The knowledge about a positive correlation between life expectancy and gross domestic product (GDP) is a commonplace. Also a positive correlation between mortality of children less than 5 yrs (U5MR) and health expenditure is well established. The drastic difference in child mortality between economically developed and economically underdeveloped countries is a point in case. Likewise, after the first gulf war child mortality increased by more than 100% in Iraq on economic sanctions.

In economically developed countries, which finance their health system sufficiently, a fundamental question is whether this money does arrive at all patients, who need it, or does it get lost for supplementation of outdated structures, bureaucracy and administration or for unjustified profits of stakeholders. For example, health expenditure and child mortality are 16.0% (GDP) and 7.8 ‰ (U5MR) in the USA vs. 9.1 and 3.0 in Sweden. In the early 2000’s Eastern Austria supplied 1.385 hospital beds for its sick children, the German part of Switzerland (with a similar population of just below 5 millions) supplied 762 beds, although U5MR was the same (5.5 ‰; in 2001) in both countries.

However, because of a dramatic lake of international, comparable data it is difficult to pinpoint strength and weaknesses of paediatric health care systems of different countries.

In coming years, child advocacy should fight for

1. adequate economic support of paediatric health care,

2. for the direct benefit of all sick children from health expenditure and

3. for provision of international comparable data on paediatric patients.