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11. Hospital Global Budgeting: Lessons from Maryland and Selected Nations

Author:
Bob Atlas
Publication Date:
06-2024
Content Type:
Special Report
Institution:
Commonwealth Fund
Abstract:
Issue: Maryland has utilized hospital global budgeting for a decade, but the approach is rarely used elsewhere in this country. The Centers for Medicare and Medicaid Services now hopes to test global budgeting in more states to help scale up this form of cost containment. Goals: Examine the ways Maryland, Canada, the Netherlands, New Zealand, and Norway employ hospital global budgeting and the lessons they offer to those hoping to see wider adoption in the United States. Methods: Analysis of the various health systems and expert interviews. Key Findings and Conclusion: Maryland and the four selected countries vary significantly in their approaches to hospital global budgeting. With its previous experience using price controls and current global budgeting approach, Maryland has succeeded in holding hospital spending growth steady for nearly a decade. While Norway combines fixed and variable payments to support global budgeting, the Netherlands and Canada’s province of Ontario are moving away from global budgeting in favor of other approaches. Meanwhile, New Zealand has added multiyear rolling forecasts and budgets to support its own model. Future approaches in the U.S. could prove more effective by factoring in the complexities, conflicting incentives, and potential unintended consequences of global budgeting.
Topic:
Public Health, Healthcare System, and Budgeting
Political Geography:
Canada, Maryland, Netherlands, New Zealand, and United States of America

12. Health for everyone, everywhere?

Author:
Lionel Osse Essima and Matthias Krönke
Publication Date:
04-2024
Content Type:
Policy Brief
Institution:
Afrobarometer
Abstract:
The theme of World Health Day 2024 (7 April) is “My health, my right” (World Health Organization, 2024). A key component of the message is to encourage governments to deliver on citizens’ right to health by making health services “available, accessible, acceptable and of good quality for everyone, everywhere.” How close are African governments to meeting this ambitious goal? Since 1990, the burden of disease has decreased substantially in Africa (Roser, Ritchie, & Spooner, 2024; also see Figure A.1 in the Appendix). Between 2000 and 2019, Africa recorded the world’s greatest growth in healthy life expectancy, which rose from 46 to 56 years (Adepoju & Fletcher, 2022). Further, between 2015 and 2021, the under-5 mortality rate fell from 87 to 74 deaths per 1,000 live births across sub-Saharan Africa (United Nations, 2023). According to the World Health Organization, these gains were achieved through increased provision of essential health services and better access to care and disease prevention services (Adepoju & Fletcher, 2022). Despite these important advances, however, many Africans still do not have access to high quality health care. Compared to other world regions, the gap is particularly acute when it comes to communicable, neonatal, maternal, and nutritional diseases (as opposed to non communicable diseases and injuries) (see Figure A.2 in the Appendix). While sub-Saharan Africa saw the world’s fastest growth between 2015 and 2022 in the proportion of births attended by skilled health personnel, from 59% to 70%, the continent also recorded about 70% of the world’s maternal deaths (United Nations, 2023). At least part of the explanation is a lack of health workers; as of 2021, sub-Saharan Africa had an average of 2.3 medical doctors and 12.6 nursing/midwifery personnel per 10,000 people, compared to 39.4 and 89.5 in Europe (United Nations, 2023).
Topic:
Education, Public Opinion, Social Services, Public Health, and Healthcare System
Political Geography:
Africa