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No Easy Answer to How Much Should Be Spent on Health Care

Capping health care expenditure as a percentage of GDP has both merits and flaws

FRIDAY, Sept. 26 (HealthDay News) -- Although capping health care expenditure as a fixed proportion of gross domestic product (GDP) may control costs, it is not necessarily the best way to reflect the priority that a society places on health, according to two Head to Head articles published online Sept. 25 in BMJ.

Nick Bosanquet, of Imperial College London in the United Kingdom, writes that from 1990 to 2005, health spending in countries in the Organisation for Economic Cooperation and Development rose by 4.5 percent, versus an increase of only 2.5 percent in GDP, and argues that such growth is unsustainable. Rather, increased efficiency with economic incentives at all points of responsibility are the answer to the conflict between rising demands for health care and restricted public financing, he writes.

Werner Christie, Norway's former minister of health, argues that tying health care expenditure to unstable economic trends wrongly characterizes health care as a cost without calculating the benefits, including economic activity generated by health institutions and quality-of-life benefits to individuals.

"There will be limits on what we choose to allocate to health care, but these should not be defined by a fixed fraction of GDP or by projections of current growth," Christie writes. "Statistics and experience from democratic countries indicate that it is possible to reach a level of health care that is politically acceptable to citizens for 8 to 12 percent of GDP, given fair agreement on cost effectiveness."

Abstract - Bosanquet
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Abstract - Christie
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