Live long and prosper, without fiscal doom [health costs]

TheGlobeandMail.com – news/commentary/editorials
Published Friday, Sep. 02, 2011

In Jonathan Swift’s Gulliver’s Travels, there are people called Struldbrugs who are immortal but age just like all human beings – a miserable, infinite fate. A more realistic version of the same idea is suggested by the facts of increasing longevity, the aging population and the continually rising share of public spending on health care.

But Steven Morgan and Colleen Cunningham, two health economists at the University of British Columbia, in a paper published this week in the journal Healthcare Policy, have done much to remove fears of a Struldbrugization of Canada, or for that matter of the whole developed world.

Living longer does not mean being sicker longer. This is not a new insight among scholars, but Dr. Morgan and Ms. Cunningham studied data, not just about a random sample of individuals, but about a very large majority of the people of British Columbia over a decade. They conclude that only 1 per cent a year of the spending on treatment in hospital, by physicians and by prescription drugs can be attributed to the aging demographic.

Instead, the seemingly irresistible, inexorable rise of health-care spending has more to do with greater use of pharmaceuticals and with more and more services from more and more specialists – not just by the old, but by all patients.

Dr. Morgan’s and Ms. Cunningham’s findings in “Population Aging and the Determinants of Healthcare Expenditures” are reason for hope. If longevity, a result of the success of modern medicine, were the main cause of the steep climb in health-care spending, little could be done to arrest the trend.

If they are right, medical personnel, governments, hospitals, patients and citizens generally can work toward the control of costs. Public policy should be able to restrain health-care spending from eventually taking over an unsustainable, grossly unreasonable share of public budgets.

The overall thinking of the Healthcare Policy article is not new among scholars, but it has not hitherto got through to much of the wider world of public-policy discourse. But Dr. Morgan’s and Ms. Cunningham’s paper, which is lucid and firmly based in evidence, should win attention.

In other words, Canada does not have to turn into the island of Luggnagg, where the wretched Struldbrugs of Gulliver’s Travels lived.

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