This presentation was made by at the 3rd Health Systems Joint Network meeting for Central, Eastern and South-eastern European Countries held in Vilnius, Lithuania, on 25-26 April 2019

1. HEALTH FINANCING AND
BUDGETING PRACTICES IN
CESEE COUNTRIES
2017 Survey Preliminary Results
Caroline Penn, Budgeting and Public Expenditures,
Public Governance & Territorial Development
OECD

2. Answered by 12 countries:
Armenia, Azerbaijan, Czech Republic, Estonia, Georgia, Greece,
Kazakhstan, Kyrgyzstan, Lithuania, Malta, Slovakia, and Republic of
Slovenia
Joint Network survey of Budgeting
Practices for Health
Officials working in
Budget Authorities who
focus on health issues
Officials working in the
Ministry of Health in
relation with the budget
authorities

3. OVERVIEW OF HEALTH
EXPENDITURE AND HEALTH
FINANCING FRAMEWORKS

4. Health spending has generally increased
over time

5. Financing of healthcare

6. BUDGETING PRACTICES IN
HEALTH

7. In all countries some health spending is
included in the central government budget

8. Budget allocation mechanisms
• Trend in OECD countries towards ‘top down’
budgeting
• The majority of CESEE countries include
budget allocations by:
- healthcare functions
- individual health facilities
- specific diseases
• Limits flexibility

9. Most countries have a plan to increase
publically funded health coverage
• Population coverage, service coverage,
financial protection
• Importance of multiyear projections
• Targets or ceiling for health
expenditure

10. Most countries have a multi-year vision
but lack long-term projections

11. Targets for increasing or containing public
expenditure on health are not common
ARM
EST
LTU
AZE
MLT
CZE
KAZ
SVK
GRC
SVN
KGZ
Floors
8%
Ceilings
17%
None
75%
Targets and ceilings imposed on the health expenditure growth rate

12. Decision making and assessment
In most countries, central
budget agencies receive
economic evaluations from
Health Ministries for all or
some new proposals
However these assessments account to a lesser extent
This suggests a lack of connection between the economic
evaluations being conducted within Health Ministries and
their perceived utility to budget agencies
Lesser extent
Large extent
Some extent

13. Performance agreements and use of
performance information
0
1
2
3
4
5
6
More intense
monitoring in
the future
Budget
decreases
Programme
eliminated
Poor
performance
made public
Budget
increases
Consequences of not meeting performance targets

14. Efficiency in health expenditure requires
good practices during the entire budget
cycle:
- Effective allocation mechanisms
- Coordination mechanisms
- Measuring and evaluating results
- Reporting and monitoring tools
• Evidence across CESEE countries of use of
budgeting tools, but room for further
development in some areas
Conclusions

15. Thank you !
caroline.penn@oecd.org