“Health Budgets” Don’t Add Up: A Forward Agenda for Access, Equity, and Delivery

Every year, health budgets are announced with promise, yet the reality remains: waiting lists grow, emergency rooms overcrowd, and families face crippling bills. This persistent gap exists because we fund systems of the past, not the needs of present-day patients. To achieve different outcomes by 2026, we must budget for a different health system now. Current challenges are stark. Prices for medicines and technologies outpace general inflation, while supply disruptions and unequal access to advanced therapies widen treatment gaps.

Donor funds often remain fragmented, failing to strengthen primary care or community health. Consequently, many governments have extended paper coverage faster than ground-level capacity, creating queues instead of access. Out-of-pocket costs stay high for the most vulnerable, primary and mental health care are chronically underfunded, and workforce burnout is endemic. To close this budget-needs gap, we must enact three fundamental shifts:

Globally: Buy Smarter, Share Faster, Build Resilience

Pool purchasing across regions for essential medicines and vaccines to secure better prices and steadier supplies. Expand voluntary licensing and tiered pricing to speed up access to innovations for safety-net populations. Direct a fixed share of development funding to health system foundations, data standards, community health platforms, and climate-resilient facilities, rather than solely disease-specific programs.

Nationally: Fund What Works and Protect Households

Move from incremental to needs-based budgets tied to disease burden and deprivation. Fence annual growth for primary care and enforce mental-health parity. Reform payment models with blended capitation for primary care and bundled payments for high-volume pathways like diabetes and maternal care. Cap out-of-pocket costs for the poorest and automate enrollment in support programs. Build a real workforce strategy with training pipelines, task-sharing, and rural incentives to grow capacity where patients live.

Locally: Redesign Access and Standardize Care

• Make same-day primary and behavioral health appointments the default. Establish nurse-led chronic clinics, virtual wards, and hospital-at-home services. Implement integrated care pathways with navigators for vulnerable groups. Fund practical equity enablers like transport vouchers, translation services, and community health workers. Fix digital basics with one patient ID and interoperable records to drive targeted recalls for immunizations and chronic disease management. Before approving any program, we must demand answers to:
• Who benefits first, and who is left behind?
• Which barrier (distance, language, stigma, cost) is removed?
• How much does this reduce out-of-pocket costs for the poorest households?
• Which metric improves by when, and who is accountable?

We must earmark taxes for prevention and use blended finance for infrastructure. Sign outcomes-based contracts and create regional reinsurance pools for catastrophic cases.

The minimum required budget growth must cover population demand, disease burden, health-specific inflation, and a dedicated equity catch-up for underserved areas and primary care. Anything less consciously chooses longer waits, worse outcomes, and deeper inequity.

This is not about spending more everywhere, but spending smarter where it counts: primary care and mental health upfront, pooled purchasing and smart payments in the middle, and rigorous transparency at the end.

Next year’s budgets can repeat the ritual or rewrite the results. The difference is whether we fund yesterday’s line items or tomorrow’s health system.