Health Financing Reforms

Africa Can Fund Its Own Healthcare—Lessons from Zimbabwe and Botswana For decades, Africa has relied heavily on donor aid to sustain critical health programs. But Zimbabwe and Botswana have shown that domestic resource mobilization is not only possible—it’s sustainable. 🔹 Zimbabwe’s AIDS Levy – Introduced in 1999, this 3% tax on income funds HIV/AIDS treatment and prevention. Despite economic hardships, Zimbabweans embraced it, ensuring a steady supply of ARVs and reducing donor dependency. 🔹 Botswana’s Universal HIV Treatment – Leveraging diamond revenue, Botswana prioritized free HIV treatment for its citizens, drastically reducing HIV-related deaths and mother-to-child transmission. The lesson? African nations can achieve healthcare self-sufficiency through political will, strategic resource allocation, and strong governance. With global health funding shifting, the time to act is now. By investing in tax levies, public-private partnerships, and domestic financing models, African countries can build resilient health systems that serve their people on their own terms. Let’s rethink health financing for Africa, by Africa. #HealthcareFinancing #GlobalHealth #Africa #Innovation #Sustainability #DevelopmentFinancing #PublicHealth #HealthSystemStrengthening #UniversalHealthCoverage Read more here: https://lnkd.in/e-fteGvM

🌍 Major Changes Ahead for EU Health Funding: From EU4Health to the Next MFF (2028–2034) 🌍 The European Commission has proposed a significant structural shift in how health policies and public health initiatives will be financed in the upcoming 2028–2034 MFF. Here are the key changes: 🔹 The End of a Standalone Health Programme Unlike the current 2021–2027 period, which is defined by the dedicated €4.6 billion EU4Health programme, the next MFF does not include a standalone health programme. Instead, EU4Health will be merged alongside 13 other programmes into the newly created European Competitiveness Fund (ECF), a single investment capacity worth €451 billion. 🔹 Where is the Public Health Budget? Health initiatives will be grouped under the ECF’s "Health, biotech, agriculture and bioeconomy" policy window, which has an indicative allocation of €20 billion. Crucially, the exact share of the budget dedicated specifically to health is not specified. This design aims to provide maximum flexibility to reallocate funds for unforeseen priorities during the MFF cycle. 🔹 Shift from Public Health Protection to Industrial Competitiveness The new framework represents a strategic change. While EU4Health focused heavily on disease prevention, reducing health inequalities, and crisis preparedness, the ECF integrates health into a cross-sectoral framework focused on competitiveness, biotechnology, artificial intelligence, and robotics. 🔹 New Public Health Focus Areas Despite the broader focus, the ECF does introduce new emphasis on areas that were not explicitly covered under EU4Health, including autism, degenerative diseases, and diseases related to pollution. 🔹 Risk of Fragmentation A major concern raised is that the ECF’s provisions are framed in general terms, blurring the lines between specific objectives and activities. This lack of precision creates a risk of fragmentation for public health priorities, which could weaken the coherence of EU actions, reduce predictability for applicants, and potentially cause crucial initiatives—like Europe’s Beating Cancer Plan and Safe Hearts Plan—to lose visibility without a dedicated financial envelope . 🔹 Other Key Funding Streams for Health Beyond the ECF, public health and health security will draw from: * Horizon Europe: Receiving a massive boost to €175 billion (nearly double its current budget) to drive health research and innovation. * Union Civil Protection Mechanism (UCPM+): An indicative €10.5 billion to integrate financing for health emergency preparedness and response. * National and Regional Partnership Plans: To support healthcare services, long-term care, and infrastructure. The Bottom Line: The COVID-19 crisis proved the importance of a strong, unified EU health policy. As negotiations for the 2028-2034 MFF continue, the key challenge ahead will be ensuring that public health policy retains its prominence and isn't diluted within broader economic and industrial goals.

Across the GCC, billions have been poured into state of the art hospitals, glass towers filled with cutting edge technology, and high profile international partnerships. Bed ratios are climbing closer to OECD averages (GCC countries now average 2–3/1000).National health budgets are steadily expanding.KPIs look stronger year after year. Yet the most important indicator tells a different story: NCDs are rising, not falling. According to WHO, NCDs cause 75% of global deaths, and in the GCC the figure exceeds 80% of mortality. Obesity prevalence ranks among the world’s highest (40–50% in some GCC states). Diabetes affects 1 in 4 adults across the region. And Cardiovascular disease remains the single leading cause of premature death. This paradox exposes a painful truth: we don’t have a shortage of hospitals we have a shortage of outcomes. Hospitals and insurers continue to track metrics that look good in financial reports but say little about real health: • Bed occupancy rate • Average length of stay • Revenue per patient day • EBITDA margins etc. These keep providers and insurers happy, but without linking KPIs to patient outcomes, they remain an illusion of progress a system that measures activity, not impact. Healthcare only changes when money follows results. That’s the harsh truth. What if providers are only paid if: For diabetics: % of patients with HbA1c <7.0 -Hospital admissions for diabetic ketoacidosis- Amputation rates For cardiovascular disease % with LDL-C <70 mg/dL post-MI BP control <130/80 mmHg 30-day readmission after AMI or heart failure For cancer :% diagnosed at early stage Time from diagnosis to treatment Survival rates Without tying payments to metrics, they remain optional. With such linkage, they become non negotiable drivers of behavior. Healthcare financing must shift to a 4 tier system: 1. Base Payment covers essential service delivery (like DRGs/case rates), paid only if safety and reporting standards are met. 2. Outcome Bonus extra payment when specific results are achieved 3. Shared Savings / Penalties providers and insurers share savings when avoidable admissions fall, but reimbursements are reduced if outcomes worsen. 4. Patient Activation Incentive rewards linked to patient engagement How? Start Small: Focus on high burden NCDs like diabetes, cardiovascular disease, and cancer. Government Mandates: Only legislation can force providers and insurers to adopt outcome based KPIs and link them to contracts. National Outcome Registries: Build unified digital platforms to track results across public and private systems. Pilot, Then Scale: Test in select hospitals or regions, refine, then expand nationally. Public Reporting: Release quarterly dashboards showing survival, complications, readmissions, and patient reported wellbeing not just financials. The GCC should not wait for others to perfect value based care it has the capabilities to lead the way now, even if the first model is imperfect.

In 2006, the Netherlands faced something very familiar. Rising healthcare costs. Fragmented insurance pools. Risk selection. Growing inequity between coverage types. Public frustration. Sound familiar? And no — they did not “blow up the system.” They did not nationalize hospitals. They did not eliminate private insurers. They restructured incentives. Under the Health Insurance Act, the Netherlands unified its insurance market into a single, mandatory system built on regulated competition. Here’s what changed: • Every insurer must offer a standardized basic benefits package. • Insurers must accept every applicant — no medical underwriting. • A national risk equalization pool compensates plans that enroll sicker patients. • Coverage is mandatory, with income-based subsidies to make participation realistic. Private insurers remained. Competition remained. Choice remained. But profit could no longer depend on avoiding sick people. It depended on operational efficiency. That shift matters. By standardizing benefits and implementing national risk equalization, the Netherlands significantly reduced the financial incentive for risk selection and for vertically integrated strategies built around controlling coding, utilization, or cherry-picking healthier populations. When insurers cannot profit from avoiding the sick — or from manipulating risk — the business model changes. Competition shifts toward efficiency, service, and supplemental offerings. Over time, this structure also makes transparency structurally possible. Standardized benefits allow meaningful comparison. Universal participation legitimizes oversight. Financial reporting becomes part of the public function. That is how infrastructure behaves — even when delivered by private entities. The result? Uninsured rates dropped to approximately 1%. Not in 1950. Not in theory. In 2006. This is important because when Americans hear “reform,” they often imagine something radical or government-run. But the Netherlands kept private insurers. They kept regulated competition. They kept employer involvement. They simply aligned the insurance market with the mission of healthcare. We already spend enough in the United States to achieve near-universal coverage. We already have private insurers. We already regulate healthcare extensively. What we have not done is align the incentives of insurance with the goals of health. That is not a spending problem. It is a structural design problem. And other modern capitalist countries have shown — recently — that structural redesign is possible without dismantling the architecture. The question is not whether reform is imaginable. It is whether we are willing to change what insurance is optimized to do. #healthpolicy #healthcarereform #infrastructure #publichealth

The Hidden Economics of U.S. Healthcare (Inspired by Bill Hennessey, M.D.) Every meaningful healthcare reform effort starts with one unavoidable truth: physician fees, often the center of fraud investigations, represent only a small fraction of total spending. Yet enforcement consistently targets doctors, small clinics, and procedural coding, while ignoring where the real inefficiencies live. If we’re serious about cost reform and systemic accountability, we need to follow the money upstream, to the financial structures that quietly consume the majority of the healthcare dollar. Here’s where it really happens: → Carrier skimming of employer contributions Health insurers routinely withdraw premium payments from employer accounts, move those funds through internal channels, and apply opaque reconciliation, often without clear reporting. Billions flow through these mechanisms before a single claim is paid. → Hospital facility fee inflation Following years of provider consolidation, identical outpatient services are billed at drastically different rates, not because of medical complexity, but because a hospital system acquired the office down the street and attached a new fee schedule. The exact same care can now cost 2–3x more. → EMR-driven billing optimization Electronic medical record platforms are designed to maximize reimbursement. Diagnostic and treatment codes are prioritized not for accuracy, but for revenue potential. The result is systemic upcharging built into the digital backbone of care delivery, all hidden behind user interfaces. The uncomfortable reality: We’ve spent years targeting the smallest leaks in the system, while the real flood happens in engineered financial architecture that few are willing to scrutinize. If regulators want to drive reform that actually lowers costs and improves accountability, the strategy must shift: → Audit insurer banking practices and fund flows, not just claims → Interrogate the billing impact of provider consolidation, not just price variation → Examine how EMR logic is influencing revenue strategy, not just clinical outcomes Bill Hennessey, M.D. framed it perfectly: Chasing the 10% may feel productive, but until we expose the 90%, we’re not reforming, we’re just rearranging dysfunction. Systemic problems require structural solutions. And in 2025, structural change means putting carrier finance, facility pricing, and digital billing logic under the same microscope as clinical fraud. #HealthcareReform #HealthFinance #CarrierOversight #HospitalBilling #EMRIntegrity #SystemicTransparency #CostAccountability #PolicyLeadership Kathy L. Casale Madison Melish Beth Vickers Armando Arevalo

New modelling shows that government will need to deliver on NHS productivity and prevention promises to prevent health costs spiralling. Joint analysis by LCP and IPPR projects the cost of government-funded healthcare to 2034/35 under various scenarios. If recent trends continue, healthcare spending will grow to over 9.5% of GDP in 2034/35. However, improvements in productivity and prevention could almost completely flatten this growth, with spending remaining at around 8% of GDP in a decade’s time. If delivered, these improvements would provide annual savings of over £50bn in 2034/35, comparable to the current UK defence budget. Excellent work from Andrew Pijper and Dr Godspower Oboli updating previous LCP Health Analytics modelling to reflect the latest data and developments, and new scenarios developed with IPPR for their new report. It was a pleasure to collaborate with Annie Williamson, lead author of the insightful new report "Realising the reform dividend: a toolkit to transform the NHS", which is out today. Links in comments to LCP blog and analysis and the IPPR report.

Singapore’s upcoming parliamentary debate on Integrated Shield Plan (IP) rider changes goes to the heart of a difficult but necessary trade-off in healthcare financing. On one hand, rising premiums and private healthcare costs are clearly unsustainable. Insurance designs that eliminate almost all out-of-pocket expenses weaken price signals and encourage higher utilisation. This is not about bad faith by patients. It is about incentives. When the marginal cost of care approaches zero, claims rise, premiums follow, and affordability for the wider risk pool steadily erodes. On the other hand, MPs are right to ask how families will cope if deductibles and co-payments become unaffordable at moments of medical stress. Sustainability cannot come at the expense of dignity or access. Cost sharing may be economically sound, but if poorly calibrated, it risks discouraging timely care, worsening health outcomes, or imposing sudden cash-flow shocks on households least able to absorb them. This debate is often framed as a matter of individual consumer choice. In reality, it produces systemic effects. Highly comprehensive riders may feel rational for one household, but collectively they drive higher utilisation, push up costs across the system, and increase pressure on public healthcare resources. The policy question is therefore not whether cost sharing should exist, but how much risk should be socialised, how much should remain visible, and how those boundaries are enforced fairly. Affordability must also be understood more broadly than premiums alone. It includes whether families can manage sudden deductibles, whether sufficient buffers and safety nets exist, and whether support mechanisms are well targeted rather than blunt. Cost sharing works only when paired with safeguards that recognise uneven financial resilience across households. At its core, this debate is a reminder that healthcare financing is a shared responsibility. Patients, insurers, providers, and policymakers all shape outcomes through incentives and expectations. Parliament’s discussion is therefore not just about insurance riders, but about fairness, resilience, and how we design systems that remain compassionate, credible, and sustainable over the long term. What do you think?

🔸 Tackling Malaysia's Healthcare Cost Challenge 🔸 Earlier this week, the Ministry of Health and Ministry of Finance Malaysia of Finance formalised the Joint Ministerial Committee on Private Healthcare Costs, co-chaired by YB Dr Dzulkefly and myself. Policy work does not always happen on public stages – some of the most critical reforms require sustained, collaborative effort behind closed doors. The issue this Joint Ministerial Committee is addressing is a critical one for Malaysia, as we strive to escape the middle-income trap. Our medical inflation is estimated at 15% for 2025—significantly higher than Asia Pacific (11%) and the world (10%). Meanwhile, less than half of our population is insured despite Malaysia becoming an ageing society. ▪️ Why This Matters Private healthcare now serves 50% of outpatient and 30% of inpatient demand, relieving pressure on our public system. But rising costs are pricing out too many Malaysians from accessing quality care. Bank Negara Malaysia's interim measures have provided temporary relief, but we must address root causes. ▪️ The RESET Framework  Our joint approach focuses on five strategic thrusts: Revamp Medical and Health Insurance/Takaful (MHIT) products, Enhance price transparency, Strengthen digital health ecosystem, Expand cost-effective options, and Transform provider payments through Diagnostic-Related Group pricing. Work has commenced on developing a base MHIT product that balances affordability and sustainability, alongside improving pricing transparency and expanding access through initiatives like Rakan KKM, which provide premium economy healthcare options in public hospitals. The Committee includes cross-sector representation, including insurers, doctors, private hospitals, and consumer associations. Real reform requires all stakeholders working together instead of trading soundbites in public. With all parties contributing expertise and thinking, I believe we can come to practical shared solutions that strengthens both our public system and creates sustainable growth for the private sector. The goal is simple: quality, affordable, accessible healthcare for all Malaysians. #HealthcareReform #EkonomiMADANI

India spends more on healthcare each year but, the key question persists: are health outcomes improving at the same pace?   After six months of cross-sector collaboration, the report “𝗪𝗵𝗮𝘁 𝗪𝗲 𝗩𝗮𝗹𝘂𝗲 𝗶𝗻 𝗛𝗲𝗮𝗹𝘁𝗵: 𝗔 𝗖𝗼𝗮𝗹𝗶𝘁𝗶𝗼𝗻 𝗩𝗶𝘀𝗶𝗼𝗻 𝗳𝗼𝗿 𝗕𝗲𝘁𝘁𝗲𝗿 𝗖𝗮𝗿𝗲 𝗶𝗻 𝗜𝗻𝗱𝗶𝗮” has been released. It sets out a clear and strategic roadmap to help shift India’s health system from a volume-led approach to one centred on value and outcomes.   I am proud to have contributed to this unique coalition and to have shared perspectives from an insurer’s point of view. Months of structured, constructive dialogue and collaboration have helped reimagine the future roadmap of healthcare in India. With a ringside, three-tiered view of the ecosystem – across my organisation, the insurance sector, and the broader system – I was particularly invested in exploring avenues to strengthen health financing and drive sustainable outcomes.   Congratulations to Leapfrog to Value and its CEO Dr. Balkrishna Korgaonkar for spearheading this important effort and bringing together diverse voices across the healthcare ecosystem.   The coalition’s work identifies core systemic gaps such as fragmented care, limited transparency of outcomes, and financing structures that reward service volume over improved health. It also highlights promising bright spots across the system.   The initiative has resulted in four catalytic proposals: ✅ People’s Commission for Health Improvement – transparent benchmarking to strengthen accountability ✅ Primary Health Care Design Laboratory – prototyping integrated, outcome-focused care models ✅ Business Case for Quality, Safety & Patient Experience – aligning incentives with what truly matters to patients ✅ Coordinated Care Bundles – piloting bundled payments for NCDs and surgeries   The roadmap presents a practical agenda aimed at improving alignment, equity and measurable outcomes. It is an important step toward a more resilient and health-focused future for India.   You can download the strategy here: https://lnkd.in/gErbNiFV Bindu Ananth, Dr. N. Krishna Reddy, Ravi Vishwanath, Sarang Deo, Tejasvi Ravi, Vishnu Vasudev, Rubayat Khan, Dr. Balkrishna Korgaonkar and Chintan Maru.

WHO issues guidance to address drastic #globalhealth financing cuts The World Health Organization today released new guidance for countries on ways to counter the immediate and long-term effects of sudden and severe cuts to external funding which are disrupting the delivery of essential #health services in many countries The guidance “Responding to the health financing emergency: immediate measures and longer-term shifts” provides a suite of #policy options for countries to cope with the sudden financing shocks and bolster efforts to mobilize and implement sufficient and #sustainable financing for national health systems External health aid is projected to drop by 30% to 40% in 2025 compared with 2023, causing immediate and severe #disruption to health services in low- and middle-income countries #LMICs. WHO survey data from 108 LMICs collected in March 2025 indicate that funding cuts have reduced critical services including #maternal care, #vaccination, health #emergency preparedness and response, and disease #surveillance by up to 70% in some countries. More than 50 countries have reported #job #losses among health and #care workers, along with major disruptions to health worker #training programmes “Sudden and unplanned cuts to aid have hit many countries hard, costing lives and jeopardizing hard-won health gains,” said Tedros Adhanom Ghebreyesus, WHO DG. “But in the crisis lies an opportunity for countries to transition away from aid dependency towards sustainable self-reliance, based on domestic resources. WHO’s guidance will help countries to better mobilize, allocate, prioritize and use funds to support the delivery of health services that protect the most vulnerable” This year’s funding cuts have compounded years of persistent health financing challenges for countries, including rising #debt burdens, #inflation, economic uncertainty, high out-of-pocket spending, systemic budget underfunding and heavy reliance on external aid WHO’s guidance urges policy-makers to make health a #political and #fiscal priority in #government budgets even during times of #crisis, seeing health spending as not merely a cost to be contained, but an investment in #social #stability, human #dignity and #economic #resilience The guidance emphasizes the need for countries to cushion the immediate impact of reductions in foreign assistance for health and to adapt to a new era of reduced assistance Key policy recommendations include: prioritize the health services accessed by the #poorest protect health #budgets and essential health #services improve #efficiency through better procurement, reduced overheads and strategic purchasing integrate externally-funded or #disease-specific services into comprehensive #PHC-based delivery models use health #technology assessments to prioritize services and products that have the greatest health impact per $ spent https://lnkd.in/enwmhgwg