Health Care System in the Industrialised Countries and the Role of Private Insurance

4. Health care demand and health care spending trends

In the industrialised countries, economic welfare and the increase in education level have changed the attitude of citizens toward their own health. A culture of prevention has boomed, as shown by positive lifestyles focusing on healthy diets, the control of smoke and drug abuse and the desire for better hygiene. As a result, new rules were issued by the legislative bodies to urge citizen to adopt a more responsible behaviour to protect their health.
In addition, the advances in medicine have generated new expectations in the fight against disease. Citizens no longer accept the inevitability of illness and consider medicine as the tool they can resort to not to surrender to sickness.
Nevertheless, since our culture forces us to live in the fast lane, it gets increasingly difficult to put up with long waiting times; many citizens turn to private health facilities, in lieu of the public, generally free ones, to speed up diagnosis and treatment.
The changed attitude of citizens towards health has lead to a demand of quality health services, to frequent medical examinations, to an increased use of medicaments, alongside with a proliferation and an overlapping of therapeutic paths. This has been followed by an increase in the health care services required by not-self sufficient elderly people who cannot rely on an informal care, because of the break up of the family.
The major breakthroughs made in medicine, the use of cutting-edge technologies and of complex equipment for both diagnosis and treatment purposes have contributed to lengthen our lives. The discovery of new medicines and vaccines has reduced the chance to contract certain diseases. New equipment like ecography, magnetic resonance, endoscopies and biological tests have upgraded the diagnostic capability and favoured the early treatment of diseases. As a result of technological developments, it is now possible to cure diseases that only a few years ago were deemed incurable.
In the OECD countries, from 1990 to 2002 the number of CT scans rose from 6.9 systems per million of inhabitants to 13.2 (OECD Health Data 2005). The increase in number of magnetic resonance equipment was even more significant: from 1.2 to 5.2 per million of inhabitants. In this case, the percentage in Switzerland (14.1), Italy (10.6) and the United States was above average.
New scenarios have emerged as a result of genetic research and the subsequent development of diagnostic (through genetic tests) and therapeutic skills, due to pharmacogenetic tests (development of customized therapies) and gene therapy (the use of genetic material to prevent or cure diseases). Although it is too early to predict or fully understand the impact in terms of diagnosis costs, the prevention and cure of diseases, and of a longer lifespan, we cannot neglect the important implications that these studies will have for medicine (Taylor and Marocco, 2005).
Positive lifestyles have contributed to the improvement of health standards. In fact, according to Eurostat projections, in the 15 EU Member States, the average lifespan for men has increased from 70.5 years in 1980 to 76 years in 2003. Over the same period, life expectancy of 60-year-old men rose from 16.8 to 20.3 years. The Eastern European countries that joined the EU on May 1st, 2004, show striking differences in terms of average life: 70.2 years This is probably due to lower prevention and to lifestyles that are less healthy as compared to the rest of Europe. In addition, during the transition from communism to a market economy, life span declined but it has started rising again over the last decade.

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