The challenge of budgeting for healthcare programmes:
The OECD has created a Joint Network on Fiscal Sustainability of Health Systems. This article, developed as input to that project, seeks to summarise both why budgeting for healthcare is particularly challenging and why the challenge is often misunderstood. I argue that sustainability is a political...
Gespeichert in:
| 1. Verfasser: | |
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| Format: | Elektronisch Buchkapitel |
| Sprache: | English |
| Veröffentlicht: |
Paris
OECD Publishing
2014
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| Schlagworte: | |
| Online-Zugang: | DE-384 DE-473 DE-824 DE-29 DE-739 DE-355 DE-20 DE-1028 DE-1049 DE-521 DE-861 DE-898 DE-92 DE-91 DE-573 DE-19 URL des Erstveröffentlichers |
| Zusammenfassung: | The OECD has created a Joint Network on Fiscal Sustainability of Health Systems. This article, developed as input to that project, seeks to summarise both why budgeting for healthcare is particularly challenging and why the challenge is often misunderstood. I argue that sustainability is a political, not fiscal, issue; that common explanations of increased spending, such as "ageing" and "technology", are either inaccurate or unhelpful; and that the nature of public support for healthcare means that standard budgetary worldviews may not be appropriate in a representative system. For example, both a focus on "fiscal space" and distrust of dedicated revenues may be contrary to budgetary values of both representation and balance. I offer explanations of why demand for healthcare spending both is peculiarly intense and tends to expand because notions of "necessary" care expand. Budget-making is made more difficult by a uniquely confusing proliferation of ideas about how to control spending, many of which are supported more by disciplinary biases than by hard evidence. I conclude by considering the impact of two structural features: whether services are delivered by a bureau or as an entitlement, and whether it is funded by dedicated revenues. The challenges can be met, but hardheaded and sceptical budget analysis is especially important. JEL classification: H51, H6, E62, H2, I1, J11, O33, P16, Z18 Keywords: Budgeting, healthcare spending, ageing society, Baumol's disease, dedicated revenues, efficiency, entitlements, redistribution, technology, unsustainability |
| Beschreibung: | 1 Online-Ressource (35 Seiten) 21 x 28cm |
| DOI: | 10.1787/budget-14-5jxst2mfm923 |
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| spelling | White, Joseph Verfasser aut The challenge of budgeting for healthcare programmes Joseph White Paris OECD Publishing 2014 1 Online-Ressource (35 Seiten) 21 x 28cm txt rdacontent c rdamedia cr rdacarrier The OECD has created a Joint Network on Fiscal Sustainability of Health Systems. This article, developed as input to that project, seeks to summarise both why budgeting for healthcare is particularly challenging and why the challenge is often misunderstood. I argue that sustainability is a political, not fiscal, issue; that common explanations of increased spending, such as "ageing" and "technology", are either inaccurate or unhelpful; and that the nature of public support for healthcare means that standard budgetary worldviews may not be appropriate in a representative system. For example, both a focus on "fiscal space" and distrust of dedicated revenues may be contrary to budgetary values of both representation and balance. I offer explanations of why demand for healthcare spending both is peculiarly intense and tends to expand because notions of "necessary" care expand. Budget-making is made more difficult by a uniquely confusing proliferation of ideas about how to control spending, many of which are supported more by disciplinary biases than by hard evidence. I conclude by considering the impact of two structural features: whether services are delivered by a bureau or as an entitlement, and whether it is funded by dedicated revenues. The challenges can be met, but hardheaded and sceptical budget analysis is especially important. JEL classification: H51, H6, E62, H2, I1, J11, O33, P16, Z18 Keywords: Budgeting, healthcare spending, ageing society, Baumol's disease, dedicated revenues, efficiency, entitlements, redistribution, technology, unsustainability Finance and Investment Governance https://doi.org/10.1787/budget-14-5jxst2mfm923 Verlag URL des Erstveröffentlichers Volltext |
| spellingShingle | White, Joseph The challenge of budgeting for healthcare programmes Finance and Investment Governance |
| title | The challenge of budgeting for healthcare programmes |
| title_auth | The challenge of budgeting for healthcare programmes |
| title_exact_search | The challenge of budgeting for healthcare programmes |
| title_exact_search_txtP | The challenge of budgeting for healthcare programmes |
| title_full | The challenge of budgeting for healthcare programmes Joseph White |
| title_fullStr | The challenge of budgeting for healthcare programmes Joseph White |
| title_full_unstemmed | The challenge of budgeting for healthcare programmes Joseph White |
| title_short | The challenge of budgeting for healthcare programmes |
| title_sort | the challenge of budgeting for healthcare programmes |
| topic | Finance and Investment Governance |
| topic_facet | Finance and Investment Governance |
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