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Fallacies in Health

Advances in technology increase health costs
Ageing populations will lead to increased costs
Buildings are expensive
Governments cannot afford more money for health services
Better health services get people back to work, and so are cheaper
Focusing on the major diseases makes sense

There are truths, universal truths, and universal truths which have proved to be neither universal nor true.
An ageing population will lead to much increased healthcare costs .
Everyone uses it all the time, as a prop, or excuse, or an opportunity. But is it true ?

Not according to Charles Normand, professor of health policy at the London School of Hygiene and Tropical Medicine. He has written [1] a lovely analysis of ten popular health economic fallacies. This is a paper worth having close to hand, because if you study it, it has clues on how to debunk other universal truths when someone uses one as an alternative to thinking.

Here are just some of the fallacies, with a short explanation of why they are fallacies:

Advances in technology increase health costs


Why should they? Advances in technology can only, in themselves, lower costs. If something does the same job at a lower cost, then the lower cost will win, whether it is advanced or not. An example from some years ago when monoclonal antibodies were in vogue was the thyroxine test which cost £1 a test for a monoclonal test, versus 5p a test for standard antibody. But they gave the same result. So collapse of new test (or its price).

The problem is that new technology often does similar, but not the same, job. New technology may increase quality, or efficiency, or we believe that it does. But measuring these things is difficult, so technology creeps in without really being evaluated in terms of bangs per buck.

Ageing populations will lead to increased costs


But elderly people are healthier now, healthcare costs are more related to approaching death than just age, and ageing is itself supplying more informal carers who are fit and able to help.

Buildings are expensive


The cost of new health service facilities (including equipment) is 50% to 200% of the annual running costs. So if buildings last 40-100 years, they are cheap.

Governments cannot afford more money for health services


Rising health service spending should be expected in a modern economy. This is because making things is cheaper and easier with automation, and because healthcare is people-led not thing-led. So a rise should be expected, especially as more affluence demands better health to enjoy that affluence. The problem with public spending is tax, because those affluent people also want more of their income to spend.

Better health services get people back to work, and so are cheaper


There are many reasons why this is wrong, as many GPs and others recognise. To cut to the chase, relationships between health services and the ability to work are slight, at best.

Focusing on the major diseases makes sense


No it doesn't. The issue is the size of the solution and not the size of the problem. Many common, chronic diseases have therapies that are at best only palliative. Solutions which are effective (cures) are those which should be sought. So arthritis of the hip may be more important than heart disease, ranked by cost-effectiveness.

These are just a few short précis of a fascinating and enjoyable read. Particularly worth reading was the acknowledgements, where Normand thanks the many university and health services colleagues who keep repeating these fallacies.

Reference:

  1. C Normand. Ten popular health economic fallacies. Journal of Public Health Medicine 1998 20: 129-132.
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