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© Borgis - Postępy Nauk Medycznych 5/2016, s. 284-291 | DOI: 10.5604/08606196.1202370
*Bartosz Kobuszewski
Financing of tasks in the area of public health in selected European Union countries and Norway
Finansowanie zadań z zakresu zdrowia publicznego w wybranych krajach członkowskich Unii Europejskiej i Norwegii
Department of Economics, Law and Management, School of Public Health, Centre of Postgraduate Medical Education, Warsaw
Head of Department: Iwona Wrześniewska-Wal, MD, PhD
Streszczenie
Wstęp. Po latach starań środowiska naukowego władza publiczna w Polsce dostrzegła znaczenie zdrowia publicznego i w 2015 roku zdecydowano się na uchwalenie ustawy o zdrowiu publicznym. Nowy akt prawny wprowadza rozwiązania, mające zapewniać maksymalizację korzyści płynących z realizacji zadań z zakresu zdrowia publicznego, m.in. dzięki nowym mechanizmom i źródłom ich finansowania.
Cel pracy. W kontekście nowych rozwiązań legislacyjnych w Polsce, w niniejszej pracy dokonano międzynarodowej analizy porównawczej wydatków na zadania z zakresu zdrowia publicznego w wybranych krajach Unii Europejskiej i Norwegii.
Materiał i metody. W analizie porównawczej wykorzystano dane publikowane przez OECD za lata 2000-2014. Analizę wielkości wydatków na ochronę zdrowia oraz zadania z zakresu zdrowia publicznego przeprowadzono łącznie dla 22 krajów (21 państw członkowskich UE i Norwegii).
Wyniki. W 2013 roku w analizowanych krajach na zadania z zakresu zdrowia publicznego przeznaczano nie więcej niż 0,5% PKB, co stanowiło od 0,7% (na Łotwie) do 5,9% (w Finlandii) ogółu wydatków na ochronę zdrowia. W Polsce na zdrowie publiczne przeznaczono w 2013 roku blisko 1,5 mld USD, czyli 0,2% PKB, co stanowiło 2,6% ogólnych wydatków na ochronę zdrowia.
Wnioski. Wielkość wydatków na zadania z zakresu zdrowia publicznego jest bardzo zróżnicowana w krajach Unii Europejskiej, jednak we wszystkich krajach włączonych do analizy obserwuje się ich stały nominalny wzrost. Dzięki temu można założyć także wzrost znaczenia zdrowia publicznego w Unii Europejskiej.
Summary
Introduction. After years of efforts of the scientific community, the public authority in Poland saw importance of public health and in 2015 it decided to enact the law on public health (LPH). The new act introduced a solution designed to provide maximization of the benefits of realization of tasks in the field of public health, among other things thanks to the new mechanisms and sources of financing.
Aim. In the context of the new legislative solutions in this paper the international comparative analysis of expenditures on public health tasks in selected EU countries and Norway was made.
Material and methods. In the comparative analysis, the OECD data for the years 2000-2014 was used. The analysis of the expenditures on health and tasks in the area of public health was carried out in total for 22 countries (21 EU Member States and Norway).
Results. In 2013, these expenses amounted to maximum 0.5% of GDP and ranged from 0.7% (Latvia) to 5.9% (Finland) of the total expenditures on health care. In Poland, it was nearly $ 1.5 billion, i.e. 0.2% of GDP, which accounted for 2.6% of the total expenditures on health care.
Conclusions. The amount of the expenditure on the tasks related to public health is very diverse in the EU countries, however in all countries included in this analysis their steady nominal growth is observed. It allows us to assume the increasing importance of public health in the European Union.
INTRODUCTION
The State is responsible for carrying out of activities that are aimed at protection and improvement of the health of its citizens. In response to the task himfaced by it, the Ministry of Health has undertaken work on the development of the law on public health (LPH). The effect of these works was presented on 17 March 2015 – The Ministry of Health published the draft of LPH then. It was argued that “the need for the preparation of the Act is primarily due to the need to establish mechanisms to achieve improvement in the health of the society. (...) There is no doubt that population health is a value in itself while a coherent and effective state policy in the field of public health in a fundamental way affects the functioning of the society. Good health of citizens is a prerequisite for the development of the country, on the one hand by stimulating economic growth, on the other hand not burdening the social security system and health. (...)” (1). The bill was discussed by the Parliament on 16 July 2015 and voting on its adoption took place on 11 September 2015 – 278 MPs voted in favor, 0 against and 147 abstained. The Senate did not suggest any amendments to the bill and finally it was signed by the President on 26 October 2015.
The objectives of the enactment of LPH were: “(...) the establishment of structures responsible for coordinating and monitoring of the activities of the public authorities that could affect the health status of the population. Another goal is to ensure stable financing mechanisms. (...) The law also aims to systematize the tasks in the field of public health carried out currently, to ensure their continuity, adequacy and comprehensiveness. Public health functions carried out thanks to the adoption of the law will correspond to the objectives in the field of the PH, resulting from the documents of the European Region of WHO (...)” (1).
In accordance with the provisions of the newly enacted LPH (2), funding for the tasks in the field of public health (PH) will originate from the funds being at the disposal of ministers, including the minister responsible for health, the state organizational units and the executive agencies, including the National Health Fund (NFZ), as well as local government units (LGUs). The limit of the budgetary expenditures, resulting from implementation of the provisions laid down by the law, is expected to be PLN 80.7 million per year (including PLN 0.7 million in the budgets of provincial governors) in the years 2017-2025. The executors of the PH tasks determined in the Act may apply also for their financing from the Gambling Problem Elimination Fund, Physical Culture Development Fund and the Sports Activities Fund for the students, while the limit of expenditures from these sources has been set at PLN 60 million per year between 2017-2025 (art. 29 of LPH).
LGUs, as implementers of statutory tasks in the field of the PH, may apply for additional funding from the National Health Fund. They must at the same time demonstrate compliance of the undertaken activities with the operational objectives of the National Health Program and the priorities of the regional health policy. It is also required to obtain a positive opinion of the Agency for Health Technology Assessment and Tariff System. When the formal requirements are met, decisions on financing of the activities of the local government units are taken by the appropriate provincial branch of the National Health Fund. Grants may amount to 80% or 40% of the total planned expenditures. The amount of the funding has been made dependent on the size of the population of a municipality, county or province – higher subsidies will go to the local government, which is inhabited by no more than 5,000 people. The Act has also reserved that additional funding from the National Health Fund can only be received by the units that provide other health care services than those ones specified in the lists of guaranteed services within the realized program. The legislator has also defined the maximum limit of expenditures of NFZ on this purpose – they cannot be higher than 0.5% of the planned value of health care services (art. 22 of LPH).
In the context of the solutions introduced in the Polish system, aimed at providing funds for realization of the PH tasks, it is worth looking more closely at the level of funding for these activities in the European Union (EU).
aim
The aim of this article was a comparative analysis of expenditures of selected EU Member States and Norway on health care and on the duties of public health.
MATERIAL AND METHODS
The comparative analysis included the expenditures of 22 countries – most of the EU countries and Norway.The data published in the database OECD statistics, based on the System of Health Accounts for the years 2000-2014, was used for this purpose (3). Due to the lack of data or its incompleteness, 7 EU Member States were excluded from the analysis: Bulgaria, Croatia, Cyprus, Ireland, Malta, Romania and the United Kingdom.
The system of Health Accounts (SHA) has been proposed by the OECD (Organization for Economic Co-operation and Development). It consists of a set of basic tables, taking into account: the source of funds in the system, the entities to which the funds are transferred and the services and goods that the money is spent on.
The system classifying the expenditures on health has been described in the new International Classification for Health Accounts (ICHA) by:
1. Classification of Sources of Funding – ICHA-HF.
2. Classification of Health Care Providers – ICHA-HP.
3. Classification of Health Care Functions – ICHA-HC (4).
The functional classification (ICHA-HC) includes: goods and services consumed by the individual people who receive benefits according to individual needs and desires, and the goods and services consumed collectively, provided to the entire population. The specific categories included in the functional classification are shown in table 1 (5).
Tab. 1. Functional classification of health care
ICHA CodeHealth care functionsICHA CodeHealth care functions
HC.1-HC.5Goods and services consumed individuallyHC.6-HC.7Goods and services consumed collectively
HC.1Therapeutic servicesHC.6Prevention and public health*
HC.1.1Hospital treatmentHC.6.1Maternal and child health, family planning and family counseling*
HC.1.2“One day” treatmentHC.6.2Medical school*
HC.1.3Outpatient treatmentHC.6.3Prevention of infectious diseases*
HC.1.3.1Treatment in primary careHC.6.4Prevention of non-communicable diseases*
HC.1.3.2Dental treatmentHC.6.5Occupational medicine*
HC.1.3.3Specialist treatmentHC.6.9Other services in the field of public health*
HC.1.3.9The remaining patient careHC.7Administration health and insurance
HC.1.4Treatment services in the patient’s homeHC.7.1Government administration
HC.2Rehabilitation servicesHC.7.1.1Government administration with the exception of health insurance
HC.2.1Patient rehabilitationHC.7.1.2Administration of (public) health insurance funds
HC.2.2Rehabilitation dayHC.7.2Administration and health insurance in the private sector
HC.2.3Ambulatory rehabilitationHC.7.2.1Administration and private social insurance
HC.2.4Rehabilitation in the patient’s homeHC.7.2.2Administration and other private health insurance
HC.3Services in long-term nursing careHC.RFunctions related to health
HC.3.1Stationary long-term care nursingHC.R.1Accumulation of capital in the sector of medical providers
HC.3.2Stationary daily long-term care nursingHC.R.2Education and training of medical personnel
HC.3.3Long-term nursing care provided in the patient’s homeHC.R.3Research and development in health care
HC.4Auxiliary health care servicesHC.R.4Control of food, hygiene and drinking water
HC.4.1Laboratory testsHC.R.5Environmental health
HC.4.2Image diagnosisHC.R.6Administration and provision of social services for the chronically ill and disabled
HC.4.3Transport services and emergency assistanceHC.R.7Administration and provision of cash benefits
HC.4.9Other ancillary services  
HC.5Medical products for outpatients  
HC.5.1Temporary use medicines and materials  
HC.5.1.1Prescription drugs  
HC.5.1.2Drugs without prescription  
HC.5.1.3Other temporary use medical materials  
HC.5.2Therapeutic equipment and durables  
HC.5.2.1Glasses and other optical products  
HC.5.2.2Orthopedic aids  
HC.5.2.3Hearing aids  
HC.5.2.4Technical medical devices  
HC.5.2.9Other medical durables  
Source: J. Suchecka (ed.) 2011 (5)
*Features from the area of the PH (code HC.6) have been marked in grey
ICHA classification also includes expenditures on the PH and prevention (code HC.6 – in table 1 marked in grey*), which include: maternal and child health, family planning and family counseling; medicine school; prevention of infectious diseases; prevention of non-communicable diseases; occupational medicine and other services in the field of public health.
RESULTS
Expenditures on health care in relation to GDP
Globally, expenditures on health care are growing at a very fast pace. According to available data of the OECD, in 2014 the biggest amount was spent health care in Germany and the Netherlands – 11.1% of GDP (tab. 2). It is worth noting that in 2000 the expenditures did not exceed 10% of GDP in any of the examined countries (the greatest amount was spent in Germany – 9.8% of GDP). However, in 2013, for which the data is more complete, more than 10% of GDP was spent on health care in 7 countries: Austria, Belgium, Denmark, France, Germany, the Netherlands and Sweden. In the period from 2000 to 2013, the expenditures increased on average by 1.7 p.p. of GDP, which shows the scale of increase in the resources devoted to health care in recent years. In Poland, 6.4% of GDP was spent on health care in 2013, which puts our country on the fourth place from the end – Poland is ahead of only the Baltic countries.
Tab. 2. Expenditures on health as % of GDP
Country\year2000200520102011201220132014
Austria9.29.610.19.910.110.1
Belgium899.910.110.210.2
Czech Republic5.76.46.977.17.1
Denmark8.19.110.410.210.410.4
Estonia5.256.15.75.86
Finland6.77.78.28.28.58.68.7
France9.510.210.810.710.810.9
Germany9.810.31110.710.81111.1
Greece7.299.29.79.19.2
Hungary6.88.17.77.67.57.4
Italy7.68.48.98.88.88.88.9
Luxembourg5.97.27.26.86.6
Netherlands79.510.410.51111.111.1
Norway7.78.38.98.88.88.99.2
Poland5.35.86.56.36.36.4
Portugal8.39.49.89.59.39.19.1
Slovakia5.36.67.87.57.77.6
Slovenia8.188.68.58.78.78.6
Spain6.87.799.198.8
Sweden7.48.38.510.610.811
Latvia5.96.15.65.45.3
Lithuania5.66.86.56.36.1
Source: own study based on OECD data, www.stats.oecd.org (accessed on 15.12.2015)
Expenditures on the public health tasks in relation to GDP and the total health care expenditure
The expenditures on the PH were stable in the analyzed countries and in the analyzed period did not exceed 0.5% of GDP (such an amount has been spent on the PH since 2010 only in Finland). Half of the countries allocated to PH in 2013 no more than 0.2% of GDP – the least in Latvia, Lithuania and Greece (tab. 3). Expenditures on the PH tasks accounted for from 0.7% of the total expenditures on health care in Latvia to 5.9% in Finland in 2013 – the average was 2.7% of total expenditure on health (tab. 4). Countries allocating the biggest means to health care – the Netherlands, Sweden and Germany (at least 11% of GDP) – were spending approx. 3% of this amount (fig. 1) on PH. In Poland, 0.2% of GDP was allocated to PH in 2013, which accounted for 2.6% of the total expenditures on health care.
Tab. 3. Expenditures on public health as % of GDP
Country\year200020052010201120122013
Austria0.10.20.20.20.20.2
Belgium0.20.30.30.30.3
Czech Republic0.10.10.20.20.10.2
Denmark0.30.20.20.20.20.3
Estonia0.10.10.20.20.20.2
Finland0.30.40.50.50.50.5
France0.20.20.20.20.20.2
Germany0.30.30.40.30.30.3
Greece0.10.10.10.1
Hungary0.30.40.30.30.20.2
Italy0.20.20.30.20.20.3
Luxembourg0.10.20.10.10.1
Netherlands0.40.40.40.40.40.4
Norway0.20.20.20.20.3
Poland0.10.10.10.10.2
Portugal0.20.20.10.10.20.2
Slovakia00.20.40.20.30.2
Slovenia0.30.30.30.30.3
Spain0.10.20.20.20.20.2
Sweden0.30.30.30.30.3
Latvia00.20.20.20
Lithuania0.10.10.10.10.1
Source: own study based on OECD data, www.stats.oecd.org (accessed on 15.12.2015)
Tab. 4. Expenditures on public health as % of total expenditures on health care
Country\year200020052010201120122013
Austria1.521.81.81.81.9
Belgium2.72.62.62.73.2
Czech Republic1.61.72.52.32.12.3
Denmark3.12.22.32.32.22.5
Estonia1.82.32.72.83.42.9
Finland4.95.35.65.65.75.9
France2.22.22.122.12
Germany3.23.33.43.23.23.1
Greece1.41.31.21.1
Hungary54.53.83.32.82.7
Italy2.62.62.92.82.82.9
Luxembourg1.12.31.921.9
Netherlands5.43.943.73.33.2
Norway22.62.72.82.8
Poland2.42.12.122.6
Portugal21.71.51.51.91.7
Slovakia02.45.72.84.22.1
Slovenia3.73.73.93.83.8
Spain1.22.52.32.22.12.1
Sweden3.23.52.933.1
Latvia0.32.93.32.90.7
Lithuania20.91.31.11.4
Source: own study based on OECD data, www.stats.oecd.org (accessed on 15.12.2015)
Fig. 1. Expenditures on health care and public health in selected countries of the European Union in 2013
Source: own study based on OECD data, www.stats.oecd.org (accessed on 15.12.2015)
Nominal expenditures on tasks related to public health
Nominally, the most is spent on tasks in the field of PH in Germany – in 2013 Germany designated for this purpose more than $ 12 billion, almost twice more than in 2000 (tab. 5). France and Italy were next – in 2013, these countries allocated to PH respectively $ 5.5 billion and $ 5.3 billion, i.e. over two times less than Germany. The fact that Poland allocated the same amount to PH as Sweden and Belgium – approx. $ 1.5 billion in 2013 – may be surprising. The least of funds was spent on PH by the Baltic countries: Lithuania – 63 million USD, Estonia $ 59 million and Latvia – 18 million USD in 2013.
Tab. 5. Nominal expenditures on public health in selected EU countries in the period from 2000 to 2013 (in million USD PPP*)
Country\year200020052010201120122013
Austria339543648660684719
Belgium8471119120312531507
Czech Republic155252486481437498
Denmark399374559558567641
Estonia132647506459
Finland447686950100710561099
France336342445171533454435515
Germany6799892112 00411 90512 08112 180
Greece423387297293
Hungary423631631569466468
Italy2 95837565266519351855327
Luxembourg1552606462
Netherlands190222593083297628292742
Norway381660731817841
Poland927**7461092114211101496
Portugal299376414400503452
Slovakia1140586283447231
Slovenia140179195196195
Spain71023063165302528872788
Sweden8221146127813391465
Latvia565766718
Lithuania5540565263
Source: own study based on OECD data, www.stats.oecd.org (accessed on 15.12.2015)
*PPP – purchasing power parity, **data for 2002
The level of expenditures on PH in the Nordic countries (Norway, Sweden, Denmark), where health systems as well as health results and disease rates are considered as ones of the best in Europe, may seem surprisingly low.
In 2013 in the analyzed countries, the average expenditures increased compared to 2000 by 47% and amounted to over $ 1.8 billion on average. The biggest, as much as 230-fold increase in expenditures on PH in the period, was recorded in Slovakia, which raises the question about the reliability of the data.
The second largest increase in funding of the PH was observed in Estonia – in 2013, this country allocated for this purpose about 354% more money than in 2000. The smallest increase in the quantity of the funds was shown by Hungary, where in 2013 11% more of funds was spent in relation to 2000. It should be noted that between 2000 and 2005 the increase was 49% and expenditures on the PH were more or less constant until 2010, when the Hungarians began to spend on public health fewer and fewer funds (in 2013 26% less than in 2010). The data relating to expenditures in Poland are available since 2002, when USD 927 million was spent on the PH. In 11 years, more than 60% of increase of financing on PH was reported.
Public expenditures accounted for 80% of the total expenditure for the PH in 2013 on average and were lower by 1.5 p.p. than in 2005 (tab. 6). The PH was financed entirely from public funds in Italy, Belgium and Latvia, while in more than 98% in Greece, Spain and Lithuania. The smallest share of public money was reported in Portugal (38%), Slovakia (52%) and Finland (55%) (fig. 2). In Poland, the rate was approx. 73% in 2013 and was lower by 22 p.p. than in 2002.
Tab. 6. Nominal public expenditures on public health in selected EU countries (in million USD PPP*)
Country\year200020052010201120122013
Austria286443533542556580
Belgium8461119120312531507
Czech Republic155210422413372424
Denmark392364542539546622
Estonia132040406154
Finland269419559571595609
France228628973492359437353780
Germany5702758510 36810 12210 23910 272
Greece415382291288
Hungary211412415344269267
Italy2 95837565266519351855327
Luxembourg1551586261
Netherlands88811702064203419691938
Norway327591618674694
Poland877**5487867727691089
Portugal213281280271199176
Slovakia178217116119121
Slovenia105134143143135
Spain71021923111297728392740
Sweden656938105311061225
Latvia464746718
Lithuania5538545262
Source: own study based on OECD data, www.stats.oecd.org (accessed on 15.12.2015)
*PPP – purchasing power parity, **data for 2002
Fig. 2. Nominal total expenditures on public health and nominal public expenditures on public health in selected EU countries in 2013 (in million USD PPP)
Source: own study based on OECD data, www.stats.oecd.org (accessed on 15.12.2015)
Nominal expenditures on public health in relation to the number of population
In terms of per capita expenditures, the most was spent on the PH by the Norwegians – in 2013, it was almost 166 USD per year (128% more than in 2002). The next come the Dutch and the Swedes, spending respectively $ 163 and $ 153 per capita annually (tab. 7, fig. 3). The other extreme is constituted by Latvia (USD 9), Lithuania (USD 21) and Greece (USD 27). In Poland, the amount of USD 39 per capita was designated for the PH tasks in 2013 – more than in 2002 by USD 15 but four times less than in Norway.
Tab. 7. Total expenditures on public health per capita in selected EU countries in the period 2000-2013 (USD PPP)
Country\year200020052010201120122013
Austria42.365.977.478.781.284.8
Belgium80.8102.7108.9112.6134.8
Czech Republic15.124.746.445.841.647.4
Denmark74.768.9100.8100.2101.3114.1
Estonia9.11935.337.448.744.5
Finland86.3130.8177186.9195.1202
France55.367.479.881.983.283.9
Germany82.7108.2146.8145.5150.2151
Greece37.934.826.926.8
Hungary41.462.663.157.14747.3
Italy5264.888.887.487.188.4
Luxembourg28.785.585.388.383.5
Netherlands119.4138.4185.6178.3168.8163.1
Norway82.3134.9147.5162.8165.6
Poland19.528.73029.239.3
Portugal29.135.739.137.947.943.2
Slovakia0.226108.652.482.642.6
Slovenia69.987.19595.294.7
Spain17.652.867.964.761.759.8
Sweden91.1122.2135.2140.6152.6
Latvia2.23136.8338.8
Lithuania16.612.918.417.421.3
Source: own study based on OECD data, www.stats.oecd.org (accessed on 15.12.2015)
Fig. 3. Total expenditures on public health per capita in selected EU countries in 2000 and 2013 (in USD PPP)
*figures for 2001, **figures for 2002, ***data for 2003, ****data for 2004
The average expenditures on public health per capita in 2013 increased by 119% in relation to 2000 (due to the aforementioned dubious reliability of the data, Slovakia has been omitted in the calculations). The largest increase was recorded in Spain (240%) and the Czech Republic (by 213%) while the lowest – in Hungary (14%) and in the Netherlands (36%). In Poland, expenditures per capita increased in 2013 by 62% in comparison to 2002.
DISCUSSION
For many years reporting on health expenditures conducted by individual EU Member States caused many difficulties to the analysts. Reliable international comparisons were difficult due to methodological differences in terminology and in the national statistics. The differences in the methods of collecting and analyzing of facts and figures led to the fact that data from individual countries was not comparable. In order to enable the analysis and comparison of countries in terms of size but also in terms of the structure of expenditures on health care, international organizations have decided to recommend the change in the approach to keeping of the statistics on the health-related costs. It was also dictated by the rapid increase in the operating costs of health systems, observed worldwide. The international comparative analyses of rising health care costs are to lead to the development of transnational tools for more efficient spending of available funds and to allow for making of rationalized decisions in the field of health policy. Thanks to the introduction of the SHA methodology by the Central Statistical Office, it is possible to compare the Polish expenditures on health care with the expenditures in other EU countries. An additional benefit from the introduction of Systems of Health Accounts is the ability to make comparative analyzes of expenditures on tasks related to public health.
In Poland, 6.4% of GDP was allocated to health care in 2013, which puts our country on 18th place. The Czech Republic, Hungary and Greece mired in crisis spent more on the health care. On the other hand, the selected European countries allocated in 2013 no more than 0.5% of GDP on the PH, which was from 0.7% (Latvia) to 5.9% (Finland) of the total expenditures on the health. Poland allocated in 2013 0.2% of GDP on the PH, which accounted for 2.6% of the total expenditures on health care. Nominally, the most is spent on the actions in the field of the PH in Germany – in 2013, it was more than $ 12 billion. On the other hand, the least is spent on the PH by the Baltic countries: Lithuania $ 63 million, Estonia – 59 million USD and Latvia – $ 18 million in 2013. In Poland, nearly $ 1.5 billion was designated for this purpose in 2013.
These comparisons seem to be particularly important in the context of the newly adopted LPH and the new mechanisms for funding of the PH in Poland, introduced by it. The legislator has secured the amount of PLN 140.7 million per year for realization of tasks in the field of PH. In addition, the National Health Fund may start making additional payments to local governments for the implementation of the health policy programs in the amount of not more than 0.5% of the planned value of health services – in 2016, is the amount of PLN 347.5 million. Funds for the realization of the PH tasks may also come from the resources being at the disposal of ministers, state agencies and executive agencies as well as local government units. The biggest problem of the new legislation seems to be the identification of an excessive number of entities responsible for financing in the area PH and resignation from the creation of the special fund, which the funds for their realization would come from. The capabilities of local government units in the field of financing of their PH tasks have also been overestimated. In 2013, the LGUs allocated for health care in total PLN 3.5 billion (6), of which more than PLN 660 million was designated for the prevention of alcoholism, more than PLN 40 million for to fighting with drug abuse and more than PLN 60 million for health policy programs (7).
Attention should also be paid to the amount of private expenditures on the PH in selected countries. According to the ICHA-HF classification, private expenditures include inter alia direct expenditures of households private insurance sector (including the so-called. quasi-insurance) and the activities of non-profit organizations (5). Therefore, an in-depth analysis of the structure of expenditures on the PH should be performed in order to find out whether the low share of public expenditures in such countries as Portugal, Slovakia and Finland is associated with strongly developed sector of non-profit organizations or rather with heavy encumbrance with expenditures on the PH (vaccinations, preventive examinations) of households.
CONCLUSIONS
The data presented by the OECD show that, as in the case of health care financing, the level of expenditures on the PH is very diverse in the countries of the European Union. However, in all of the analyzed countries, there has been a steady nominal increase of funding these activities over a decade (2003-2013), the amount of money spent on the PH increased by 71% and amounted in 2013 of $ 1.8 billion on average. It shows the growing importance of the PH in Europe.
Piśmiennictwo
Uzasadnienie projektu ustawy z dnia 15 lipca 2015 r. o zdrowiu publicznym, druk sejmowy nr 3675.
Ustawa z dnia 11 września 2015 r. o zdrowiu publicznym.
Baza danych statystycznych OECD: www.stats.oecd.org (dostęp z dnia: 15.12.2015 r.).
Schneider M, Kawiorska D, Baran M et al.: System Rachunków Zdrowia w Polsce. Praca zbiorowa, s. 9-10; http://www.bpz.gov.pl/old/file/SHA.pdf (dostęp z dnia: 15.12.2015 r.).
Strzelecka A: Wydatki publiczne na ochronę zdrowia. [W:] Suchecka J (red.): Finansowanie ochrony zdrowia. Wolters Kluwer, Warszawa 2011: 64-65, 69-71.
Sprawozdania budżetowe jednostek samorządu terytorialnego, oficjalna strona Ministerstwa Finansów; http://www.mf.gov.pl/ministerstwo-finansow/dzialalnosc/finanse-publiczne/budzety-jednostek-samorzadu-terytorialnego/sprawozdania-budzetowe (dostęp z dnia: 15.12.2015 r.).
Główny Urząd Statystyczny: Zdrowie i ochrona zdrowia w 2013 roku. Zakład Wydawnictw Statystycznych, Warszawa 2014; www.stat.gov.pl.
otrzymano: 2016-04-04
zaakceptowano do druku: 2016-04-25

Adres do korespondencji:
*Bartosz Kobuszewski
Department of Economics, Law and Management School of Public Health Centre of Postgraduate Medical Education
ul. 61/63 Kleczewska, 01-826 Warsaw
tel. +48 (22) 560-11-148
bkobuszewski@cmkp.edu.pl


Postępy Nauk Medycznych 5/2016
Strona internetowa czasopisma Postępy Nauk Medycznych