European Observatory on Health Systems and Policies, Belgium; London School of Economics, United Kingdom; London School of Hygiene and Tropical Medicine, United Kingdom.
European Observatory on Health Systems and Policies, Belgium; London School of Economics, United Kingdom.
Health Policy. 2022 Dec;126(12):1226-1232. doi: 10.1016/j.healthpol.2022.10.004. Epub 2022 Oct 11.
There is a perception that population ageing will have deleterious effects on future health financing sustainability. We propose a new method-the Population Ageing financial Sustainability gap for Health systems (or alternatively, the PASH)-to explore how changes in the population age mix will affect health expenditures and revenues. Using a set of six anonymized country scenarios that are based on data from countries in Europe and the Western Pacific representing a diverse range of health financing systems, we forecast the size of the ageing-attributable gap between health revenues and expenditures from 2020 to 2100 under current health financing arrangements. In the country with the largest financing gap in 2100 (country S6) the majority (87.1%) is caused by growth in health expenditures. However in countries that are heavily reliant on labour-market related social contributions to finance health care, a sizeable share of the financing gap is due to reductions in health revenues. We argue that analyses giving equal attention to both health expenditures and revenues steers decision makers towards a more balanced set of policy options to address the challenges of population ageing, ranging from targeting expenditures and utilization of services to diversifying revenue.
有一种观点认为，人口老龄化将对未来的卫生融资可持续性产生不利影响。我们提出了一种新方法——人口老龄化对卫生系统财务可持续性差距（或简称 PASH），以探讨人口年龄结构变化将如何影响卫生支出和收入。我们使用了一组基于欧洲和西太平洋国家数据的六个匿名国家情景，这些国家代表了不同的卫生融资体系，根据现行卫生融资安排，预测了从 2020 年到 2100 年，卫生收入和支出之间因人口老龄化而产生的差距的大小。在 2100 年融资缺口最大的国家（国家 S6）中，大部分（87.1%）是由卫生支出增长引起的。然而，在严重依赖劳动力市场相关社会缴款为医疗保健供资的国家，相当大一部分融资缺口是由于卫生收入减少所致。我们认为，对卫生支出和收入同等重视的分析，使决策者能够针对人口老龄化的挑战，制定出更平衡的一整套政策选择，这些政策选择范围从针对支出和服务利用，到收入多元化。
