Improving Sustainability through Population Needs-Based Planning

OHE Lunchtime Seminar with Professor Stephen Birch, McMaster University, Canada and University of Manchester, UK

In place of fear: Improving sustainability through population needs-based planning

The fiscal sustainability of publicly funded health care systems is a challenge to policy-makers in many countries as health care absorbs an ever increasing share of both national wealth and total government spending. New technology, aging populations, and increasing public expectations of the health care system are often cited as reasons why health care systems need ever increasing funding as well as reasons why universal and comprehensive public systems are unsustainable. However, increases in health care spending are not usually linked to corresponding increases in needs for care within populations. Attempts to promote fiscal sustainability of systems such as limiting what the range of services covered of the groups of population covered may compromise their political sustainability as some groups are left to seek private cover for some or all services. In this paper an alternative view of fiscal sustainability is presented which identifies the failure of planning and management of health care to reflect needs for care in populations.  In this presentation an integrated needs-based analytical framework for health service, workforce and expenditure planning is presented. By identifying the separate determinants of workforce requirements, the analytical framework avoids the “illusions of necessity” that have generated continuous increases in supply. The framework is also used to broaden policy thinking on addressing service gaps beyond the traditional focus on the size of education and training programs as a method of increasing supply. Using data from the General Household Survey for England we illustrate application of the framework and show how, in the absence of appropriate planning methods, increases to service use may reflect provider interests more than population needs.

Dr. Stephen Birch is a Professor in The Centre for Health Economics and Policy Analysis at McMaster University in Canada and part time Chair in Health Economics at the University of Manchester Centre for Health Economics.  He holds visiting appointments currently at the University of Technology Sydney, Australia and previously at the University of Cape Town, South Africa and University of Malmo, Sweden.  He is senior scientist at the WHO Collaborating Centre on Health Workforce Planning at Dalhousie University, Canada and a former member of the UK Department of Health’s Centre for Workforce Intelligence.  He has served as a consultant with WHO and the World Bank as well as many national and provincial health departments on health workforce planning.  He was a consultant to the Barer-Stoddart report on physician planning in Canada, The Kilshaw report on Physician payment reform in Canada and the George Committee on the future of the physician workforce in Ontario. He led research in Canada on the development and application of needs-based models of health care funding and has further developed these models for application to health workforce planning. His main research interests are in the economics of health care systems with particular emphasis on equity, resource allocation and alternative delivery models.  He has over 200 publications in peer reviewed journals and was ranked equal first in Canada in the 2012 World Bank publication on the quantity and impact of health economics research.  He was Senior Editor for Social Science and Medicine from 1997-2012 and has served on various public boards including the Local Health Integration Network and the District Health Council in Hamilton, Ontario, the Health Professions Regulatory Council of Ontario and the Community Health Council for York District Health Authority.

When: Thursday 23 October 2014, 12:00-2:00pm.

Where: Waterloo Suite, St Ermin's Hotel, 2 Caxton Street, London SW1H 0QW

The slides from this seminar can be viewed below.


Thursday, 23 October 2014