What price good health?
Written By Project M
Good health is priceless; bad health tends to be expensive. In these days of an aging population, people are living longer but not necessarily more healthily. The over-60s already account for a quarter (23%) of the global burden of death and illness, according to John Beard, director of aging and life course at the World Health Organization (WHO).
The concern is that an aging population will equate to higher healthcare costs, weighing down individuals, families, healthcare systems and economies. As a consequence of global aging, the incidence of non-communicable diseases, such as heart disease, stroke and diabetes is set to rise. So is cancer: the annual number of new cancer cases is projected to balloon to 17 million by 2020, and 27 million by 2030, according to Beard.
Then there’s dementia. Its prevalence rises sharply with age: around a quarter of people aged 85+ suffer. Michael Hurd, director at the RAND Center for the Study of Aging, found that dementia has a total annual societal cost of $41,000 to $56,000 per case in the US, amounting to $159 billion to $215 billion nationwide in 2010. By 2040, estimates suggest that these costs will more than double.
BITTER PILL TO SWALLOW
Before we panic, costs might not be as extreme as expected. Population aging is only a relatively minor driver, says Beard. Aging contributed only 2% of global healthcare cost inflation in a study for the US from 1940 to 1990 (a period of faster aging than is currently being experienced), with bigger drivers including new technologies and inefficiencies in the system.
In addition, research from Tom E. Getzen, professor of risk, insurance and health management at the Fox School of Business at Temple University suggests that healthcare spending as a percentage of GDP is determined by what the country can afford. Once the country determines that amount, it is split up among age groups.
For many elderly, however, the price of medicine remains too high. Even in developed countries, older people often have to choose between buying medicine and food. Prescriptions in the US regularly go unfilled because of cost, says Tim Dall, managing director for healthcare and pharma, IHS Life Sciences.
Lowering medication price seems the obvious answer but could cause pharmaceutical firms to lose the impetus to innovate. While some medications are expensive when first introduced, prices fall substantially as they go from brand to generic, explains Dall.
“In early years society may pay a high price but in the long term, we are better off,” he says. “If the price falls over time, it is a win for everybody. The pharmaceutical company gets a reward for innovation and society benefits because people eventually have access to lower cost medication.”
MORE GERIATRICIANS, FEWER COSMETIC SURGEONS
It’s not just the price of pills, it’s also a case of whether medication is age-appropriate. Older bodies are different – they have different conditions and metabolisms to younger people. But widespread uncertainty remains about responsiveness to and tolerance for drug treatments in a population of over-65s – let alone one of over-80s.
Clinical trials for new drugs, for example, rarely address populations of over-75s as a sizeable cohort. Instead, medical interventions are generally tested on healthy, younger people whereas most people over 65 suffer from more than one condition. There is also the danger of interactions between different medicines: older people tend to take more medications.
Our systems aren’t geared up to the healthcare needs of an aging population, concedes Beard, which basically requires the delivery of integrated care services. “We don’t have enough geriatric specialists or the breadth of skills among frontline clinicians and caregivers,” he explains.
Beard believes geriatric care should be on the curriculum of every health professional so they can acquire basic skills and knowledge to deal with the elderly, which will form the biggest proportion of future clients. Part of the problem is that taking care of older patients and unravelling the complex problems associated with multiple chronic illnesses isn’t so profitable.
“With better reimbursement models, we might be training more geriatricians and fewer cosmetic surgeons,” says Jonathan S. Skinner, professor, department of economics, The Dartmouth Institute.
Ultimately, Skinner says we don’t train enough geriatricians to deal with the growing numbers of elderly; we could exacerbate already long wait times for appointments, reduce access to care for some of the nation’s most vulnerable patients, and reduce patients’ quality of life.
To add to the problem, there is an inadequate number of carers. As people age, many are unable to live alone unaided, for reasons ranging from simple frailty to conditions such as dementia. In the past, family members, particularly women, provided support, but with families spreading out geographically, there are fewer children and grandchildren there to help out.
With today’s woman busy juggling their own lives that may involve careers, families or higher education aims, many elderly are left to rely on paid help. Unfortunately, countries have limited access, particularly for poorer people, for the long-term services needed, ranging from chronic care management to long-term care, explains Beard.
“There needs to be a continued role for families but governments need to provide care for people who have significant needs, with advanced dementia for example or with severe physical losses,” Beard says.
Technology can assist by relieving caregivers of routine, mundane tasks. In Japan, “robot nurses” already clean patients or assist them from wheelchairs and onto beds, for example. More broadly, telemedicine will enable medical professionals to offer advice at a distance, while patients’ vital signs can be monitored remotely.
But sophisticated technology lacks the human touch. Sometimes for the elderly, particularly those without friends and family nearby, paid care workers provide valuable contact to society and are often the highlight of their day. Companies need to look at the needs and aspirations of older people and try to develop products to fill caregiving gaps.
OLD AGE ISN’T A DISEASE
Depressingly, health systems are poorly aligned to the needs of older populations. Most are designed to cure acute diseases, while older people experience chronic diseases and normally more than one of them, says Beard.
“The way forward,” he argues, “would be to provide integrated services that have an overall assessment of the elderly’s needs, identify priorities and then have interventions that address those priorities rather than respond to each individual condition.”
We need to extend affordable healthcare to all older adults, he continues. We should emphasize low-cost disease prevention, encouraging the elderly to reduce salt intake for instance or keep up to date with vaccines, and focus on early detection, rather than treatment.
As Beard points out, the elderly individuals aren’t suffering some unknown, terminal disease called old age. They are patients for whom proper treatment may well increase the length and quality of life for several decades. But they are also consumers, with specific desires and often the assets to match, and citizens with rights.
Source: Project M, October 25, 2016