Global demand for health care is increasing as populations grow older, and more technological solutions become available for use in treatment and prevention. As a consequence, the cost of health care is also increasing across the world. Health care providers are finding it challenging to maintain financing that is sustainable as well as affordable.

Countries have made various choices in the set-up of their health care financing systems. These systems respond to the challenge of rising health care costs in different ways. Anglo-Saxon countries have a large tradition of tax-financed health care and government-led provision of health services, while ‘Bismarckian’ systems are based on insurance arrangements often with a larger role for private provision of health services.

ECORYS assists Ministries of Health and Finance worldwide by analysing the (future) costs of providing health care services, and proposing strategies to ensure financial sustainability. The crucial relationship between a Ministry of Health and a Ministry of Finance is often the core to our advice - focusing on issues of budget management, predictability of funding and the efficiency of spending budgets. For developing countries, the impact and efficiency of health-related donor contributions are another important area of our work.

In insurance-based health systems, financing issues tend to revolve around delivering an affordable insurance package, the purchase of health care by insurers and incentives for health service providers to work efficiently while delivering good quality care. Increasingly, the potential of social, private and community-based health insurance arrangements is being tested in low-income countries in Africa and Asia to increase the affordability and accessibility of care for their populations. 

ECORYS is actively involved in research and advice on innovative health insurance schemes in low-income countries as a co-founder of the Netherlands Platform for Health Insurance for the Poor. The purpose of the platform is to promote the effectiveness of health insurance in low- and middle -income countries through research and capacity building. Members of the platform are from public and private organizations in the Netherlands including the Ministry of Foreign Affairs, development organizations, universities and research institutes. 

More information
For more information, please contact:

Arthur ten Have
Partner Health
T +31 (0)10 453 86 82
E This e-mail address is being protected from spam bots, you need JavaScript enabled to view it

Wija Oortwijn
Partner Health
T +31 (0)10 453 84 21
E This e-mail address is being protected from spam bots, you need JavaScript enabled to view it

Project references

Project: Impact of health insurance on the poor in developing countries
Country: Netherlands, Africa, Asia
Client: Netherlands Platform for Health Insurance for the Poor
Activities: Policy makers in low-income countries and from development partners increasingly view health insurance as an alternative mode of health financing. As limited evidence is available for these innovations, this study aims to inform policymakers about the existing evidence on the performance of health insurance arrangements in low-income countries, in particular on their impact on the accessibility, quality and efficiency of health care for the unprotected poor. The study consisted of a worldwide systematic review followed up by the development of a policy and evaluation framework based on several country case studies, which will support aid organizations and their partners in policy making and defining new projects.

Project: Strategic Expenditure Management through a Medium Term Expenditure Framework (MTEF)
Country: Tajikistan
Client: European Commission
Activities: An ECORYS team of long- and short-term experts are implementing a 2.5 year MTEF project. In the project the MTEF process in the health, social protection and education sectors is strengthened which should lead to greater transparency in the planning of budget expenditure programmes. The MTEF should ultimately contribute to the development of a more professional, transparent and effective public finance management in Tajikistan to improve service delivery in the social sectors.

Project: Evaluation of compulsory deductibles in health insurance
Country: The Netherlands
Client: Ministry of Health, Welfare and Sports
Activities: On 1 January 2008, compulsory deductibles were introduced in Dutch health insurance aiming to reduce cost and unnecessary use of health care. ECORYS evaluated this new and controversial policy upon request of the Dutch Parliament. Important issues included the impact on the use of services and health outcomes; cost savings and cost of exemption-schemes; and the impact on insurance policies of insurance companies.

Project: Building capacity on health economics in Surinam
Country: Surinam
Client: Ministry of Public Health, Surinam
Activities: The overall objective of the course was to improve the understanding of health financing and health economics, in particular concerning priority setting. A two-week training course was organized for 20 professionals from the Surinam Ministry of Public Health, health insurance organisations and the Anton de Kom University of Suriname. The course was organised in cooperation with the Anton de Kom University and the Erasmus University Rotterdam.

Project: Punjab Millennium Development Goal Programme
Country: Pakistan
Client: Asian Development Bank
Activities: ECORYS assisted the Punjab’s Government in preparing a first time expenditure review for the health sector. This analysis provided background for a second stage. In this stage a strategic review was conducted of options to change the health financing system including the feasibility of setting up health insurance.