Older how? Ageing projections, technology and the sustainability of European healthcare

Most discussions on the financial sustainability of health systems start with the inevitable statement that we are getting older. Europe’s population is ageing. We are living longer than ever before and having fewer children. The net result is a decrease in the share of working people for every person of non-working age, but also a pressure on health systems from chronic diseases and general ill-health. 
But how are we getting older? If most of us will live until 100 years or more, how will those last 10-20 years look like? Are we spending these extra years on the golf course or in the nursing home? Or are we even working part time? The answer to that question is maybe the most important for those who are trying to understand what challenges European healthcare systems will face in the future, and how to prepare for them.  
A key contribution to this discussion is the 2018 EU ageing report, published by the Commission in late May. The 2018 ageing report, which is an update of a similar report from 2015, does not try to give a definitive answer to this question, but calculates the consequences of a number of different scenarios. For example the “demographic scenario” assumes that Eurostat’s projections on future longevity of the EU population are correct[1], but that all extra life years will be spent in ill health. In other words, our health starts deteriorating at the same age as today, but we will live longer. The result is of course more years being dependent on healthcare and long-term care services, and is a scenario that should be frightening for EU citizens and finance ministers alike.
A very different scenario is the “healthy ageing scenario”, which on the contrary assumes that all extra life years gained will be spent in good health.
What is the difference between these scenarios from an economic standpoint? Well, in the “demographic scenario”, healthcare expenditure as percentage of GDP will on average for EU27 increase with 14% between 2015 and 2070 (but for some countries much more, such as 21% for the UK and an alarming 26% for Ireland and Spain). If Europe instead develops according to the “healthy ageing scenario”, the increase is only 1%. A huge difference – one could say the difference between a sustainable trajectory and a severe fiscal headache for the public sector.  
Keeping the elderly population healthy is therefore not only an imperative for health ministers around Europe, but also for finance ministers. The solution to this equation lies in innovation, both in technology, process and organization of healthcare. Technology is mostly treated as a cost driver in the ageing report, but in fact the prudent implementation of new technologies is absolutely necessary in order for Europe to stay on the healthy path.
  • Prevention is often hailed as the solution, but only new diagnostic methods, genomics and predictive analytics will bring about truly personalized, effective and “smart” prevention by catching people who are on the verge of developing chronic diseases before they develop serious symptoms.
  • Innovative medicines can not only prolong life, but also greatly improve quality of life and ensure that people can stay healthy and working longer. The industry is continuously investing in finding a more effective treatment for Alzheimer’s, which would greatly improve the independence and quality of life for patients, and the proper use of diabetes medication can help patients manage their disease and avoid debilitating complications.
  • E-health solutions such as comprehensive Electronic Health Records will facilitate integrated care models, making sure that no patient falls between the cracks of different healthcare institutions and services.
But we should not forget innovation also in process and organization of healthcare. More than ever before, we must turn our attention to how different healthcare interventions and care models impact the quality of life and functionality for patients. As noted in the Commission’s State of Health in the EU report, European healthcare systems are good at collecting data on the number of hospital beds and the number of screenings performed, but not as good in giving reliable information on how patients’ health status is actually impacted by all these different interventions.
In order to future-proof our healthcare systems and ensure that our citizens not only stay alive, but also in good health, we must become much more serious in collecting standardized and comparable data on health outcomes throughout the health system. This is an area where the EU and also the OECD can assist Member States by driving the standardization of health outcomes measurement and health statistics reflecting patient-relevant outcomes, and supporting member states in developing systems for the collection and sharing of health data. We in the European pharmaceutical industry are already contributing to this transition, including in partnership with public partners through the Innovative Medicines Initiative, and are committed to doing more. If all stakeholders and policy makers work together toward the same goal, we can make Europe the continent of healthy ageing.

[1] According to these projections, life expectancy at birth for males is expected to increase by 7.8 years from 2016 to 2070, and for females by 6,6 years over the same period.

Thomas Allvin

Thomas Allvin is Executive Director for Strategy and Healthcare Systems at EFPIA. Before joining EFPIA, Thomas...
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