Excess deaths are soaring as health systems falter

Ino 1516 Thomas more described the ideal health system. “These hospitals are well supplied with all kinds of medical equipment and the nurses are understanding,” wrote the philosopher in “Utopia”. “Even if no one is forced to go, virtually everyone would rather be sick in hospital than at home.”

Five centuries later, those who prefer to be sick in hospital would struggle to get past the lobby. People often complain about the shortcomings of their country’s health care system. They tend to ignore the extent to which the pressure is visible in the rich world. British National Health Service (nhs) is in a winter slump like never before, with people having heart attacks waiting 90 minutes for an ambulance. Things are so bad in Canada that a children’s hospital called the Red Cross. Even in Switzerland, whose healthcare is often admired, the system is under enormous strain.

Worst care is contributing to a huge number of excess deaths. Mortality in Europe is about 10% higher than expected in a normal year. In mid-December French and German deaths were a quarter higher. Chaos is also harmful in ways that cannot be measured. It is distressing to think that one day you will have to call 911, 112 or 999 and that no one will come to help you.

Health care spending is at an all-time high in the rich world. The problem is, “all-time high” doesn’t necessarily mean “enough.” Population aging increases demand. Healthcare systems compete for staffing with other parts of the economy, so the salaries of doctors and nurses must keep pace with prevailing rates of pay. Costs rise even as healthcare productivity stagnates. The cutthroat logic of this “cost disease” means that in aging societies, health care spending usually has to grow as a share of the economy just to maintain a given level of care. Countries, such as Great Britain and Italy, which in the years leading up to the covid-19 pandemic cut their health spending GDP, or kept it constant, they were already on their way to worse services.

Yet tight budgets don’t fully explain the mess. Even in places with ample funding, healthcare is struggling with the unprecedented effects of the pandemic. On the demand side, covid has left sicker populations behind. After years of avoiding the flu, many people are now getting it. The world is also discovering some of the costs of blocks. In 2020-21 many hospitals and GPs canceled appointments for non-covid conditions. People who have deferred treatment for other illnesses present with late-stage illnesses that require more expensive treatments; they also have less chance of recovery.

Covid also affects the supply side. Many hospitals continue to isolate COVID-positive patients and maintain strict cleaning regimes. This consumes time and resources. Also, the staff is exhausted. The result appears to have been a decline in productivity. Excluding primary care, the nhs it has 13% more doctors and 10% more nurses than in 2019, but is treating fewer patients from its waitlist.

What can be done? More money would make little immediate difference. It takes time to recruit staff and vacancies are already high. But it may be possible to boost productivity by reducing anti-covid measures that are unnecessary in mostly vaccinated populations. Beyond this year, spare capacity is needed. Governments that cannot find ways to increase productivity will have no choice but to increase funding and thus raise taxes. Reforms that were already desirable, such as streamlining processes or introducing more competition, may become essential.

Governments thinking about the next pandemic should also take note of the long-term consequences of lockdowns. There is a painful trade-off between suppressing disease in the short term and avoiding bottled-up problems in the future. As More advised, “he’s a pretty poor doctor who can’t cure one disease without giving you another.”

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