Sustaining Healthcare Delivery

Times of Malta, Business Section, September 2011

By, Anthia Zammit LL.B, LL.D

National health care services and goods are not free. They are paid for by the national insurance and tax contributions of the same population that receives them.   Over the last decades, healthcare expenditure in European countries, including Malta, has been increasing far more rapidly than GDP, raising serious concerns about the long-term sustainability of current trends. The overwhelmingly wide disparity between public and private charge-out cost to patients in Malta does nothing to ameliorate the situation.

A number of key determinants – population demographic, economic performance and income, institutional and budgetary framework, scientific advancement, lifestyle changes and the ageing population – have been cited for rising health expenditure.  Most health care decision makers agree that addressing the social determinants of health more consistently and systematically would lead to substantial gains in public health and long-term cost-savings.

Medical innovation comprises new technological equipment, surgical procedures and medicinal products. Although innovation can reduce costs per individual treatment, factors such as the increasing number of applications, indications and treatable conditions, coupled with the broadening definition of ‘disease’ make new medical technology a major cause of the rise in health expenditure. The adoption and diffusion of new medical technologies and information services (e-health) is an expensive and yet indispensable aspect to proper health care management as harmonized EU-wide online databases form the crux of patient rights enhancement through the sharing of patient records and real-time access to information on medicinal products and their manufacturers and distributors.

The main challenge is the design and implementation of efficient, pluralistic systems of health care delivery and funding, where public and private financing would substantially promote economic investment and scientific innovation, without imposing unsustainable burdens on public budgets or denying care to the disadvantaged population.  Achieving this is far from straightforward.    Author David Bornstein writes in The New York Times “As health care costs continue to spiral out of control, it’s often forgotten that one of the best ways to lower health care expenditures is to reduce the amount of medical care that’s needed to keep people healthy. This is no revelation. However, because of the financial incentives in our health system, the things we can do to promote health, and prevent illness, are not prioritized.” The difficulty stems from the fact that monetary value cannot be placed on ‘intangibles’ such as preventative health care measures. Medical therapies and medicines are used to treat tangible, visible symptoms of a known disease or condition.   The manifest division between preventative and curative health measures is reinforced by the custom of monetary payment for measurable effects of treatment.

The diseases that account for the highest mortality rates in the advanced industrial regions on both sides of the Atlantic, such as cardiac disease, cerebrovascular disease, cancer, Alzheimer’s disease and arthritis have been largely attributed to environmental factors such as pollution and diet, and the aging process itself. Moreover, although discovery of the genetic code and biochemical study of disease has proven valuable for diagnosis, the successful discovery of medicinal treatment has been demonstrably difficult. The hefty price tag that comes attached to novel state-of-the-art medical treatment is likewise disconcerting, and presents real concern on access and affordability. Untreated chronic illness (such as diabetes and hypertension) has furthermore shot up the percentage of the population needing expensive medicinal treatment and medical intervention to alleviate symptoms of serious secondary illness.

The pharmaceutical industry justifiably argues that the use of today’s medicines effectively contributes to preventative health care as medicinal products save long-term costs associated with more expensive, invasive medical treatments such as surgery and financial losses as a result of reduced employee productivity. However in certain instances, the use of medicines could even be avoided altogether if the disease is prevented from the very onset or if it is diagnosed early. The great societal cost, in health care provision and medical expenditure, as a result of unhealthy lifestyle choices and lack of health education must be acknowledged and tackled by legislatures as the first step towards increasing patient autonomy and patient empowerment. Rigorous health literacy programmes are of course essential if consumers are to derive any benefit from health information campaigns.

On the European level, Article 168 of the Treaty for the European Union reasserts the principle of subsidiarity in public health. This means that individual member states retain responsibility for the “definition of their health policy and for the organisation and delivery of health services and medical care,” including the “management of health services and medical care and the allocation of the resources assigned to them”. As States continue to shoulder the burden of preventable illness, an aging population, and the cost of new therapies and medicinal treatments, it will become apparent to governments that maintaining their health care system is doomed to become unsustainable. In light of this, failure to draw up rigorous preventative-healthcare legislation and adequate implementation frameworks aimed at reducing the need of healthcare usage might very well prove detrimental to the sustainability of health care delivery to the populations of developed nations.

Anthia Zammit served as a member of the European Patients’ Forum Policy Advisory Group (2011 – 2013). Based in Brussels, Belgium, the EFP is one of Europe’s largest patient-representation, public health, and health advocacy umbrella organisations (2011 – 2013) representing an estimated 130 million patients.