Economic and environmental crises put pressure on health spending

The paper from health economist Associate Professor Martin Hensher - recently published in the journal Health Economics, Policy and Law - examines the worldwide trend towards ever-slower economic growth and what this means for healthcare.

Associate Professor Hensher said that since the 1960s healthcare spending in developed countries had increased rapidly as a proportion of GDP. In Australia, the share of total healthcare spending has doubled in the past 50 years, rising from less than 5 per cent of GDP in 1971 to 10 per cent in 2018.

But Associate Professor Hensher said a slowing global economy coupled with ecological constraints was forcing healthcare systems to confront the reality that more healthcare was not necessarily better healthcare.

"Healthcare systems have to start making some changes, as we can't and won't keep growing at the pace we've been previously accustomed to," he said.

"Slowing growth in healthcare expenditure is already visible across the globe, and this directly reflects the long-standing trend of slower economic growth. These trends will impact the private sector every bit as seriously as the public health system."

Associate Professor Hensher's research identifies several key forces that have been driving economic growth lower for decades, with little sign that conventional economic policies are being adjusted to meet these challenges.

"Future healthcare systems will need to be much more tightly focused on reducing overtreatment and low-value care, reducing environmental impact, and improving efficiency in both public and private sectors," he said.

Associate Professor Hensher said the expanding use of technological advances was the biggest driver of increases to healthcare spending.

"Many amazing new technologies have allowed us to deliver better outcomes and improved survival over the years.  But as we keep on introducing new technology that allows us to diagnose, treat and care for people in new ways, this new technology is not necessarily replacing older interventions, it's often being prescribed to a whole new set of people," he said.

"Over time, new drugs and technology tend to be used in larger and larger numbers of people. We have more 'things' to do and more people using them. When you look at the economic law of diminishing returns, the more you give something to people the less it will benefit them, and - in the case of healthcare - the more chance of harm occurring.

"The danger is some of what we're doing is hurting people rather than helping them. For example new cancer drugs may help extend life by a few weeks or months in some patients, but do nothing more than inflict debilitating side effects in some others.

"Most poignantly, in the USA the well-intentioned introduction of improved new drugs for pain control in the 1990s has led to the catastrophic opioid epidemic, which has killed more than 400,000 Americans. These were useful drugs which can be of great value to patients when used carefully - yet they unintentionally and unexpectedly triggered harms at an almost unimaginable scale."

Associate Professor Hensher said strong evidence now existed of pervasive overuse of healthcare across the world.

"Estimates suggest that between 10 and 30 per cent of all care currently provided may constitute overuse globally. While estimates of all forms of 'waste' in healthcare systems, not just overuse, generate similarly large numbers. Perhaps 20 per cent of all health spending in OECD countries is wasted, and up to 30 per cent of US health spending," he said.

"More healthcare is not better, unless it is the 'right' care. Overtreatment, overdiagnosis and waste in health care represent not only potential harm to patients and inefficiency for health systems, but also a form of ecologically damaging overconsumption.

"Healthcare has an enormous environmental footprint. In Australia it accounts for 5 to 7 per cent of national greenhouse gas emissions. Yet it's only been in the past few years that the sector has started to discuss this impact."

Associate Professor Hensher is now looking at an approach to factoring in the environmental costs of healthcare to economic evaluation of new technologies, something he hopes to publish early next year.

"As an absolute minimum, environmental costs and damages will increasingly need to be built into all forms of the economic evaluation of healthcare," he said.

"The greatest opportunity lies in acting upon the increasing evidence that more health care is not always better, either for patients, the population at large, or the planet; and that less is sometimes more when it comes to achieving the best outcomes for patients and society as a whole. That way, we can focus on making the right health care innovations and developments available to everyone who needs them, without accepting the harms which have sometimes accompanied them in the past.

"As we get better at ensuring we deliver only the right care to those who really need it, we can continue to improve health even while we meet the economic and ecological challenges we will face in the years ahead."