Health financing

WHO Sessions at the 13th World Congress in Health Economics

Date: 13-17 July 2019
Location: Basel, Switzerland


The International Health Economics Association (iHEA) was established to increase communication among health economists and foster a higher standard of debate in the application of economics to health and health care systems. It provides a forum to engage around new methodological developments in health economics, the latest research findings and the implications of this research for health policy and practice. This congress theme, New Heights in Health Economics, reflects this desire to provide a high quality and innovative programme and to facilitate interaction with colleagues from around the globe.

WHO’s Department of Health Systems Governance and Financing hosted a number of organized pre-congress and congress sessions during iHEA 2019. These sessions brought together policymakers, practitioners and leading academics to engage and build skills on timely research across a range of health systems governance and financing-related topics.


Saturday, 13 July:

  • 08:30 – 12:30: Global Health Expenditure Tracking
  • 13:00 – 17:00: Data on Budget Impact & CEA to Inform Benefit Packages

Sunday, 14 July:

  • 08:30 – 12:00: Training Workshop: Household Survey Data on OOP Expenditure
  • 08:30 – 12:00: Financing Common Goods for Health
  • 13:00 – 16:30: Financing for UHC: Driving System Change through Strategic Purchasing

Monday, 15 July:

  • 13:30 – 15:00: Making Fiscal Space Work for Health
  • 15:30 – 17:00: Multiple Funding Flows and Incentives

Saturday, 13 July 2019

Global Health Expenditure Tracking

Time: 8:30AM – 4:30PM
Location: Universität Basel - Kollegienhaus - Hörsaal 001


Section 1: Disease and programme specific expenditure deep-dive. The 2011 released System of Health Accounts (SHA 2011) framework is used to produce expenditures by disease and programme intervention areas using five mutually exclusive main categories – namely, infectious and parasitic diseases, reproductive health, nutritional deficiencies, noncommunicable diseases, and injuries. Vertical programme approaches to tracking these expenditures (e.g. National AIDS Spending Assessment for HIV/AIDs and Joint Reporting Framework for immunization) serve a different objective than the SHA 2011 framework, and utilize different scopes, boundaries and data sources. As a result, the expenditure amounts generated from these various disease-specific methodologies and those from SHA 2011 can significantly deviate from each other. Even within the same scope and boundary, results can fluctuate wherever a different method is used for allocating shared expenditures – e.g. health workforce salaries – or when data come from different primary sources.

Section 2. Measuring Primary Health Care expenditure without knowing what it is? The functional classification of the System of Health Accounts 2011 delineates health care activities by type: individual or collective services; basic purpose (curative, rehabilitative, long-term care, preventive); and mode of provision (inpatient, day-care, outpatient and home-based). The functional classification provides important information on service delivery and support policy makers in tracking the implementation of health system strategies, including strategies promoting primary health care.

Section 3. Domestic government spending and external aid on health: policy implications Domestic government spending on health is critical to achieving UHC and SDG 3. It is one of the key indicators for monitoring government commitment to health. However, external funding is still essential in many low-income countries to meet the funding gaps for basic services.

Section 4. Domestic government spending on health and health aid: which number to use? Health expenditures from both domestic public sources and external are of great interest for national health financing policy and global health policy. Globally there are many efforts on data collection and data estimation of external aid on health. With the increasing interest in external aid it is often confusing to see different sets of numbers. The session will bring together major players in this area to talk about the sources and estimation methods of external aid on health.

Data to Drive Benefit Package Design: A Hands-on Orientation to WHO Tools for Informing Strategic Purchasing Priorities Through Cost-Effectiveness and Budget Impact Analysis

Time: 1:00PM – 5:00PM
Location: Universität Basel - Kollegienhaus - Hörsaal 114


Session Description The objective of this session is to orient participants to existing, practical tools for country level economic analysis to guide strategic purchasing priorities under UHC. The format combines technical presentations, country experiences, and hands-on training.

Sunday, 14 July 2019

Measure What Matters: Training Workshop on Household Survey Data on Out-of-Pocket Health Expenditure

Time: 8:30AM – 12:00PM
Location: Universität Basel - Kollegienhaus - Hörsaal 119


Session Description Evidence on financial protection comes from heterogeneous household surveys instruments. This workshop is intended to introduce key concepts, related data collection challenges, propose evidence-based relevant changes to survey instruments and innovative approaches to improve the reliability, relevance and comparability of household out-of-pocket health payments.

Financing Common Goods for Health

Time: 8:30AM – 12:00PM
Location: Universität Basel - Kollegienhaus - Hörsaal 118


Session Description This half-day session will present a new WHO knowledge programme to address obstacles to under-financing of common goods for health. This session will articulate, provide the technical and economic rationale for, identify modalities, and provide country experiences for financing common goods for health.

Section 1: Motivation, framework and financing mechanisms
Chair: Agnès Soucat, World Health Organization

  • When both markets and governments fail health. Abdo Yazbeck, Independent Consultant
  • When market fail: common goods for health. Peter Smith, Imperial College London
  • Financing common goods for health: a country agenda. Susan Sparkes, World Health Organization
  • Financing global common goods for health: when the world is a country. Gavin Yamey, Duke University

Section 2: Country perspective on financing common goods for health
Chair: Joseph Kutzin, World Health Organization
Discussant: William Savedoff, Center for Global Development

  • Sri Lanka: Palitha Abeykoon, Sri Lanka Medicine Association
  • Liberia: Tolbert Nyenswah, National Public Health Institute of Liberia
  • India: Ajay Shah, National Institute for Public Finance and Policy, India

Financing for Universal Health Coverage: Driving System Change through Strategic Purchasing

Time: 1:00PM – 4:30PM


Session Description By explicitly aligning funding with service and population priorities as well as quality of care, strategic purchasing has the potential to drive improvements in efficiency and equity. However, whether this potential is realized depends on how a country translates strategic purchasing concepts into design and implementation. This session examines core economic issues that underlie strategic purchasing, including: (1) using strategic purchasing to leverage delivery system change, (2) examining the effect of fragmented financing and mixed payment on the effectiveness of strategic purchasing, and (3) how governance arrangements can enable or disable strategic purchasing.

  • Session 1: Overview of strategic purchasing
  • Session 2: Using Strategic Purchasing to Leverage Delivery System Change
  • Session 3: Fragmentation: The Achilles Heel of Strategic Purchasing?
  • Session 4: Governance of Strategic Purchasing: Accountable to Whom and for What
  • Session 5: Summary: Global Lessons and challenges in the use of strategic purchasing to drive progress towards UHC
  • Session 6: iHEA Special Interest Group on Financing for Universal Health Coverage in Low- and Middle-Income Countries

Monday, 15 July 2019

Making Fiscal Space Work for Health

Time: 1:30PM – 3:00PM
Location: Universitätsspital Basel - Klinikum 1 - Hörsaal 2
Chair: Joseph Kutzin, World Health Organization


Session 1: Assessing Fiscal Space in the SDG Era
Discussant: Sanjeev Gupta, CGD

Hélène Barroy, World Health Organization
Ajay Tandon, The World Bank

Session 2: Fiscal Space and Efficiency: The Missing Link?
Discussant: Jeremy Lauer, World Health Organization

Jonathan Cylus, London School of Economics & World Health Organization
Jacob Navignon, Kwame Nkrumah University Ghana

Multiple Funding Flows and Incentives – How Does the Provider Payment Mix Shape Provider Behavior in Low- and Middle-Income Countries

Time: 3:30PM – 5:00PM
Location: Universitätsspital Basel - ZLF - Gross


The session is made up of five parts:

  • Part 1: Words of welcome and introduction of the session
  • Part 2: WHO/RESYST collaboration:
    • Presentation 1: the WHO/RESYST analytical approach developed to capture the incentives generated by mixed provider payment systems and their implications;
    • Presentation 2: Empirical findings extracted from the application of the analytical framework in six countries;
  • Part 3: Moderated group discussions: participants will discuss two of the following three questions successively:
    • 1. Future research agenda: what methods and data sources can be used to measure provider behavior as a result of incentives generated by MPPS?
    • 2. Policy implications: what are the policy recommendations of these findings? How can the political economy dimension be factored into these recommendations?
    • 3. Governance of mixed provider payment systems: what governance model/measures should be implemented to overcome the challenges posed by multiple, ill-coordinated funding flows? Who should coordinate the mix of funding flows to ensure coherence among the flows, and how? What government capacity is required to provide effective stewardship over mixed funding flows?
  • Part 4: Synthesis of the group discussion and discussant
    • Each rapporteur will present a rapid feedback from the group discussion followed by a reaction from a discussant.
  • Part 5: Concluding remarks by the chair