Aging population puts pressure on health system

As the population ages, healthcare models will change to cope with the increasing burden.

As the population ages, healthcare models will change to cope with the increasing burden.

Think the health system isn't working like it should. Maybe that's because you're wanting more than it can deliver. Helen Harvey looks at what sort of healthcare we can expect in an ageing society.

Faith Richards hit a national nerve when she said you needed to lie to get elective surgery in New Zealand.

On Tuesday the 70-year-old New Plymouth woman disclosed she had spent her $20,000 life savings to get her hip operated on, after being refused surgery through the public health system largely because she wouldn't lie about how much pain she was in.  

She isn't the only one who has given up on waiting for the public health system to help them out and taken matters into their own hands. And with an ageing population her story is likely to become more and more common.

With large numbers of baby boomers due to hit retirement age in the next 10 to 15 years, pressure on the already stretched health system will only increase and the way health services are delivered will have to change.      

It's simple maths. District Health Boards are funded per head of population, so the more people a province has the more money it gets. Taranaki's population is barely growing - it has increased just 2.8 per cent over the last 27 years and without a sudden influx of migrants it is unlikely to ever grow faster than that. So, for now at least, health funding to Taranaki in the near future is unlikely to increase terribly much.  

But by 2043 it is estimated the number of people aged over 65 will grow by nearly 70 percent - to more than a quarter of the region's population. You don't need to be a doctor to know the older a person gets the more likely they are to end up in hospital, so either DHBs are going to have to learn to do more with less, or individuals are going to have to increasingly rely on their own resources to meet their healthcare needs. 

Grey Power National Health Advisory Group chairwoman Jo Millar✓ thinks it's strange people are worrying about what's going to happen to the health system in the future, anyway.

"There won't be one," she says.

"The system is so broken at the moment.

"There are people who can't get medical treatment and operations.

"We need to be fixing what is wrong now so it will be there in the future." 

The Ministry of Health's policy is to keep people in their homes as long as possible, something Millar agrees with, but sometimes people need some form of assistance - vacuuming or help with showering, she says.

 "The DHBs have got insufficient money and the first thing cut back on is the home help. So they are defeating the purpose."

Another of her bug bears is elective surgery. If people needing cataract operations got them straight away instead of being on a points system, it would save money in the long run, she says.

"It's a minor operation, but has a huge impact on lives."

People with cataracts have to stop driving, so they stay home,  become isolated, depressed and become a bigger burden on system than if they would have been if they had had the operation sooner, she says. It's a similar argument to the one Richards presented against her being refused a hip operation and the reason she decided to spend her life savings getting it done straight away rather than wait another year to be bad enough for the public health system to throw her a bone. 

While she can understand why Richards did what she did, Millar does not want to see it become the accepted practise. 

"If we don't protect what we've got now and we lose any of it, we'll never get it back in the future," she says. 

The view of the Taranaki District Health Board about the future of health care is not half as pessimistic.

It's message; don't panic. 

There are already various strategies and plans and priorities in place to manage the long projected demographic time bomb, Taranaki DHB acting chief executive Rosemary Clements says.

And reducing the burden on the health system is a major part of that. 

One way is for people to take responsibility for their own health. Another is for treatment traditionally given in hospital to be provided by a GP or in the patient's home, Clements says.

"People need to take responsibility for their health and we need to empower them to do that.

"If they live a healthy lifestyle then they'll age in a way that is healthy. And at the moment we are far from it."

If someone gets an infection they go to hospital to get IV antibiotics. But that could be done by the GP or at home, she says.

"Rather than us doing to things to you, we are going to enable you.

"Take renal dialysis, for an example. If you are on a machine for dialysis we will train you to do that at home, rather than bring you into an institution and do it to you."

If people need an operation or get an awful disease, then the DHBs role will be to assist them to get back to health, she says. 

"If possible in your own home with the support you need and the knowledge you need to support your own condition." 

That's going to reduce a huge burden on the health sector and will free up resources for people who really need help, she says.

But exactly who is seen to need help may become an issue for intense discussion and vigorous debate. And if the onus is on people to take responsibility for their own wellbeing, there may be repercussions for those not seen to be doing this.

Victoria University Professor of Sociology Kevin Dew says people who are deemed responsible for their own health issues, such as smokers or those who are obese, may become stigmatised, 

"It may even get to the point where smokers will not be eligible for services non smokers have access to."

There will be more rationing of services, because demand will continue to increase, Dew says.

"We've had that already around elective services. The need may be based on a clinician's value judgement on whether this person supports their family, do they have dependants?  I'll put them higher up the list than someone else." 

The elderly take a huge proportion of resources, he says. 

"We have a culture of wanting to do something, rather than nothing.

"That might change in the future and we may become more accepting that you don't have to throw massive resources at people who have a much more limited time to live.

"We may well open up that kind of debate."

But he doesn't see an end to the public health hospital system, nor does he believe the notion people will have to take more responsibility for their health has much traction

"There will be efforts to make it more efficient, but those sorts of things have gone on for decades. We started all this in 1938 and fundamentally it hasn't changed since then," he says. 

And he doesn't think health insurance is the answer to future problems, because most people can't afford it.

"It's very expensive and those wealthy enough to take out insurance do, but it's out of reach for so many people."

Down the track expectations about what services will be available will have to change, Dew says.  

But he doesn't think the notion people will have to take more responsibility for their health has much traction.

And the suggestion people's choice around their activities are a prime mover of bad health is misguided, Dew says, because of differences in social class.

"The idea people are going to have to make better choices around healthy behaviours because of a more rationed health system doesn't acknowledge there are lots of health problems related to inequalities in society."  

It's a strong argument with numbers to support it. It is estimated that up to 80 per cent of people are in the health system because of conditions caused by other determinants of health other than their behaviour, such as housing or environment. And inquality is on the rise in New Zealand, as much as three times faster than in other OECD countries. 

Professor Paul McDonald, Pro Vice Chancellor for the College of Health at Massey University, says New Zealand can make changes, but big ideological shifts have to take place around dealing with social inequality. 

"We rely on very over simplistic solutions that keep sending us down the same paths." 

Only 0.1 per cent of the annual increase in the health budget is a result of population ageing, he says.

"It is actually chronic illness that is driving the costs and the fact that we treat chronic illness in a healthcare system that is designed for acute conditions."

Despite that, the aging population is undoubtedly going to put pressure on the health system, he says

"As you get older and towards your final years of life costs associated with health go up.

"I think we need to be concerned but we should use that concern to motivate us to do something about it," McDonald says. 

"The story is for change, but it doesn't need to be disruptive change."

 - Stuff

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