Affording the NHS: estimating demand pressures and the options for addressing the challenge of fiscal sustainability

Rising health spending is increasingly becoming a key concern for policy-makers across many high-income countries due to ageing populations and increasing levels of illness. This is no different for England. Recent health projections have indicated growing major illness which translates to larger increases in health spending relative to GDP. To address this challenge of fiscal sustainability, we need to better understand the different drivers of health care spending and how amenable they are to change. Improving the efficiency of care and reducing health needs have important roles to play but will not be sufficient by themselves. The scope for further funding cuts to other public services is also limited and can have countervailing effects on health spending. This means that the challenge of long-term fiscal sustainability will have to be addressed through increased government revenue such as tax revenues or through increased private spending.