Western Governments should revisit Greek history

Curbing healthcare costs is like the second of the twelve labours of Heracles, completed at the behest of Eurystheus, the king of Mycenae.

The first time he fought the Lernaean Hydra, a serpentine water monster with multiple heads, Heracles found that for each head he chopped off, two more grew back in its place.

The task seemed hopeless.


Here are just a few of the problems that health reformists face -

  • An ageing population who have grown up a sence of entitlement, demanding every new treatment as soon as it hits the market
  • Corporations that capitalize on this populations anxieties by continuously offering ‘the latest life saving’ services while demeaning any attempts at cost control as ‘cruel and heartless’
  • Powerful unions, professional bodies and guilds that demand restrictive and often illogical work practices and make sacking bad staff difficult
  • A shallow media that would rather indulge in emotional 'sound bites' than confront health managers over their ever rising costs, uneven quality and unwillingness to use implement new technology
  • A fractured and illogical payment system that rewards over use of unnecessary tests and expensive hospital treatments, while depriving primary care programs of funding

Private versus public healthcare

The traditional way of dealing with healthcare problems is to 'push the patient' across the other side of the political court.

Australian politicians have turned to privatisation, claiming it will –

‘drive down costs, force patients to behave like price conscious consumers and force efficiencies.’

In fact, many private patients in Australia are -

  • Paying more in private specialist fees, joint replacements and administration costs that public patients
  • Often left with hidden but substantial out of pocket costs, while public patients having the same procedure get little or no bills
  • Often refusing to go into private hospitals. Public hospitals now employ an army of staff to get patients to sign over their private cover to the public hospital and ensure they get single beds or extra days in hospital in return

On the other side of the world, some members of the British political classes have been trying to turn the National Health Service into a religion for years. However the sad reality is that the NHS  -

  • Now costs ten times more than it did when the service was introduced in 1956 (this is taking inflation into account)
  • Is over focused on acute hospital treatments, while general practitioners are squeezed continuously and home care is underfunded and fragmented
  • Has a bloated bureaucracy - between 2004 - 2008 alone the cost of managers, clerical staff, consultants and temps doubled
  • One in ten Brits now have private health cover to manage growing elective waiting lists and Emergency departments that often fail their waiting time targets

A few countries have begun to control costs and increase efficiency -

Denmark implemented major healthcare reform in 2007

They reduced the number of their hospitals by one third, and forced those that remained to both modernise, and focus on a particular specialisation.

Primary care in community hubs that were able to managed the entire of patients treatments became a major focus.

The result? After a short term public backlash, costs are stable, reform is up and the community is satisfied.

Singapore forces people to save for their healthcare through mandatory savings accounts.

If they are unwell and require hospitalisation they can receive heavily subsidized treatments. If they can’t afford hospital care, the government may add money to their private savings account.

The result? 5% of GDP spent on healthcare (that’s half what other western nations are paying) to achieve some of the best outcomes in the world.

Germany has a joint payment system funded by compulsory private insurance and government funds.

Patients are allowed to seek almost any type of care they wish whenever they want it.

Health insurance plans have to compete with each other. The ability to be treated at home if you wish, is a legally mandated right.

The result? An highly efficient system, with build in competition and a far higher level of home care than other western nations.

The future

Healthcare costs will continue to skyrocket, sucking ever more money away from public infrastructure and education, bankrupting both governments and individuals.

The children born in Western countries today are expected to live until they are 100. Combined with rising technology and job losses, pension costs will also keep rising.

I predict that countries that fail to tackle widespread health industry reform, will eventually collapse under the weight of debt.

Modern reformists should re read the Greek classics.

Heracles eventually overcame the mythical serpent by calling on the assistance of his nephew Iolaus. Together they used their brains and tactics to outsmart the monster, rather than just hacking at it with a sword.

Wikihospitals July 2015

References

Hospital centralization and performance in Denmark—Ten years on

The 3 factors that make Singapore’s health system the envy of the West

What Health Care Needs: Real Consumers and Dynamic Competition – The Atlantic October 2012

10 charts that show why the NHS is in trouble - BBC, May 2018

Spending on NHS bureaucracy up 50 per cent The Telegraph December 2009