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Lecture 8

HLTC43 Lecture 8.pdf

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Health Studies
Scott Sams

HLTC43 Lecture 8 Wednesday, July 3, 2013 10:00 AM Cue Column: Note-Taking Area: Sustainability and Reform Purpose: To explore concerns over the responsiveness and sustainability of the health care system and competing proposals for reform. Lessons from today’s class: 1. Health care might not be as unsustainable as we have been led to believe. • Believe HC is unsustainable ○ Maybe it isn't as we've led to believe 2. Whether or not publicly funded, universal health care is a “Canadian value” depends on your ideological perspective and values. • Fairly new perspective • Reason to question if it is really Cdn or not 3. Proposals for reform of the system are similarly value-laden. What threats to the sustainability of health care exist, and how urgent is addressing them? (see Duckett, 2012, pp. 27-47) • “Agenda-setting” and the sustainability discourse ○ What issues we as public & policy makers think are imp issues to deal w/ } issues getting to public agenda  Ability of various interests influencing public agenda ○ Q: why does gov't do things that it does? (why does certain actions but not others) ○ Three, inter-related agendas: 1. Media agenda  Media frames health as HC policy ◊ Agenda setting by mass media must occur  If media shows it, must be "imp" 2. Public agenda  Concerns of citizens on various issues ◊ Based on opinion polling ◊ Connected to media 3. Policy agenda  Issues debated by policy makers  Media coverage affects citizen concerns ==> citizen concerns influence policy makers ==> as result, sustainability of HC biggest debates of all time • I confused: what’s sustainability? ○ Adequate resources  Is HC affordable?  Do we have material resources & ppl to work ○ Response to emerging trends  Can it keep up w/ future □ Change policies to changing needs? ○ Intergenerational equity  Response to emerging needs can't just focus on future generations □ If so, only short term • Mo elders, mo problems? ○ Big problem: aging population  They'll demand and consume more HC HLTC43 Page 1 • Mo elders, mo problems? ○ Big problem: aging population  They'll demand and consume more HC  The following are HC affordability □ Takes up more of gov't budget □ Share of per person for GDP □ Spend more per person on HC  Predicted to affect how much we spend/person LE = life expectancy ○ Aging effect on health expenditure  Increased LE ==> increased GDP per capita □ Makes health costs more affordable □ Live more, make more $ ==> pay for HC cost □ More costs towards end of life ○ Dependency burden  Dependency ratio: portion of ppl 15-65/entire pop □ How much of pop is dependent □ 45% dependent in 2011; 65% dependent by 2036 □ Might not be accurate of tax paying population • Expenditure trends ○ Growth relative to the economy  As econ grows, health expenditure grows over time w/out threatening sustainability □ Concern, if health expenditure grows faster than econ ○ Canada relative to comparators  Similar in growth rate to UK, western Europe  Outlier, is USA } higher spending in proportion of GDP growth  Big issue is price growth rather than productivity • So what’s the issue, bub? ○ Financial stability?  Two types of sustainability: □ Econ: good returns on investment  Do benefits outweigh costs □ Financial sustainability:  Level of health spending  More poli than econ judgement ○ Crowding out? ○ Excess price (wage) growth!  HC costs increasing more than GDP □ Why: due to wages and benefits □ In USA, wages are high • The policy response ○ Major reforms?
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