Health Improvement in a Period of Austerity: a Public Health Perspective

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This article reviews historical precedents, which might help to guide current practice. It discusses the role of explicit rationing, distinguishes between need and demand and their respective determinants, and considers evidence as a means of prioritising health services. It subsequently outlines some of the strategies to improve or maintain individual and population health. To achieve these objectives, governments must analyse the provision of health services, including preventive care, and ensure that adequate information is available on the utilisation and outcome of these services to determine where care provision is deficient. Health improvements and maintenance must entail both considerations of the provision of health care services as well as measures to improve health. In addition, it is important for any society that adequate information is available on both the utilisation and outcome of any services provided both for evaluation and monitoring, in order that appropriate changes can be made in a timely manner.