Managing Health Care Costing and Financing

Workshop: February 28 – March 2, 2018ILjubljana, SloveniaIBudget Preparation and Execution

The workshop examined possible approaches to the improvement of health care systems financing and reduction of sector specific fiscal risks through better coordination of allocated financial resources. It discussed the specifics of health care sector financing, prospects for improvement of spending efficiency; coordination of funds from different national levels and utilization of external funds to ensure the desired policy outcomes. Fiscal programming challenges of the sector and possible solutions will also be addressed throughout examining good practices in the region and beyond.

How you benefited?

This workshop aimed to help public officials better understand key factors undermining the efficiency of health care spending, as well as shortcomings in procedures and institutional organization, in order to explain what improvements can be made to ensure better management of health care policies.

Upon completion, participants were able to:

  • Understand the role, objectives and elements of Economic Reform Programmes and position of health care policies within this document
  • Assess how to streamline the process of spending review evaluation of health care sector and use these findings in making better budget allocations
  • Describe factors that could cause inefficiencies in health spending, and what could be done to address them
  • Appraise the benefits of utilization of performance information when making budgetary allocation decisions
  • Identify specific shortcomings in procedures and institutional arrangements that constrain coordination of health care policies. 

What you learned?

Health care reforms will be a key fiscal challenge in coming years especially at a time when countries need to undertake large fiscal adjustments to reduce public debts in the wake of the financial crisis. Since health care spending pressures have and will continue to intensify as combination of technological advances and demographic factors, containing the growth of this spending will be an important pillar of fiscal consolidation strategies.

These developments have also been recognized by many South East European (SEE) countries by highlighting the health care reforms within their Economic Reform Programmes (ERPs) as some of the priority policies for ensuring fiscal stability and market competitiveness. Having this in mind, the workshop outlined the role, objectives and elements of ERPs while explaining the implications of health care reforms to achievement of countries’ overall fiscal objectives.  

There is not a unique approach to providing and financing health care, because the differences in the level of public health spending across countries reflect their preferences and constraints. Therefore, there is no “optimal” level of public health spending that can provide a benchmark for comparing countries. Yet there is a need to ensure that whatever “model” for health care is adopted, public health care services are provided in an efficient way.

This workshop provided thorough overview of the most common factors causing large inefficiencies in health spending, with the aim of unveiling how reduction of both allocative and productive inefficiencies could enable achievement of the same level of health outcomes with a lower level of spending. These findings serve to Ministries of Finance as important input for undertaking health care spending review evaluations and preparing recommendations that combine containing costs and improving spending efficiency.

During this workshop emphasis was put into understanding possible arrangements for adequate monitoring and evaluation of health care policy outcomes, as well as into how this performance information could be used in budgetary allocation decision making process. This is of particular importance in context of making progress towards introduction of performance based budgeting practices in SEE countries.

Finally, due to complexity of stakeholders involved (ministries of health, ministries of finance, health insurance funds, institutions on both national and sub-national level etc.) in management of health care sector, this event also discussed how coordination and cooperation in exchange of financial and non-financial data could be incentivized.  

The event was held in English, and highly participatory. Participants were encouraged to share their experiences and country practices.

Who should attend?

Invited were public officials in SEE who are working at: 

  • ministries of finance budget department as analysts of health care budgets;
  • ministries of health finance and policy departments participating in development and programming of health care policies, as well as on the preparation of annual budgets;
  • health care funds working on programming and budgeting of health care policies;
  • other public institutions (such as parliamentary committees, and those on subnational level) with mandate in the field of health care;
  • preparation of the inputs for ERPs in particular on the field of health care;
  • coordination, monitoring and evaluation of development and implementation of ERPs. 

No fee was charged, and meals and refreshments were provided during the event. Flights, transfers, and accommodation were funded for up to three officials per EU 2014-2020 Instrument for Pre-Accession (IPA II) beneficiary country, as well as for one official per country from Armenia, Bulgaria, Croatia, Georgia, Moldova, Romania, and Ukraine. Applications of additional self-funded candidates from the CEF Constituency (and beyond) were considered, as far as space permits.


  • Mojmir Mrak- Professor at University of Ljubljana and CEF Senior Program Adviser 
  • Mitja Čok- Professor at University of Ljubljana
  • Dorjan Marušič- International Health Care Expert and Former Minister of Health of Slovenia
  • Volkan Çetinkaya- Senior Economist, World Bank
  • Sanja Madžarević Šujster- Senior Country Economist, World Bank
  • Eva Zver- Institute of Macroeconomic Analysis and Development of Slovenia
  • Goran Drakulić- USAID's Fiscal Sector Reform Activity in Bosnia and Herzegovina


This learning initiative was supported by:

Slovenia's Development Cooperation Ministry of Finance Slovenia Safe & WB & EC
Ministry of Finance, the Netherlands World Bank Group U.S. Agency for International Development (USAID)