Finnegan's Take

A new report paints a stark picture of European healthcare in 2030 but says GPs are the answer

I’d recommend reading the latest health report by the Economist Intelligence Unit – if you’re elated and need your mood taken down a few notches.

They’ve seen the future and it ain’t pretty.

With Europe’s population ageing, chronic diseases on the rise and medical inflation running way ahead of economic growth, the number-crunchers in London have come up with five possible scenarios for 2030.

The first is that technological breakthroughs magically solve the chronic diseases crisis but the chances of that are slim. The next is the creation of a pan-European healthcare system – something that would require agreement from all 27 member states in a policy area where there are huge philosophical differences, and at a time when the financial crisis has strained relations in the bloc. This one, I believe, can also be discounted.

In any case, while it could create some efficiencies, it wouldn’t necessarily answer the fundamental questions posed by an ageing population. Presuming then that universal health coverage continues to come under severe pressure, the Economist Intelligence Unit suggests either prioritising public spending on the most vulnerable in society, or simply privatising all aspects of the healthcare system.

Thankfully, there is a fifth option: shift resources towards preventative medicine and radically cut back on inpatient care. Here, the heroes of the hour are GPs. With echoes of a dodgy Witney Houston song, the Economist believes that GPs are the future – teach them well and let them lead, they say.

According to Dr Mukesh Chawla, manager of health, nutrition and population for the World Bank, “Just appointing general practitioners as gatekeepers should suffice to deal with the growing healthcare expenditure problem.”

An optimistic view, perhaps, but it shows how reliant future health systems will be on general practice and highlights the need to invest – even at a time of public spending cutbacks and a private sector credit drought.

Primary care will have to bear a bigger burden but it’s not all bad news for GPs. Yes, they will be expected to treat more patients, reduce specialist referrals and ration health resources – but they might get more money for it. “This will imply some upgrading of the skills, status and pay of medical generalists and more scope for them to deploy their knowledge and skills,” according to the report, entitled The Future of Healthcare in Europe.

GPs will be “patient managers” rather than just doctors in the Brave New World of 2030 healthcare. The report quotes Dr Margaret O’Riordan of the Irish College of General Practitioners, who makes the case for putting GPs at the heart of our future health service.

“With ageing you also get a multitude of sicknesses, co-morbidities, where the average person has three to four chronic diseases, each being cared for by different specialists. If you treat one disease, you may upset another. The GP is in the unique position to manage multi-morbidites in a holistic manner.”

So, the most feasible and palatable or the five scenarios will mean taking resources from hospitals and giving them to general practice. Less inpatient care, more community-based management of chronic disease, more primary car teams – but haven’t we’ve heard this before?

The Economist’s report is based on an extensive series of interviews with doctors, patient groups and policymakers, but they could just as easily have read the 2001 Primary Care Strategy published by Ireland’s Department of Health.

The problem, as Ireland’s experience has shown, is that while everyone might agree that we should move to a more GP-focused health system in order to save money and improve services, getting there is difficult and expensive.

The only hope is that these extraordinary times will breed radical solutions. We must hope policymakers don’t waste a good crisis.

Europe’s demographic nightmare

According the World Bank, public expenditure on healthcare in the EU could jump from 8% of GDP in 2000 to 14% in 2030 and continue to grow beyond that date. The reason? Europe’s population is ageing and chronic diseases are on the rise.

The UN’s World Population Prospects report projects that the proportion of Europeans aged 65 years and older will grow from 16% in 2000 to 24% by 2030. Life expectancy is also on the increase, particularly in the richer European countries.

Eurostat figures show that life expectancy for male babies born in 2030 is more than a decade higher than that for those born in 1980 in the EU-15.

The problem did not come out of the blue. Demographic trends have been clear for decades, prompting some European countries to implement sweeping reforms. Alas, none has found the magic bullet yet.

2030 Vision: Five scenarios for European healthcare
– Technology triumphs and cures chronic disease, while e-health takes a prominent role in the management of healthcare;
– European nations join forces to create a single pan-European healthcare system;
– Preventive medicine takes precedence over treating the sick;
– European healthcare systems focus on vulnerable members of society;
– European nations privatise all of healthcare, including its funding.

This article originally appeared in ‘The Practice’ magazine

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