Costs of health care: a lopsided debate.

Abstract

From every quarter and almost daily, health care workers are exposed to yet another opinion (-ated) viewpoint, claiming that the country can no longer afford its health service or keep up with the developments of modern medicine. No opportunity is lost to stress the concept that making sure that the health service of a nation has an adequate level of funding is a cause perdu and no longer even a cause celebre. This viewpoint is being embraced rapidly and is diffusing almost without perception into the general population – it is in danger of becoming another accepted truth, yet with surprisingly little debate, either in depth or in the public domain. This is curious – those who are involved often express passionate opinions, arriving at a consensus is difficult, and perhaps those who know most about the topic under discussion shy away from public pronouncements, lest it be politically incorrect. And yet there could not be a more important debate than the appropriate funding of the health of the citizens of a nation. The debate, when it occurs, is almost exclusively dominated by considerations of expenditure. Only recently has the debate expanded somewhat to a discussion of the appropriate use of resources (now described as evidence-based medicine) and to the benefit that can be gained by the resources used. Nevertheless, this benefit assessment has not been taken into the wider context of investment in the health of a nation, its levels of productivity, and the efforts and benefits that will accrue if a population is either maintained or restored to the productive cycle of the economy of that nation. Surely there is time for such an assessment to be made in broader terms. So far, we believe, the debate has been lopsided. It is vital that data be available that can be interpreted in all implications. It is not enough to determine costs alone (nation x spends 6.6% of its GDP on health care), but it is also vital that this expenditure be analysed in detail and perceived as an investment in the health of the nation rather than just a cost burden for the taxpayer. This requires fundamental rethinking, and parliamentarians should be willing to debate whether investment in the health of the nation or cost burden of maintaining a healthy population is the starting point of the discussion. Before requesting that the taxpayer invest a greater proportion of his/her income in education, health, social security, etc., the citizen is entitled to know from the politic body what the estimates on expenditure and cost recovery are. What percentage of GDP is recovered when a fraction of the GDP is used to keep the worker in tune with the economic cycle of the society? Costs can also be thought of as mainly a representation of expenses incurred with lost income – lost income as a result of inadequate recovery of gained days at work and its associated increase in productivity and hence increase in GDP. More difficult but not absent in the equation of costs versus benefit is the additional benefit of the intellectual gain obtained by the society when the aim is restoration of health. Not in dispute is the notion that progress in medicine has contributed to the present demographic explosion and, at the same time, to the rectangular structure of the society. We must remain cognizant of the fact that it is modern medicine, today so attacked for its costs, that has created the conditions which will allow society and its health care programs to move from “medicine to survive” to “medicine to feel well”, a strategy that will allow the restoration of hitherto lost organ functions and hence the restoration of the individual to a quality life and a quality work place. At present, there are only inadequate models for the investigation and indeed measurement of the potential financial gain that is to be obtained through modern medicine. There are many studies that analyse cost/benefit relationships and can show the impact of vaccination programs or the efficacy of certain drug regimens and what the consequences might be if these are not available in financing health care. Government budgets are continuously limited, without an analysis of the needs of the individual or the lost benefit from an untreated person. In a number of EU states, social insurance bodies are pursuing an almost exclusively income-oriented expen-