<br><span class="gmail_quote">From: <b class="gmail_sendername">Ruggiero, Mrs. Ana Lucia (WDC)</b> <<a href="mailto:ruglucia@paho.org">ruglucia@paho.org</a>><br>crossposted from: <a href="mailto:EQUIDAD@listserv.paho.org">EQUIDAD@listserv.paho.org</a><br>
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<p style="MARGIN-LEFT: 0.5in"><b><font face="Arial" color="maroon" size="3"><span style="FONT-WEIGHT: bold; FONT-SIZE: 12pt; COLOR: maroon; FONT-FAMILY: Arial">Financing the Health Care System. Is Long-term Sustainability Possible?</span></font></b></p>

<p style="MARGIN-LEFT: 0.5in"><b><font face="Arial" color="navy" size="2"><span style="FONT-WEIGHT: bold; FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial"> </span></font></b></p>
<p style="MARGIN-LEFT: 0.5in"><b><font face="Arial" color="navy" size="2"><span style="FONT-WEIGHT: bold; FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial">Canadian Centre for Policy Alternatives - December 15, 2008</span></font></b></p>

<p style="MARGIN-LEFT: 0.5in"><font face="Arial" color="navy" size="2"><span style="FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial">Sean Burnett</span></font></p>
<p style="MARGIN-LEFT: 0.5in"><font face="Arial" color="navy" size="2"><span style="FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial"> </span></font></p>
<p style="MARGIN-LEFT: 0.5in"><font face="Arial" color="navy" size="2"><span style="FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial">Available online as PDF [15p.] at: </span></font></p>
<p style="MARGIN-LEFT: 0.5in"><font face="Arial" color="navy" size="2"><span style="FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial"><a onclick="return top.js.OpenExtLink(window,event,this)" href="http://www.policyalternatives.ca/~ASSETS/DOCUMENT/Saskatchewan_Pubs/2008/Financing_Health_Care_Dec_11.pdf" target="_blank"><font color="navy"><span style="COLOR: navy">http://www.policyalternatives.ca/~ASSETS/DOCUMENT/Saskatchewan_Pubs/2008/Financing_Health_Care_Dec_11.pdf</span></font></a> </span></font></p>

<p style="MARGIN-LEFT: 0.5in"><font face="Arial" color="navy" size="2"><span style="FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial"> </span></font></p>
<p style="MARGIN-LEFT: 0.5in"><font face="Arial" color="navy" size="2"><span style="FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial">"… The report analyzes three indicators of sustainability: the ratio of total health care spending to Gross Domestic Product (GDP), the ratio of public spending on health care to GDP and the ratio of government health expenditures to total government revenue.  …."</span></font></p>

<p style="MARGIN-LEFT: 0.5in"><font face="Arial" color="navy" size="2"><span style="FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial"> </span></font></p>
<p style="MARGIN-LEFT: 0.5in"><font face="Arial" color="navy" size="2"><span style="FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial"> </span></font></p>
<p style="MARGIN-LEFT: 0.5in"><font face="Arial" color="navy" size="1"><span style="FONT-SIZE: 9pt; COLOR: navy; FONT-FAMILY: Arial">"…..The Analysis of Health Care Expenditures focuses on expenditures for health care as a determinate of sustainability. The first part looks at historical trends in spending, followed by estimated cost drivers and the expected influence these will have on total health care spending. Finally, financing options will be reviewed for their impact on public spending.</span></font></p>

<p style="MARGIN-LEFT: 0.5in"><font face="Arial" color="navy" size="1"><span style="FONT-SIZE: 9pt; COLOR: navy; FONT-FAMILY: Arial">In a recent paper Ruggeri (2006) analysed sustainability of health care. He suggests there are several indicators of sustainability with three being the most useful:</span></font></p>

<p style="MARGIN-LEFT: 0.5in"><font face="Arial" color="navy" size="1"><span style="FONT-SIZE: 9pt; COLOR: navy; FONT-FAMILY: Arial">1 The ratio of <i><span style="FONT-STYLE: italic">total </span></i>health care spending to GDP.</span></font></p>

<p style="MARGIN-LEFT: 0.5in"><font face="Arial" color="navy" size="1"><span style="FONT-SIZE: 9pt; COLOR: navy; FONT-FAMILY: Arial">2 The ratio of <i><span style="FONT-STYLE: italic">public </span></i>spending on health care to GDP.</span></font></p>

<p style="MARGIN-LEFT: 0.5in"><font face="Arial" color="navy" size="1"><span style="FONT-SIZE: 9pt; COLOR: navy; FONT-FAMILY: Arial">3 The ratio of <i><span style="FONT-STYLE: italic">government </span></i>health expenditures to total government revenue.</span></font></p>

<p style="MARGIN-LEFT: 0.5in"><font face="Arial" color="navy" size="1"><span style="FONT-SIZE: 9pt; COLOR: navy; FONT-FAMILY: Arial">These indicators provide a framework to determine sustainability using additional data to the original Ruggeri study. The chosen indicators are important because they can be used to refute claims by opponents of the public health care system that it is in fiscal crisis…."</span></font></p>

<p style="MARGIN-LEFT: 0.5in"><font face="Arial" color="navy" size="2"><span style="FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial"> </span></font></p>
<p style="MARGIN-LEFT: 0.5in"><b><font face="Arial" color="navy" size="2"><span style="FONT-WEIGHT: bold; FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial">Content</span></font></b></p>
<p style="MARGIN-LEFT: 0.5in"><font face="Arial" color="navy" size="2"><span style="FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial">Introduction </span></font></p>
<p style="MARGIN-LEFT: 0.5in"><font face="Arial" color="navy" size="2"><span style="FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial">Categories of Health Spending </span></font></p>
<p style="MARGIN-LEFT: 0.5in"><font face="Arial" color="navy" size="2"><span style="FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial">History of Fiscal Federalism </span></font></p>
<p style="MARGIN-LEFT: 0.5in"><font face="Arial" color="navy" size="2"><span style="FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial">Moving Towards a "Two-Tier" System </span></font></p>
<p style="MARGIN-LEFT: 0.5in"><font face="Arial" color="navy" size="2"><span style="FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial">Analysis of Health Care Expenditures <br>The Impact of Future Costs on Sustainability </span></font></p>

<p style="MARGIN-LEFT: 0.5in"><font face="Arial" color="navy" size="2"><span style="FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial">Not a Public Health Care Fiscal Crisis </span></font></p>
<p style="MARGIN-LEFT: 0.5in"><font face="Arial" color="navy" size="2"><span style="FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial">Policy Recommendations </span></font></p>
<p style="MARGIN-LEFT: 0.5in"><font face="Arial" color="navy" size="2"><span style="FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial">Avoid Privatization </span></font></p>
<p style="MARGIN-LEFT: 0.5in"><font face="Arial" color="navy" size="2"><span style="FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial">Reform the Pu</span></font></p>
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