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The impact of austerity and other social policies on health care at home and internationally Workshop PNHP National Conference 2013 Jacob Bor PhD Adam Gaffney MD. Austerity, Unaffordability, and Universal Health Care. Change in GDP. 6/10: ECB CALLS FOR “FISCAL CONSOLIDATION”. BAILOUT. - PowerPoint PPT Presentation
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The impact of austerity and other social policies on health care at home and internationally
WorkshopPNHP National Conference 2013
Jacob Bor PhDAdam Gaffney MD
Austerity, Unaffordability, and Universal Health Care
Canada France Germany United Kingdom
United States
OECD0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
16.0
18.0
20.0
Comparative National Health Expenditures
Source: OECD, 2011 Data
Perc
ent o
f GDP
2007 2008 2009 2010 2011 2012
-8
-6
-4
-2
0
2
4
6
GreeceGermanyUnited StatesSpainPortugal
Change in GDP
Source: World Bank, http://data.worldbank.org/indicator/NY.GDP.MKTP.KD.ZG
BAILOUT
6/10: ECB CALLS FOR “FISCAL CONSOLIDATION”
Austerity and Health Care
“The massive deterioration in the underlying fiscal position over the last decade can largely be attributed to an expansion of social spending (particularly health and pension expenditures) …”– IMF Country Report No. 12/57 “Greece: Request
for Extended Arrangement Under the Extended Fund Facility,” March 2012
Kondilis E, Giannakopoulos S, Gavana M, Ierodiakonou I, Waitzkin H, Benos A. Economic crisis, restrictive policies, and the population's health and health care: the Greek case. American journal of public health 2013;103:973-9.
Men < 65: Suicide, Infectious Dz, and Homicide Mortality
Gili M, Roca M, Basu S, McKee M, Stuckler D. The mental health risks of economic crisis in Spain: evidence from primary care centres, 2006 and 2010. European journal of public health 2013;23:103-8.
I. Cuts
II. Copays
Portugal: User Fees
Barros PP. Health policy reform in tough times: the case of Portugal. Health policy 2012;106:17-22.
III. Corporatization
How to Unravel Universal Health Care: Cuts, Copays and Corporatization
1. Reduce Supply1. Austerity/Cuts2. Reductions in services3. Privatization
2. Reduce demand1. Deterioration in quality2. Rise in user fees3. Exclude access (the immigrants, the wealthy)
Transatlantic Parallels• AMERICA AND THE ACA– The “Quiet Revolution” in
cost sharing– Undocumented
immigrants still excluded– Private insurance
protected/subsidized
– Cuts: Safety net hospitals
• EUROPE AND AUSTERITY– New and rising
copayments– Spain: Undocumented
newly excluded– UK: New role for
increased private care; Spain: Privatization of hospitals, etc.
– Cuts: All levels
A different direction?