Description
Introduction: Problem statement and the role of health financing
The contribution of health systems to climate change and environmental degradation is increasingly being acknowledged: globally, the health sector contributed approximately 5.2% to greenhouse gas emissions in 2019. Vice versa, climate change also affects human health in numerous ways, often leading to increased health expenditure.
Climate change also has implications for health financing, as the way health financing arrangements are designed can play a mitigating role, but at the same time, the health financing arrangements need to be adapted to support and align with the necessary changes in the health sector and to address the rising health needs and expenditure. Mitigation measures are those actions that are taken to reduce greenhouse gas emissions, while adaptation measures serve to reduce vulnerability to the current and future effects of climate change.
Objective of the paper and methodological approach
To contribute to the conceptualization of the role of health financing, this paper provides an overview of policy options for mitigation and adaptation measures within the three health financing functions. We then identify initial key questions which can help advance the policy and research agenda for climate-protective health financing.
To do so, we used a deductive approach to explore how key health financing tasks can be modified for that purpose and also reviewed available grey literature.
Results
Under revenue raising, as a form of mitigation, governments can tax goods and services with negative health or environmental effects. In purchasing, mitigation can be pursued through the adjustment of payment methods, in order to incentivize health facilities to reduce their climate and environmental footprint. A form of adaptation, under pooling, is the use of adaptable risk equalization or risk adjustment mechanisms as well as eligibility criteria during adverse climate events and related health emergencies, to protect people most at risk. There are many more options which will be presented in the paper.
Climate-protective adaptation in and mitigation measures through health financing arrangements are not yet widespread. While little is published, a number of countries have taken steps; we give some examples of emerging practices in low- and middle-income countries.
Discussion and conclusion
More financial resources will inevitably be required for the health sector to protect human health from climate change, for instance to expand surveillance and control programs for infectious diseases and to retrofit health facilities to withstand more extreme weather events.
The role of health financing for mitigation and adaptation measures needs to receive more attention on the policy and research agenda, so as to fully exploit the potential to contribute to halting climate change. All health financing policy instruments will need to be designed in such a way, by setting appropriate incentives and disincentives, that negative effects on climate and environment are minimized, while positive contributions to climate protection are optimized. More documentation and dissemination of country examples and best practices are needed to broaden the knowledge about climate-protective health financing options.
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