Public health - what do we need and what we can afford

Abstract

The healthcare systems of most developed and developing countries will be jeopardized by a fast changing demand of services. Contemporary medicine allowed to extend human life by 10-20 years, reaching in many cases life expectancy over 80 years. On the other hand, the “western” living standards lead do development of many chronic conditions – now referred to as diseases of civilization. Taken together we have now longer living citizens, suffering from multiple conditions (comorbidity) which demand chronic treatment. This causes the increased demand on medical services to increase their HLY (healthy life years) and HRQoL (health related quality of life). The chronicity of their treatment as well as extended time causes a substantial raise in medical costs. In Poland, the public payer estimated that treatment of a person older than 65 costs over 3,5 thousand zloty/year, as opposed to 1,4 thousand/year in younger population. In OECD countries, the average financing of healthcare reaches about 8% of GDP, which in many cases proves not to be enough, however. Most likely a substantial raise in public spending in this field cannot be expected. There several alternatives, but most of them based on private spending. In many countries, the alternative of choice is additional (supplementary) health insurance, which can be either obligatory (it adds up to the public funding) or voluntary (private funding).