3. Health, environment and behavior: a policymakers perspective Flashcards
health status
life expectancy / preventable mortality
risk factors
daily smokers / obesity
quality of care
mortality after stroke / screening / antibiotics
access to care
satisfaction, low out-of-pocket spending
3 pillars of quality and assessability
- financial sustainability
- staffing sustainability
- societal sustainability
financial sustainability (pillar 1)
healthcare expidenture as % of GDP.
healthcare expidenture will displace other targets of public policy
staffing sustainability (pillar 2)
how many people should work in healthcare to meet the projected demand? large claim on the labour market, combined with a workforce that is stagnated, would lead to increased competition from other public / private sectors for scarce labour.
societal sustainability (pillar 3)
concerns about waiting times, willingness to pay for others is coming under pressure. This concerns particularly lifestyle-related conditions caused by smoking and obesity
factors that contribute to growing healthcare demand
- demographic changes
- changes in health status
- economic development
- technology
- social / cultural changes
demographic changes and healthcare demand
proportion of older people is increasing. this leads to more pressure on healthcare.
changes in health status and healthcare demand
total life expectancy will increase. more multimorbidity in chronic diseases and dementia. therefore more pressure on healthcare
economic development and healthcare demand
income elasticity is usually above 1 –> consumption of healthcare increases faster than income increases.
productivity grows slower than in other sectors.
so less productivity in combination with more consumption puts pressure on the healthcare
technology and healthcare demand
complex relation with demand
increases quality, higher prices, increases supply, further increases life expectancy, which puts higher pressure on healthcare
social / cultural changes and healthcare demand
oldest support ratio is declining. also calls for more personalization. health disparities experienced by socially disadvantaged populations.
also puts a higher pressure on healthcare
Strategic Knowlegde Agenda
three broader themes which we focus on
- health / environment / behaviour
- scarcity / solidarity / prioritizatoin
- innovation / implementation / control
which has made infections less deadly and more preventable?
improvements in the physical environment (waterworks and sewage), hygiene, medication and vaccinations have made infections less deadly and more preventable
paradox prosperity ( = welfare)
the scientific progress that underlies the successes in cancer control would not have been possible without the socio-economic development that led to increased cancer risks at an earlier stage.
risk solidarity
insurers must accept every applicant and apply community rating. Risk rating is forbidden.
income solidarity
we pay an income-related contribution, set by the Minister of Health as well as a flat nominal premium set by each health insurer separately
prevention paradox
successful prevention results in lower healthcare costs in the short run, but in the long run it results in higher costs.
substitution of inexpensive lethal diseases towards less lethal and therefore more costly
relapse in individual behaviour change
no self-belief / social pressure in diverting from plans / lapses occurring at home.
conclusions on health / environment and behaviour
demand is rising while resources are become more scarce
broader environment is a necessary route to promote health
scarcity and a focus on prevention can put a pressure on solidarity, an important building block of our system
