title: Health care financing and the sustainability of health systems.
abstract: The economic crisis brought an unprecedented attention to the issue of health system sustainability in the developed world. The discussion, however, has been mainly limited to "traditional" issues of cost-effectiveness, quality of care, and, lately, patient involvement. Not enough attention has yet been paid to the issue of who pays and, more importantly, to the sustainability of financing. This fundamental concept in the economics of health policy needs to be reconsidered carefully. In a globalized economy, as the share of labor decreases relative to that of capital, wage income is increasingly insufficient to cover the rising cost of care. At the same time, as the cost of Social Health Insurance through employment contributions rises with medical costs, it imperils the competitiveness of the economy. These reasons explain why spreading health care cost to all factors of production through comprehensive National Health Insurance financed by progressive taxation of income from all sources, instead of employer-employee contributions, protects health system objectives, especially during economic recessions, and ensures health system sustainability.
authors.affiliation: Center for Health Services Management and Evaluation, Faculty of Nursing, University of Athens, 123 Papadiamantopoulou Street, 11527, Athens, Greece. lliaropo@nurs.uoa.gr.
authors.forename: Lycourgos
authors.initials: L
authors.lastname: Liaropoulos
authors.affiliation: Health Economics Unit, Public Health Building, University of Birmingham, Birmingham, B15 2TT, UK. i.goranitis@bham.ac.uk.
authors.forename: Ilias
authors.initials: I
authors.lastname: Goranitis
mesh_terms: D003695:Delivery of Health Care / Q000191:economics*; D057172:Economic Recession; D006291:Health Policy; D009313:National Health Programs