Foreword and Acknowledgements

The health systems we enjoy today and expected medical advances in the future will be difficult to finance from public resources without major reform. Such reforms require effective co-operation between Health and Finance Ministries. Public health spending in OECD countries has grown rapidly over most of the last half century. It represents on average about 6% of gross domestic product (GDP) in OECD countries, and is projected to consume an additional 2 percentage points of GDP over the next 20 years. These spending increases have contributed to important progress in population health: life expectancy at birth has increased, rising on average by ten years since 1970. The challenge is to sustain and enhance these achievements in a context of tight fiscal constraints in many countries, upward pressures on health spending from factors such as new technological advances and demographic change.