Whilst the health agenda in the USA has captured most of the headlines, the same issues are confronting other countries too. The central issue remains how to pay for the services, which are expected to be needed by an aging population with a shrinking taxpayer base.
In Australia a tax review has just been completed and the third inter generational report is about to be handed down. This looks at projections for the next generation.
One of the snippets from the tax review caught my eye. It claimed that the cost per head of pharmaceuticals in Australia had trebled in twenty years from around $200 per head to over $600 whilst in the preceding twenty years it had remained stable. This was put down to the development of “blockbuster “drugs.
The cost of drugs in Australia is much less than in the USA due to a system called the Pharmaceutical Benefits Scheme, which in simplest terms makes the government the “sole “ buyer of drugs that are listed on the scheme. So where is most of the money going?
By far the biggest spend is on cholesterol lowering drugs (statins) which accounted for AUD $1billion in 2008/09. Other biggies were reflux drugs and blood thinners at around AUD $200 million each and a common antidepressant at AUD $100 million.
The next question is what are we getting for our money? Life expectancies have continued to gradually increase over the last century by about one quarter of a year per year. This rate has not accelerated over the last twenty years. Rates of heart disease and reflux have not plummeted.
Given the amount expended on pharmaceuticals you would think that questions about benefits would be asked. By this I do not mean clinical trials, which shows that the drug “works”, I mean questions about benefits to society in terms of longevity or better levels of health. There seems to be silence on that front.
It actually gets worse. An Australian review showed that average cholesterol levels in the population had fallen 0.2 units in twenty years. This is despite a trebling in the use of statin medications since 1997 at significant cost, to “lower “cholesterol.
In the whole “healthcare” reform agenda there are always arguments about how we are going to afford the cost of disease. There are never any questions asked about ways to reduce spending on disease by people being…healthier. When one looks at the “conditions” treated by the most expensive drugs they are mainly lifestyle conditions and the cleverly coined term “risk factors”.
In other words we are treating with expensive tablets that which we have brought about through our habits be they dietary, exercise or other. Logically then, if it was not a pill that caused the problem, why is a pill the answer?
What is needed is a change in the way we look at health care. Our current systems are disease systems. The cost comes from treating disease. There is little or no support for or investment in people being healthy. A genuine health system would be looking to keep people healthy rather than pick up the pieces after they have become sick.
As individuals we need to be responsible too. Around three quarters of spending on disease is for diseases that come about not through random action but by our daily actions. We need to be responsible for our own health. Eating the right foods, being active, drinking water, managing our stress and getting enough sleep are not expensive and not difficult.
Given that “lifestyle” diseases are the major “cost” to the disease system, the solution lies not in more expenditure on treatment but in real prevention.
The best way not to be sick is to be healthy.