3. Health, environment and behavior: a policymakers perspective

Question 1

health status

Answer 1

life expectancy / preventable mortality

Question 2

risk factors

Answer 2

daily smokers / obesity

Question 3

quality of care

Answer 3

mortality after stroke / screening / antibiotics

Question 4

access to care

Answer 4

satisfaction, low out-of-pocket spending

Question 5

3 pillars of quality and assessability

Answer 5

1. financial sustainability
2. staffing sustainability
3. societal sustainability

Question 6

financial sustainability (pillar 1)

Answer 6

healthcare expidenture as % of GDP.

healthcare expidenture will displace other targets of public policy

Question 7

staffing sustainability (pillar 2)

Answer 7

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.

Question 8

societal sustainability (pillar 3)

Answer 8

concerns about waiting times, willingness to pay for others is coming under pressure. This concerns particularly lifestyle-related conditions caused by smoking and obesity

Question 9

factors that contribute to growing healthcare demand

Answer 9

1. demographic changes
2. changes in health status
3. economic development
4. technology
5. social / cultural changes

Question 10

demographic changes and healthcare demand

Answer 10

proportion of older people is increasing. this leads to more pressure on healthcare.

Question 11

changes in health status and healthcare demand

Answer 11

total life expectancy will increase. more multimorbidity in chronic diseases and dementia. therefore more pressure on healthcare

Question 12

economic development and healthcare demand

Answer 12

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

Question 13

technology and healthcare demand

Answer 13

complex relation with demand

increases quality, higher prices, increases supply, further increases life expectancy, which puts higher pressure on healthcare

Question 14

social / cultural changes and healthcare demand

Answer 14

oldest support ratio is declining. also calls for more personalization. health disparities experienced by socially disadvantaged populations.

also puts a higher pressure on healthcare

Question 15

Strategic Knowlegde Agenda

Answer 15

three broader themes which we focus on

1. health / environment / behaviour
2. scarcity / solidarity / prioritizatoin
3. innovation / implementation / control

Question 16

which has made infections less deadly and more preventable?

Answer 16

improvements in the physical environment (waterworks and sewage), hygiene, medication and vaccinations have made infections less deadly and more preventable

Question 17

paradox prosperity ( = welfare)

Answer 17

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.

Question 18

risk solidarity

Answer 18

insurers must accept every applicant and apply community rating. Risk rating is forbidden.

Question 19

income solidarity

Answer 19

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

Question 20

prevention paradox

Answer 20

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

Question 21

relapse in individual behaviour change

Answer 21

no self-belief / social pressure in diverting from plans / lapses occurring at home.

Question 22

conclusions on health / environment and behaviour

Answer 22

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