Last week, the Foresight Center published a report on healthcare funding titled "The Sustainability of Healthcare: Scenarios Through 2035." Healthcare needs additional funding, but tax hikes or increased allocations from the state budget are neither the only nor necessarily the best solutions. As the population ages and demand for health services grows, so too will healthcare costs. Smart solutions, better use of existing funds and attracting private money can help.

Private funding means either individuals voluntarily investing more in their own health or employers taking an interest in doing so. Neither is a silver bullet for solving healthcare financing issues — and they have not been presented as such — but both are important avenues for bringing additional resources into the system. They are not alternatives to a solidarity-based healthcare system, but rather supplements to the existing one.

Everyone who contributes on their own helps save costs for others

The report is permeated by the misconception that some people gaining access to health insurance somehow harms others' access or the services funded by the Health Insurance Fund. It's hard to agree with the claim that more money in the system would be harmful or would reduce access to health services. If someone attends an appointment either through insurance or by paying out of pocket, more of the Health Insurance Fund's resources remain available for treating others.

Employers have submitted a number of proposals to the government for improving the healthcare system. Only two of these made it into the report's conclusions: strong investment in information systems and digitalization and a shift toward outcome-based funding. These have significant potential and now we can only hope that the consensus is followed by swift action — that is, the implementation of actual changes.

Employers have also repeatedly proposed expanding the authority of healthcare workers. The current system is highly physician-centric and our skilled nurses and other specialists are underutilized. Nurses, nurse practitioners, pharmacists, optometrists, psychologists and physiotherapists could all contribute much more to public health. To make this happen, they need to be allowed to carry out examinations and procedures in line with their qualifications and to record them in the national health information system.

More competition

Other issues related to the efficiency of the healthcare system, however, were left out of the study's focus. For example, employers and the prime minister's business advisory council have recommended increasing competition in the provision of healthcare services. Services funded by the Health Insurance Fund are primarily provided by state-owned hospitals and medical institutions, which are not required to participate in tenders, demonstrate treatment outcomes or prove quality in order to receive funding. These services could be procured to a much greater extent on a so-called free-market basis, which encourages productivity and innovation.

While in other critical sectors, such as national defense and energy, competition helps bring about the best solutions, it's unclear why competition is being sidelined in healthcare and how such an impactful issue in terms of spending and service quality was omitted from the study.

I also found the report lacking in financial models for the outlined future scenarios. Without assessing the growth potential of various funding sources, the impact of voluntary contributions on people's health, life expectancy, sick leave rates and the broader economy, or the key drivers of rising healthcare input costs, among other things — it is impossible to understand the full effects and make sound decisions based on them.

More healthy years

With studies and scenarios of this kind, it's important to first agree on the purpose of the analysis and what we expect from the healthcare system. One possible goal for the money invested in healthcare could be to increase the number of years people live in good health.

That requires investment in prevention. True, prevention begins with diet, sleep and physical activity, but too often we neglect secondary prevention — intervening when early signs of health issues appear. Right now, we only take action once the problem has progressed into a serious illness and treating it at that stage is more expensive than early intervention. When discussing healthcare funding, we should always consider how to prevent the onset of severe medical conditions.

One way to do this is by strengthening primary care with the support of occupational health services. Working people undergo regular mandatory occupational health checks, during which unrelated health problems often surface. Currently, occupational health services refer people to their family doctors for further examination, but as a result, thousands of treatment journeys end prematurely and the problems worsen.

That's why occupational health doctors should have access to a fund that allows them to order necessary tests immediately and refer patients directly to specialists — not just to family doctors. The experience of Finland, Sweden and the Netherlands shows that early intervention through occupational health services, especially for mental health and work capacity, can reduce the number of days lost to incapacity by up to 40 percent.

So, the goal of the next study should be to look for ways to achieve better health outcomes using existing resources and by enabling voluntary contributions — not to search for reasons and excuses why such approaches wouldn't work.

The opposition has tried to bring a no-confidence motion against Minister of Social Affairs Karmen Joller (Reform), citing the involvement of private funding as a pretext, but the minister has done nothing to deserve that. The problem is that financial shortfalls and long-overdue reforms have piled up over time. And now is precisely the time those problems must be solved.

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