Here's the abstract:
Although the concept of solidarity sits at the center of many European health sector debates, the content of the services and benefits that solidarity ensures has changed considerably over time. In prior economic periods, solidarity covered considerably fewer services or groups of the population than it does today. As economic and political circumstances changed, the content of solidarity changed with them. Recent examples of these shifts are illustrated through a discussion of health reforms in Netherlands, Germany and Israel (although not in Europe, the Israeli health system is structured like other European social health insurance systems). This article suggests that changed economic circumstances in Europe since the onset of the 2008 financial crisis may require a further re-set of the content of services covered by solidarity in many European health systems. A key issue for policymakers will be protecting vulnerable populations as this re-design occurs.
When money is the constraining resource as it is here, the path of least resistance is probably to ask higher income people to pay more for the same coverage. This is what the U.S. does with Medicare Part B services. Under current law, about 2% of beneficiaries with the highest incomes pay a premium surcharge called the Income Related Monthly Adjusted Amount or IRMAA. Over time, the percentage of beneficiaries paying the IRMAA is likely to grow, perhaps significantly, because of changes recently passed as part of the legislation that eliminated the SGR formula.
ReplyDeleteWhile healthcare is important, there are numerous other important and worthwhile priorities both public and private. Legislators in each country have to make tough choices as to what their society can afford and how high taxation can increase before it impedes the economy’s ability to grow.
On the positive side, I’m optimistic that technological innovation can increase what I call health span as opposed to lifespan. For example, new drugs that could ultimately cure Alzheimer’s and dementia or at least push back the most severe effects of those diseases by 5-7 years or more would be a huge cost saver even if the drugs themselves are somewhat expensive. Self-driving cars and household robots could allow the frail elderly to continue to live independently in their own homes for years longer than they can now. More realistic patient and family expectations at the end of life could significantly reduce futile or marginally useful end of life care as compared to current practice. I’m an optimist on this at least over the longer term.