or not a country’s economy can support higher levels of spending on health. This pressure for increased expenditure is driven by population ageing, new technologies and growing consumer expectations around what health services populations require as well as their level of quality. In the second case, serious and enduring underfunding of a health system can create instability, disrupt the future supply of services and limit timely access to appropriate care.  

Evidence-informed policy

The Observatory contributes to the evidence base on health system sustainability through a number of studies and policy briefs, as well as direct knowledge transfer events with policy-makers. The long-term stability of a health system’s financial resources can be assessed by reviewing a number of factors. These include the degree of diversification of revenue sources (such as taxation and social contributions, depending on a country’s age structure) and the expected impacts of demographic changes on health system needs. Physical resources can be investigated, for example, by assessing approaches to capital investment in facilities, while the sustainability of human resources can be analysed by looking at workforce planning, modes of payment and any policies designed to change the skill mix of groups of health workers such as doctors and nurses (see our webpages on the Human Resources).  

The link between fostering sustainability and enhancing health system performance is also clear. Improvements in the efficiency of a health system’s organization, financing and delivery modalities can: 

  • maximize value for money;
  • minimize waste;
  • help future proof the system to meet growing demands. 

Another aspect of sustainability the Observatory is exploring is how investment in health promotion and disease prevention can maximize health gains in the population and reduce future challenges.

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