Healthcare spending is increasing : we need to design health into our communities and prove the projections wrong. 

A recent article, “Future and potential spending on health 2015–40”, published in The Lancet sheds light on the funding of healthcare worldwide and contains projections that will be of interest to all working in the healthcare sector.

Looking ahead to 2040 is a minefield for anyone but this study sets out to do so by applying academic methodologies to the task and too that extent is a valuable contribution to the literature on this subject. In summary, investment in healthcare is found to be increasing worldwide and some common assumptions are challenged.

Global spending on health from sources including government, private insurance, and patient payments is projected to increase from over $9 billion in 2014 to over $24 billion in 2040 (inflation adjusted to 2015 prices). Indeed increases are expected in nearly all countries for both government and total healthcare spend.

It is a commonly found view that less well-off countries will spend more money in coming years to improve the health of their (often increasing middle class) populations and indeed this is anticipated for in India and China . However in other cases it broadly remains the case that those countries with low investment in health today will still be in the same position in 2040. The USA and UAE provide an interesting example – both are predicted to have similar GDP per capita by 2040 but by contrast projected health spend of 18.5% and 4.6% of GDP respectively on health by 2040.

In a UK context the report finds that spending on healthcare will increase from 9.1% of GDP to 9.6% with an annual growth rate of 1.8%. This is low compared to China at 7.7% but could hardly be described as a ‘declining market’ when at 2015 prices investment will grow from $3749 to $6169 per head.

Similarly it is projected that government (and therefore tax payers) will be doing the heavy lifting 83.3% – when it comes to paying for healthcare, virtually the same as now (83.1%). The contribution of private insurance (7.1%) and patient payments (9.5) are expected to remain very similar to now.

This is perplexing however and nothing like the projections we see in the media or in discussion and perhaps this is where the limitations of the study (often the most thought provoking part of any study) are worth considering. 

The study notes that the projections are based on “past trends and relationships… This research does not address novel policies that skirt observed historic norms, potential environmental changes and challenges, and technological innovations in excess of the innovations observed during the last 20 years.” 

For me this gets to the heart of some serious questions for anyone working in the field of health and wellbeing from clinicians to architects, and important questions for wider society. As a starter for ten:

What might the novel policies and approaches be that could counter this trend? Programmes such as NHS England’s Healthy New Towns programme look to potential futures that design health into the fabric of our communities rather than treating people once they are sick. An event in Bristol last Autumn posed the question: Developing Healthy Neighbourhoods: Build-in Health or Build More Hospitals?

My own research poses the question: Why do streets make people sick? If the design of the places we live in kept us healthy in the first place then would this have an impact on these projections?

These projections could be viewed as a failure to address the large health issues societies around the world face. Should policies be looking now at investment in programmes that will stem the tide of chronic disease and seek to influence these projections. What are the investment models and strategies that might be needed to do so?

What about those predictive models – are they sophisticated enough and do they allow us to plan policy and interventions now that might help us understand where to have the biggest impact on the burden of disease both in economic terms and quality of life?

Could it be said that some of the costs of infrastructure and health system tools are based on over-reliance on an over medicalised view and ‘rich world’ approach to treatment of illness and disease. The report emphasises that the need for these tools arises due to changes needed to treat chronic, non-communicable diseases. 

With this in mind where are the examples of, and investment in, good practice from around the world that can be implemented – examples such as kangaroo care / skin to skin contact in neonatal treatment is the sort of example that springs to mind.

Where are the examples of, and investment in, promotion of healthy behaviours such as those demonstrated by The Caerphilly Collaborative Cohort Study: non-smoking, a low body weight, regular exercise, a plant based diet, and a low alcohol intake (note to self too!). My own interest is also in the impact the design of the streets where we live has on these behaviours too.

As the study looks at health only and not for example social care spend – how might this total budget change over time. The Conservative Party Manifesto from the 2017 election has been highlighted in the press for leaving an insurance model out of proposals for social care funding and yet others have recommended this plays a part in future funding.

Improved projection data for health spend is a valuable and welcome contribution: we should all be concerned enough to take up the challenge of proving these projections wrong.

Original Article Citation (Open Access): Global Burden of Disease Health Financing Collaborator Network (2017) Future and potential spending on health 2015-40: Development assistance for health, and government, prepaid private, and out-of-pocket health spending in 184 countries. The Lancet. pp. 2005–2030. doi:10.1016/S0140-6736(17)30873-5.