![\"Richard](\"http:\/\/www.bmj.com\/home\/icons\/bmjh7648e.jpg\")
When governments spend money on \u201chealth\u201d they get lots of sickness but very little health. Increasing expenditure on healthcare\u2014now 17% of GDP in the United States and 9% of GDP here\u2014leads to more and more people clinging onto life in a seriously impaired state. Better, I believe, to recognise that death is a friend and that our money can be better spent.<\/p>\n
Politicians and even medical schools have failed to notice that the nature of health care has changed fundamentally. If you ask a woman in the street to describe what doctors do she\u2019ll probably answer: \u201cDiagnose patients\u2019 problems and cure them.\u201d The chief medical officer a few years ago defined the work of doctors as \u201cdiagnosis, diagnosis, diagnosis.\u201d But less and less of medicine is about diagnosis and almost none of it is about curing.<\/p>\n
The main activity of health care these days is looking after frail, elderly people with not one disease but many. We don\u2019t have good figures for Britain, but data from America shows that people with more than five conditions account for two thirds of Medicare costs. Visit any hospital or GP surgery, and it\u2019s frail elderly people that you\u2019ll see. The days of \u201cEmergency ward 10\u201d and \u201cDr Kildare\u201d (showing my age here) are long gone.<\/p>\n
The patients may have changed but unfortunately the health system hasn\u2019t. Many of the frail elderly people are not looked after well. Their concerns don\u2019t tend to be their diabetes or high blood pressure but rather are social: Can I live on my own? Will I be able to make it to my granddaughter\u2019s wedding? Who\u2019ll look after my cat if I go into hospital? But their social concerns are often forgotten by the army of specialists each devoted to one part of their body\u2014heart, lungs, blood, gut, kidneys. The costs ratchet up as they are passed from specialist to specialist, but the patients are no happier.<\/p>\n
Like most of the world we have health systems that are driven by the four d\u2019s: diseases, diseases, drugs, and death. But it\u2019s time to move from a 20th to 21st century system, argues Lord Crisp, once chief executive of the NHS, in his excellent new book \u201cTurning the World Upside Down.\u201d The health system that has been successful in combating the infectious disease is becoming part of the problem rather than part of the solution. We should concern ourselves with health not disease, recognise that doctors are very expensive and can be replaced by cheaper, more holistic practitioners, use more non-drug treatments, and learn not to keep fighting death but to welcome it as a friend.<\/p>\n
What Crisp calls \u201cthe triad of the professions, commerce, and technology\u201d are driving us towards unaffordable and unsuitable health systems. The United States may well be the first empire to be brought down not by disease but by health care. The triad is \u201cstrongly incentivised to do more, treat more patients, and increase overall costs.\u201d The vested interests are huge.<\/p>\n
We currently spend over \u00a3100 billion on health care and around $8 billion on social care. The ratio is wrong. Increasingly people need caring not curing, and the care should be person not disease centred. For most people social concerns trump health concerns. Politicians instead of squabbling over how we should pay for long term care for the elderly should be bold and recognise the need for a shift from medical to social care.<\/p>\n","protected":false},"excerpt":{"rendered":"
When governments spend money on \u201chealth\u201d they get lots of sickness but very little health. Increasing expenditure on healthcare\u2014now 17% of GDP in the United States and 9% of GDP […]<\/p>\n