Financing public health services in Europe

Abstract

Background Mechanisms for and levels of financing for public health services in Europe are insufficiently documented and understood. Concerns have been raised in a number of countries over recent budget cuts. Methods Our study draws on (i) a review of grey and published evidence, (ii) detailed descriptions of the financing of public health services in nine European countries (England, France, Germany, Italy, Moldova, the Netherlands, Poland, Slovenia and Sweden) using a structured data collection template, and (iii) a review of WHO, Eurostat and OECD datasets as well as national statistics. Results Levels of financing for public health services remain difficult to assess, but available data suggest that funding is low as a percentage of total health expenditure. Available data differ between international and national databases, further complicating a detailed assessment. Public budgets at national, regional and local levels (financed mainly through taxation and social health insurance) are the main source of financing for public health services. In some countries, such as Poland, private sources also play an important role. Allocation mechanisms frequently do not allow for medium- to long-term planning. Approaches that bring together health and other sectors for the funding of public health programmes remain rare, as does the use of taxes dedicated to public health. Countries such as England and the Netherlands have seen major budget cuts for public health services in recent years, while others (Italy, Germany) saw increases in funding, sometimes linked to new policy developments, such as the new Prevention Law in Germany. There are also major differences in financing levels and mechanisms within countries, in particular in decentralized systems. Conclusions The lack of sufficient and sustainable resources is a challenge for public health services in several countries, but there are also positive examples that can be emulated.