During the economic crises, policy makers in health, faced with financial pressures can respond with the following options:

  • meet spending commitments by maintaining or increasing public funding for health care through depleting reserves, increasing deficit financing or changing the mix of public funding sources by introducing new taxes or new earmarking for health;
  • reduce public spending on health care by making changes to coverage - breadth (population), scope (service package) or depth (cost sharing);
  • obtain more from available resources by improving efficiency and/or cutting costs.

In making decisions about the possible choices, policy makers need to consider the impact of proposed reforms on health system goals. Achieving fiscal balance is not regarded as a primary goal of the health system, such as health gain or financial protection.

Governments' responses exist in a context of broader context - constraints and opportunities outside of the health system. Many cannot be fully evaluated, and their long-term effects may not be evident for a while.