[LUM#6] Healing at Any Cost?

[LUM Magazine] - Published on September 5, 2017 in Science and Society

A surge in chronic diseases, a redefinition of healthcare practices, the digital revolution… As the 21st century begins, our health insurance model seems to have reached a crossroads.

Between 1970 and 2012, the share of GDP allocated to health care more than doubled, rising from 5% to nearly 12% of national wealth. How can this be explained? Valérie Clément, a researcher at the MRE and specialist in the economic evaluation of health, immediately dispels a persistent cliché—that of the “old-age crisis”: “Population aging is only a marginal factor, because people are aging in increasingly good health.” The reasons are to be found elsewhere: rising costs in the healthcare sector, technological innovations made accessible to all, improved screening policies…

Social Justice

Healthcare is not just a cost, after all.“A good healthcare system benefits the economy: good health increases labor productivity and has an indirect effect on savings—and thus on investment,” notes the associate professor at the School of Economics. “The real question, then, is: Who funds it, and based on what collective decision?”

As part of the welfare state—established in 1945 out of a “basic concern for social justice”— health insurance is funded through a collective effort via social security contributions. This social pact has been undermined by the perception among a growing proportion of citizens that they are spending more and more for less and less coverage. A key factor is the increase in long-term illnesses (ALD), which are covered at 100%, a development that has automatically reduced the reimbursement rate for the rest of the population.

Toward the Individualization of Risk?

“A healthy 35-year-old man has no reason to benefit from such a system today,” the researcher summarizes . Faced with this new reality, the temptation to make a historic break is emerging: could the future lie in the individualization of risks, based on a “bonus-malus” model in which everyone pays what they owe based on their behavior? This prospect is made all the more plausible by the advent of connected devices that facilitate personalized monitoring. For Valérie Clément, we’re not there yet: “The French are very attached to the principle of socializing health insurance costs. It’s also important to note that public funding is very effective.” The effectiveness of private funding, meanwhile, remains to be proven. This is illustrated by the example of the United States, the world leader in per capita health care spending, yet with results that have been widely criticized.

A Necessary Shift in Practices

What is the solution for keeping health insurance costs under control? “Healthcare delivery must be more collaborative, multidisciplinary, and coordinated,” the specialist asserts. In fact, the consolidation of healthcare providers into health centers is already a reality.

Another approach: to include in the economic evaluation a range of non-pharmacological interventions that have not yet received much consideration (see Alternative Care ). These include prevention and the promotion of best practices, which have a very tangible impact on healthcare spending. This touches on the individual responsibility of each person, in a country that still consumes 40% more medications than Spain, for example, favoring new and expensive drugs over generics.

Keywords: Economy, LUM#6, LUM Magazine, Health, Company