No magic to curb rising healthcare costs

Dear Editor

There are no systems in which healthcare has been made “magically cheaper”, as rightly raised by Dr. Salisbury (1). The healthcare demand and need are increasing, and the costs are rising. This is an effect of aging populations and of the apparently never-ending growth in preventive, diagnosis, and treatment possibilities. Further, in many high-income countries including the UK, the gain in healthy and disability-free life expectancy has not matched the growth in total life expectancy (2). There is obviously a cost to the health system.

One misconception is to assume that if you improve the health of the population, you can stop the increase in healthcare costs. This is also an argument often used to promote prevention although preventing diseases will in some cases save money but in other cases will add to healthcare costs (3, 4). We should remember, first, that prevention aims to prevent or at least postpone diseases, increase life expectancy, and improve quality of life but does not aim to save money; second, that treatment for some conditions can be more cost-effective than prevention (4). Preventive interventions can limit the costs rise and be good investments (i.e., add a reasonable amount of benefits for the resources spent), but any improvement in population health opens new avenues for more prevention, more diagnosis, more treatment, and, as a result, more costs.

Another misconception is that identifying healthcare needs is easy and critical to predicting healthcare costs. Needs are however highly dynamic and context-specific, and they relate in complex ways to population health status (5). Trying to design a healthcare system and anticipate costs based on population needs is appealing but will not work if policymakers do not account for the rapidly changing demand and offer; that requires not only a need-oriented and patient-centered approach but also giving more weight to healthcare providers for designing the system. For a more cost-effective care delivery despite constrained resources, applying an evidence-based and user-informed strategy to healthcare is necessary more than ever for NHS and other healthcare systems.

Arnaud Chiolero, epidemiologist and professor of public health, Stéphane Cullati, senior lecturer in epidemiology and public health, from the Population Health Laboratory (#PopHealthLab), University of Fribourg, Switzerland

References

1. Salisbury H. The NHS is not unsustainable. BMJ 2023; 381:991.
2. Spiers GF, Kunonga TP, Beyer F, Craig D, Hanratty B, Jagger C. Trends in health expectancies: a systematic review of international evidence. BMJ Open 2021; 11(5): e045567.
3. Smith R. A four minute guide to the rudiments of health and healthcare for those responsible for maintaining health systems. BMJ 2023; 380:107.
4. Cohen JT, Neumann PJ, Weinstein MC. Does preventive care save money? Health economics and the presidential candidates. N Engl J Med 2008; 358(7):661-3.
5. Wright J, Williams R, Wilkinson JR. Development and importance of health needs assessment. BMJ 1998; 316(7140):1310-3.