Health Care Policy Should Not Focus on Finance, Says Research

Study published in Value in Health wins Elsevier’s Atlas award

Amsterdam, May 21, 2015

Focusing on finance could jeopardize the long-term survival of our health care systems, according to a study published in Value in Health. The researchers, from Bocconi University, Milan, Italy, urge policy makers to consider social and political sustainability when building universal health care systems.

Their work has been selected by an international scientific committee to be given the Atlas award. The Co-Editor of Value in Health, Professor Michael Drummond, said the following about the research,“Apart from being cost-effective, health care systems need to be equitable, diverse, democratic and interconnected. There also needs to be the political will to sustain a major policy direction in healthcare. The journal was pleased to publish this paper, which was part of a special issue called Sustainability of Universal Health Coverage: Five Continents, Four Perspectives.”

Universal health care gives all people equal access to health care, regardless of how much money they have. The authors of the study say this is a human right, and governments need to shift their focus away from finances to provide it.

“Until now, discussions about universal health care have focused on economic sustainability; policy makers are concerned about how they’re going to pay for care,” said Professor Elio Borgonovi, lead author of the study from Bocconi University, Milan, Italy.

“We think there’s a problem with looking at it this way: what about the issue of getting political consensus, or making sure that all people – rich and poor – have equal access?”

For the study, the researchers looked at the current discussions around universal health care. They summarized and analyzed arguments about the economic, political and social factors affecting the development of universal health care, and looked at case studies around the world.

They concluded that considering financial sustainability alone is not enough to provide universal health care; social and political sustainability is just as important.

“There has been a real focus on economics in recent decades,” said Prof. Borgonovi. “Policy makers assume that getting the finances right means they will automatically reach political consensus and social equality, but we don’t agree. The three factors – economic, political and social – are connected, but they’re also independent, and they all need to be considered.”

Traditionally, health care systems have been managed using financial budgets as a basis for decisions about new hospitals, free services and treatments to offer. One of the challenges universal health care faces is an aging population: as more people have access to health care, they will live longer, requiring more treatment and therefore costing more.

However, the researchers say it’s not so simple: countries with universal health care, like the UK, often spend less on the system than countries without universal health care. Rather than focusing on the money, policy makers should think about the social aspect by involving patients in planning, and build political consensus without finance being a factor.

“I’m afraid that in this period of economic pressure, policy makers will miss out on the opportunity to create universal health care systems that survive in the long term,” said Prof. Borgonovi.

“Health care is an industry based on knowledge, which has the potential to provide thousands of new jobs, and a much-needed boost to the economy. But that will only happen if policy takes a longer view,” continued Prof. Borgonovi.

“A strong health care system can provide new jobs and boost so many industries – pharma, biotechnology and informatics, for example – but we’ll miss out on this if policy makers continue to focus on the money.”

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Notes for editors:
The article is “Sustaining Universal Health Coverage: The Interaction of Social, Political, and Economic Sustainability” by Elio Borgonovi and Amelia Compagni (doi: 10.1016/j.jval.2012.10.006). The article appears in Value in Health, Volume 16, Issue 1 Supplement (January-February 2013), published by Elsevier.

 Value in Health published this paper, which was part of a special issue called Sustainability of Universal Health Coverage: Five Continents, Four Perspectives.

The article and all other articles within the Special Issue are made freely available on

Journalists who would like more information or want to interview the authors are welcome to contact:

About Value in Health
Published on behalf of the International Society for Pharmacoeconomics and Outcomes Research, Value in Health publishes research on the economics of health and health policy. It aims to provide valuable information for health care decision makers as well as the research community, helping them translate research into real health care decisions.

About Atlas, Research for a better world
Science impacts everyone's world. With over 1,800 journals publishing articles from across science, technology and health, our mission is to share some of the stories that matter. Each month Elsevier’s Atlas will showcase research that can (or already has) significantly impact(ed) people's lives around the world and we hope that bringing wider attention to this research will go some way to ensuring its successful implementation.

With so many worthy articles published the tough job of selecting a single article to be awarded "The Atlas" each month comes down to an Advisory Board. The winning research is presented alongside interviews, expert opinions, multimedia and much more on the Atlas website:

About Elsevier
Elsevier is a world-leading provider of information solutions that enhance the performance of science, health, and technology professionals, empowering them to make better decisions, deliver better care, and sometimes make groundbreaking discoveries that advance the boundaries of knowledge and human progress. Elsevier provides web-based, digital solutions — among them ScienceDirect, Scopus, Research Intelligence and ClinicalKey— and publishes over 2,500 journals, including The Lancet and Cell, and more than 35,000 book titles, including a number of iconic reference works. Elsevier is part of RELX Group, a world-leading provider of information and analytics for professional and business customers across industries.

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