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Health after wealth
by Michel Andrieu
An ageing population, combined with changing lifestyles and the emergence of new health threats, will increase the pressure on national health systems in OECD countries.
Over 65s accounted for 10% of the OECD’s population in 1950; they will account for twice that by 2050. The oldest and frailest are the fastest growing group among the elderly. In France, the number of over-75s is expected to increase by 40% over 1990-2010. Because the elderly are by far the largest users of health services, this “double ageing” process will mean higher health costs and an increasing concentration of health expenditure on the aged.
By 2040 in OECD Europe the share of health expenditure accounted for by the over 65s is expected to range from 30% in Belgium to 63% in Sweden; this compares with 22% and 51% respectively in 1980.
Lifestyle changes due to rising affluence may improve personal health, but ironically the burden on health care could become heavier as higher living standards tend to raise the demand for higher quality (and hence more costly) health care as well. Also, alterations in family structure, such as a rising number of single-person elderly households and weaker inter-generational ties, can boost demand on public health provision. Moreover, the participation of women in the labour force is expected to rise in most countries, and this will increase the demand for publicly provided care.
The future will bring its health threats too. Some communicable diseases may become virulent. There will be health risks from pollution and the degradation of the environment. With global warming some tropical diseases could reach Europe or North America, while there is no sign as yet that the condition of the ozone layer, with its attendant skin cancers, eye diseases and weakening effects on the immune system, is about to improve.
Disability-free life expectancy is rising too.
On balance, the quality of life should improve in the coming decades, rather as it has in recent ones. OECD data show that not only is life expectancy rising, but the number of years on disability-free life expectancy is on a steadily improving trend too (see Observer 216, page 60). Although the number of age-dependent chronic conditions stands to become more prevalent, advances in science and technology will boost the quality of health care, holding the promise of more effective cures for today’s deadly diseases and perhaps remedies for new pathologies. Progress in biotechnology offers new opportunities to anticipate, prevent and treat a number of genetic diseases, including cancer. Surgery is also becoming more efficient, thanks to medical imaging and the trend away from major incisions to endoscopic techniques. Finally, the application of informatics will significantly improve the availability, management and effectiveness of health care services. Telemedicine and information management will bring specialised services and expertise to the most remote areas. Artificial intelligence and expert systems will be used routinely in clinical diagnosis and will play a key role in preventive medicine.
Some of the new advances will call for more sophistication in the management of health care because of the complex ethical questions they raise, such as about genetic manipulation, or organ transplants. Some of these questions have profound cultural and political implications.
Health care is also about raising revenue and controlling costs. Indeed, health systems in most countries will be confronted sooner or later with common pressures: they will all need to adjust to changing health care needs as populations age and new health threats emerge; they will all have to contain costs and establish a financial arrangement which is viable and politically acceptable without compromising social equity.
Substantial cost savings could result from efforts to curb treatments of doubtful therapeutic value. Moving from a “fee-for-service” to a “fee-for-benefits” approach could be another way to improve quality of health care and contain costs. And a new allocation of financial responsibilities among key players, with greater individual responsibility for health, might also be the answer, provided an inequitable dual-tier system is not generated in the process to simply add to the problem of “double ageing”.
Bibliography
Challenges Of An Ageing Europe, (orig. Les Défis d’une Europe Vieillissante), by Jouvenel, Hugues de, in: Futuribles, Hors Série, PP. 38-51, 1999.
Demographic Issues In Medicare Reform, by McKusick, David, in: Health Affairs, Vol. 18, No. 1, 1999.
Ageing and Technology, by Banta, David OECD, Directorate for Science, Technology and Industry, Paris, 1998.