austerity, unaffordability, and universal health care

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?