Walker's World: The real healthcare crisis

By MARTIN WALKER, UPI Editor Emeritus  |  Jan. 20, 2014 at 5:35 AM
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PARIS, Jan. 20 (UPI) -- At Davos in the Swiss Alps this week, the bankers and thinkers and business leaders who constitute the Amen Corner of globalization will be addressing the implications of longevity and demographics.

One leading issue, already alarming politicians and officials in countries, is what this means for health costs. There are 32 countries in the world where life expectancy has risen to more than 80 years. By the end of this decade, more than 50 counties expect to face a similar tidal wave of elderly people.

The conventional wisdom is that longevity will be so expensive that it threatens to bankrupt public spending and private savings. Good recent data from Canada suggest that average health costs per age group break down as follows:

Age 1-64 $4,050

Age 75-79 $11,200

Age 80+ $17,600

Data from the United Kingdom are particularly useful because the single-payer system of the National Health Service covers everybody. The latest figures suggests that over-65s in the United Kingdom visit their doctor seven times a year, on average, while those aged 16-44 do so four times a year. The over-65s account for two-thirds of general and acute hospital bed use, even though they are only 16 percent of the population.

In the United States, spending on over-65s was more than three times the figure for those of working age. Almost universally, spending per head on health grows slowly until age of 55 when it escalates rapidly, frequently tripling by the age of 80.

But to take this at face value and conclude that the elderly are the problem would be to make a mistake. The data also reveal that the problem is that the nature of medical care is changing. Traditionally, medicine dealt with acute problems, like a broken limb or a sudden illness, fixed the ailment and the patient usually returned to normal life.

Increasingly, however, medicine is dealing with chronic problems that go on for years. Illnesses are more and more being managed rather than cured.

Cancer patients can survive for years. Victims of diabetes and Alzheimer's disease usually need treatment for their remainder of the lives. This, rather than age itself, is the real reason why health costs are rising.

The 15.4 million people in England with at least one long-term condition already consume 70 percent of the NHS's $180 billion budget as well as 60 percent of the $25.4 billion spent on social care in England.

"It's the healthcare equivalent to climate change. It is putting pressure into the system, which, unless we change the way we address the problems, will overwhelm the system," says Dr. Martin McShane, director in the English NHS for people with long-term conditions.

These long-term conditions include arthritis, heart disease, breathing problems, obesity and mental health conditions such as Alzheimer's and depression.

But this isn't just about the elderly. It is about people of all age-groups with these long-term problems. That, rather than longevity itself, is the real challenge.

NHS data show that a small minority of people account for a greatly disproportionate share of health costs. Just 1 percent of NHS patients account for 16 percent of overall days spent in hospitals, where the costs are highest.

Three percent of patients account for 32 percent of all in-patient days. Five percent of patients account for nearly half in-patient days. Often they don't need costly operations but they do need continuous and costly care.

This raises two important issues: First, could genetic medicine reduce the numbers of people with these long-term conditions, if one could identify, isolate and deal with a gene that was responsible? If so, much of the problem is solved. But genetic medicine has so far proved far more complex than this, with genes having multiple, rather than single effects so such treatment could prove worse than the original ailment.

Second, if the cost of long-term care is largely a result of the need for intense and continuous human care, could robotics take over many of the tasks, from monitoring patients to delivering medicines, from bed-changing to keeping the patient entertained and free from depression? Japanese hospitals are already finding that robot pets and robot children can have very positive effects on the mental health of geriatric patients.

In short, longevity isn't the real problem and methods are emerging that could help control the costs of care, even as we wait for the promise of genetic medicine to bear fruit. And those are the kinds of challenges the assembled brains of Davos know how to tackle.

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