Recently, the International Monetary Fund (IMF) through its fiscal monitor and vulnerability index coupled with the European financial crisis has put both the revenue and expenditure sides – and social spending specifically – front and center in the global debate. With the new Universal Health Coverage (UHC) flavor of the day potentially resulting in large recurrent increases in health spending, and with the future of official development assistance (ODA) and development assistance for health (DAH) in question, the fiscal side cannot be ignored.

A complex line of transmission underlies the connection between changes in macroeconomic environment, the general government budget and the inter- and intra-sectoral allocation of resources, including in the health sector. As countries get richer, total and public health spending goes up as a share of the economy. The increase in public spending on health is affected by a variety of reasons, which might include, for instance, sector-specific and economy-wide cost pressures, public demands for spending, and ability to spend. At the same time, spending pressures are increasing, not only for health, but for all sectors.

This tension leads to the need for “thoughtful analytics” on the interplay between fiscal health and health (and other) spending. Health, like any other spending, often competes with other sectors for scarce resources. Under what conditions is it possible to make the case for increasing spending in health (if at all) and how can health policymakers effectively articulate that case?

At this session, we will discuss the current body of health financing work at the World Bank to provide the analytical basis and public finance essentials to assist health policymakers, Bank staff, donor partners, NGOs, and other relevant stakeholders in the development and implementation of fiscally sound and sustainable policies, an area of particular relevance given the potentially large costs of providing universal coverage with its requisite health systems scale-up.


John (“Jack”) Langenbrunner is a Health Economist with the World Bank with both research and operations experience. He currently coordinates the new Health Financing and Health Insurance Thematic Group within the Bank, and leads the Bank’s Global Expert Team for Health Financing and Health Systems in 2011-2012.

Since 2008 he has worked on health financing issues and health insurance design and development issues mostly in mainland China, but also Mongolia, Philippines, Cambodia, Thailand and other East Asian and Pacific countries. Prior to that, Jack worked in Eastern Europe in the EU New Member States and in other countries such as Russia, Croatia, Azerbaijan, Kyrgzstan, and Kazakhstan. He has worked as well in selected countries in the Middle East on the development of health systems and health insurance including Egypt, Saudi Arabia, Bahrain, Iran, Jordan, and Lebanon.

Jack’s most recent book is Financing Health Care in East Asia and the Pacific: Best Practices and Remaining Challenges, released in 2011 and co-authored with Aparnaa Somanathan.  He also has recently co-authored two books on resource allocation and strategic purchasing by insurers and other public and private organizations, and has authored or co-authored a number of papers related to this initiative. He also led the Bank’s work on a manual for National Health Accounts for low- and middle-income countries. This so-called NHA “Producers Guide” was published in 2003.

Previous to his work at the Bank, Jack was with the US Health Care Financing Administration, a public health insurance program for over 80 million Americans.  He later went in the early 1990s to the US Office of Management and Budget for three years, where he (among other things) served on the Clinton Health Care Reform Task Force for the US White House.