Futurism and how to pay for it dominate the discussions about healthcare delivery closing out the second decade of the 21st century. Biomed and biotech advances are coming on line at a rapid pace, while the methods to pay for them and deliver them to the public are stuck in a tenacious web of political and theological bafflegab, ennui, and archaic bureaucratic insouciance.
Healthcare and medicine are on the brink of another historical milestone, i.e., a revolution in longevity. Babies born today are likely to live healthy lives into their hundreds. Public Health England data predict life expectancy of schoolgirls is now greater than 100 years. Women living in more than half the districts of England are expected to live beyond 90. Male life expectancy already exceeds that of women.
This path towards greater life expectancy reminds me of the Cheshire cat’s forewarning to Alice in Wonderland: “If you don’t know where you’re going, any road will get you there.” There are implications for retirement savings, government pensions, and quality of life in old age; for work rules for the robust elderly; for changes in social and familial relationships and responsibilities; for issues regarding independent living and government financed senior facilities; for financing medical care, and more.
My neighbor, a Holocaust survivor no less, is 96 years old. He lives with his eldest son’s family and employs an aid to take him back and forth to the doctor and synagogue. Mr. B. is loaded with healthcare tech wearables which can call for assistance if he falls, measure his blood pressure, heart rate, glucose level and breathing, and remind him to take his medications. He can be linked to his doctor via mobile devices, though Mr. B. prefers office visits. Two retirement/nursing facilities are under construction within blocks of Mr. B.’s basement apartment in his son’s home. And while his children love the idea of their father moving into either one, Mr. B. feels independent staying where he is, where he will not run through his savings like he will moving into a facility.
Mr. B. has a sleep aide machine at home and oxygen breathing assistance medical device. He is potentially a high-cost patient at his age if he needs be hospitalized or 24-hour care warranted. He takes more pills than most to regulate his heart and for other ailments.
This situation has implications for setting healthcare priorities finishing out the decade. The family is absorbing more of the rising healthcare costs for their elderly parent. The rate of the consumer portion of health insurance increases has continued to rise substantially since 2001, outpacing the consumer price index.
Israel’s socialized medicine model is running in the red. It takes six months to get an appointment with a specialist for non-emergency care. The insurance funds run huge deficits, delaying payments to doctors and hospitals. It takes approximately 25 years to build a new hospital, and hospitals are overcrowded at various times, leaving patients on gurneys in the halls. A good part of these conditions are caused by the growth rate of Israel’s aging population, which is among the highest in the Western World and increasing. Its over-65 population will double by 2035, with little or no planning underway for the services they need.
This situation is mirrored in many Western countries such as Japan and the U.S., where state budgets are being “shellacked,” as Scott Becker and Molly Gamble point out in Becker’s Hospital Review (June 22, 2015). Many governments and communities are using outsourcing companies to plan quality of life programs for their ageing populations with an eye to costs and sources of payments. Costs too burdensome to families will impact their stability, hence outsourcers need be very sensitive to balance payer responsibilities.
The Affordable Care Act is bringing in thousands of new entrants to the medical care delivery system. The health sector has to get to know these individuals, many of whom as young people seldom visited doctors and others who without health insurance much of their lives are not in the system. The physician I visited for the first time in many years ordered a battery of baseline tests that the government paid for in my late 60’s. Several meetings were necessary before the physician got to “know” me and my ailments.