Making a case for investing in health systems

On September 10-11, 2024, we gathered in Amsterdam for the closing workshop of Workstream 1 (WS1) of the Technical Support Instrument (TSI) project, Resources Hub for Sustainable Investing in Health, supported by DG Reform, led by Expertise France , and with contributions from the Observatory, Austria, Belgium, Slovenia, and other member states.

The first session, led by Jon Cylus from the European Observatory on Health Systems and Policies and myself, addressed the current challenges in Making the Case for Health Investments and reviewed key arguments for doing so effectively. High-level panelists Liisa-Maria Voipio-Pulkki (former Director General, Finland), Maris Jesse (former Managing Director, Social Health Insurance, Estonia), and Yann-Gael Amghar (Head of Social Department, France) discussed how their countries manage health investments in budget negotiations and how the project’s tools could support this, bringing their perspectives on aligning health investments with broader government strategies while addressing budget constraints.

Subsequent sessions presented three pilot projects that made the case for public investment in health, demonstrating the socioeconomic benefits of strategic health investments.

1. Austria assessed the economic effectiveness of Primary Healthcare Units as part of broader reforms,
2. Belgium conducted a Health Impact Assessment on reducing tobacco selling points, and
3. Slovenia performed high-level financial impact assessments for primary healthcare, with a focus on a telephone triage and advice project.

The leadership of this project— Simon Drees and Simone Gelmetti from DG REFORM, Alain Lefebvre from Expertise France; together with Loukianos Gatzoulis from DG SANTE, and myself concluded the event with main lessons. Some key takeaways:

? The importance of demonstrating the value of health investments to financial authorities, especially in times of budget constraints, was strongly emphasized. As discussed in the sessions and in the policy brief, it is crucial to show clear evidence of their impact on health outcomes, societal wellbeing, and cross-sector co-benefits. Demonstrating value for money, fiscal sustainability, and effective stewardship of resources is essential, as is garnering the support of the public and key stakeholders.

? Governance mechanisms to engage with ministries of finance and other stakeholders are critical. The discussion highlighted the need to understand the policy cycle and theory of change, along with key considerations in the political economy of health reform, including power dynamics, transparency, and stakeholder participation.

? Beyond health outcomes and cost-benefit tools, the focus must also be on governance, stakeholder engagement, and political economy tools. Success in health policy relies on the science of implementation. While data is vital, integrating these tools into political and governance frameworks is equally important. Participants shared how these tools have already been applied in practice, with compelling examples from all involved countries.

Download the reports:

• Financing for health system transformation: Spending more or spending better (or both)?
• A mapping exercise: making the case for public investment in health
• EU resources for investing in and strengthening health systems: Tailored options for Austria, Belgium and Slovenia