Most Western Countries Now Provide A Basic Level Of Healthcare

The majority of Western countries provide healthcare for their citizens in some form, paid for through a range of mechanisms including general taxation, compulsory insurance and employer/employee sickness funds.

Probably the best known exception is the USA which still has large numbers of people (28 million [Ref 1] and [2]) who have no access to free and universal healthcare [3]. In a country where many espouse the motto to “Make America Great Again (MAGA)”, it really is a sad situation that some enjoy moderate or considerable wealth whilst those least able to support themselves are unable to access even basic healthcare provision at no or low cost.

There Is An Ongoing Challenge To Fund This

In the UK, the funding/underfunding of the National Health Service (NHS) is frequently in the news as Hospital Trusts try to balance the care of the citizens in their region against the costs of resources needed to treat their different health needs. A number of other factors also influence available NHS resources such as:

The impact of poor financial management.
The outcome of class actions and individual claims for negligence in the form of punitive damages and legal costs.
Bed blocking (patients waiting to go home or into care but prevented from doing so by lack of available care and support services etc.).
Over-prescribing of drugs that are not used—wasting resources—or that can be purchased over the counter.

A more recent element in the equation has been the rise and impact of social media. Crowd funding as an option to raise financial assistance for families in challenging health situations has demonstrated the compassion, generosity and willingness of many people to help. In other words, utilising the power of the internet to realise large sums from many modest and some more generous public donations.

On-line petition organisations have also begun to play their part. Anyone can raise a petition for their cause inviting others to sign in support of someone’s heartfelt need. Looking behind some of these real-life and death situations often reveals tragic stories pitted against a “health machine” that has decided that the costs and benefits of treatment are too high and too low respectively. This is in contrast with some petitioners’ views that they, or the person they are supporting, have a right to be treated no matter what the financial challenge and cost to wider society.

For example, there was a recent petition for a young person who needed access to a particular drug that could slow down the rate of progress of their condition. This was made public because the UK’s National Institute for Health and Care Excellence (NICE) had determined that the cost and longer term outcomes for the treatment did not merit the NHS funding of £500,000 per patient per year. That is equivalent to 89 knee replacement operations [4] or 52 hip replacements [5] and [6].

Drug companies’ commercial positions often have a disproportionate impact on the situation. Understandably they have spent many years developing, testing and trialing a drug for use for a specific (sometimes rare) condition and need to balance that investment with a reasonable return, given the potential number of actual patients that might benefit [7]. In some cases the companies will make the drug available at a (commercially sensitive) discounted price—facilitating treatment for some people at reduced costs to the Health Service providers.

Some Crude (But Simple) Numbers To Help Understand The Costs Vs Contributions Equation

There are approximately 66.6 million [8] people in the UK of which about 30.3 million [9] pay Income Tax and National Insurance contributions. HMRC revenues for 2017-18 were £130 billion in NI Contributions [10] and £594 billion in Income Tax [11] making £724 billion raised from individual citizens (averaging out at £23900 per taxpayer or £10900 per citizen). The NHS budget for 2017-18 was approximately £125 billion [12] which approximates to about £1900 per person.

Costs for the elderly in care homes averages out at between £31200 per year (without nursing care) and £47300 with it [13] and [14]—although it can be much higher.

The average salary in the UK is £27200 [15] and a person on that salary would pay in the region of £3100 in Income Tax and £2300 in National Insurance contributions. This would be about £5400 in total [16]. So for someone needing care home accommodation this would require in the region of six people paying Income Tax and National Insurance on the average UK wage to support them.

Given the reality of these broad brush figures, this perhaps prompts an important question:

In health funding terms — can you put a value on a person’s life?

In modern Western society the answer is most likely to be “No”—certainly not in terms of a figure that would be published.

But there are three things that can be done to try and ensure better outcomes in the short and the long-term.

1 Act Upon The Personal Responsibility We Have To Ourselves And To Others As Citizens

As contributing members of society, as far as we are able, we should seek to:

1.1 Look after ourselves in both mind and body

Lifestyle and diet can have a very strong influence upon our longer term health situation and we are regularly advised to exercise and eat/drink well [17] and [18]. The vast majority of us have some control over our time and circumstances and can/could take active steps to maintain or improve our physical and mental health and well-being through appropriate diet, moderate exercise, relaxation and social interactions.

But do some of us pay lip-service to this or even abuse our bodies through eating too many foods that we are told are not good for us, excessive alcohol, smoking, drug abuse or spending too much of our leisure time in front of a computer or TV screen [19], [20] and 21]?

Let’s acknowledge though that people may use/abuse substances, develop eating disorders etc for a wide range of complex reasons—possibly as coping mechanisms related to their current context or a situation in the past.

Food labelling may be misleading at times (fat free doesn’t always mean better, for example). People can make poor decisions because of bad advice, lack of skills, poverty, affluence or even arrogance.

Doing the positive things does not guarantee that we will remain healthy, although the statistics tend to support reduced health risks for those who are active and seeking to live well.

1.2 Recognise that for many, full health is not an option

Personal health (or the lack of it) is not always a matter of choice. For some it is a constant battle to get through each day. Health issues people face could include:

Inherited conditions. Some people have genetic conditions that means that, apart from trying to manage symptoms, they have little ability to control or affect their underlying situation unless new and developing treatments can be offered to them.
Contracted diseases. Some of these come from our environment (parasites, fungal, bacterial or viral infections, air pollution, certain hazardous occupations or accidental exposure to dangerous materials etc.). In particular, some of our wider societal behaviours even contribute to this [22], [23].
Complications arising from inherited and contracted conditions. These could include the need for transplants, intensive care support and so on.
Mental health issues. These may have developed as a consequence of experiencing a traumatic situation or event, our upbringing, family, social or work pressures or other factors.
Getting older. The impact of ageing or an accident that may substantially reduce mobility, metal capacity or the risk of age-related diseases etc.

1.3 Pay our taxes

For those of us who are employed or retired, paying all our required taxes contributes to the pot from which the government must make budget decisions. With a national debt of £176 trillion and a deficit of £40 billion (as at March 2018 [25]) we can readily see that there is no excess that can easily be channeled into providing more money for the NHS (unless at the expense of other government Departments) or further increases in our indebtedness.

It seems that some people are prepared to pay more in tax to provide additional resources for the UK’s NHS [26]. In Germany, for example, somewhere around 15% of salary (often split equally between employee and employer) is deducted for healthcare services, plus income taxes, pensions and other deductions.

2 Understand that society as a whole cannot pay for everyone to have any treatment—regardless of cost

As the sum of human medical knowledge expands, new and/or more effective treatments for an increasing number of health problems offers the prospect of improved lives for many. This raises everyone’s expectations that whatever we have wrong with us should be treated at no cost to us (at the point of delivery) if there is a treatment available.

But surely this is unrealistic?

Decisions are made daily by the medical profession [27] as to what is the “best use” of limited resources (something that NICE in the UK seeks to provide informed views upon). This decisions could include:

Not undertaking an intervention (treatment programme) because the patient’s condition is too weak.
Balancing this condition and its treatment against other conditions that the patient has and the interrelationships between them.
Recognising that the rate of progress of the condition does not warrant immediate intervention — e.g. delaying a surgical procedure or postponing or withholding a drug programme.
Making choices between different drug or other treatment options.
Having discussions with the patient, or their immediate family, as to the most appropriate course of action, taking account of the specific circumstances of the patient and their support networks.

We ought to recognise that there is no limitless supply of funds. Choices have to be made and unfortunately we see this most clearly when someone’s real life situation becomes public in some way. When it is personal it naturally becomes important to us and we will do whatever it takes to try and ensure the best outcome for ourselves or those we love and care for.

Putting more resources into the NHS will only alleviate conditions in the short-term as potentially:

More conditions can be treated more quickly (improved throughput).
More people can benefit from treatments (greater coverage) This might mean less of the so-called postcode lottery where treatments may only be offered because of local specialists or local funding decisions.
Enabling special cases to be funded where in the past that would not have been possible.

3 Support the development of new treatments and patient support processes

There are ways that some people can further the progress of medical research and patient care:

3.1 Contribute to drug and other intervention development

The drugs industry, medical engineering companies, universities, medical specialists and charities seek to research, develop and help to implement solutions that:

Diagnose conditions more effectively.
Create surgical, chemical and other treatments that can extend life, reverse conditions or even cure patients completely: all at a price.
Improve quality of life for those with difficult and untreatable conditions.

However the outcomes may not necessarily be ‘cost effective’ (however we choose to define that).

Many of us will not be able to help fund such initiatives directly. However some people may have the option to invest money into health research or education, to become involved in clinical trials, or become guinea pigs for pioneering treatments if they are affected by a condition where treatment is experimental or not straightforward.

3.2 Help fund voluntary and charitable organisations that serve those most in need

We can choose to contribute to charities that provide care and support for those with chronic (long-term), life-restricting (quality of life), or life-limiting (length of life) conditions. Whether this is in the form of fundraising, sponsoring a friend or relative, or volunteering ourselves, each of these things can help to assist people with complex needs.

A Biblical response?

Christianity and most other religions uphold the sanctity and preservation of life, without any qualification on the quality of that life. As part of society and contributors to it we have our role to play; in particular loving our neighbours.

As Christians we are told that our body is the temple of the Holy Spirit (1 Corinthians 6:19) and consequently we should be careful what we put into it and how we look after it. We have a duty to ourselves then, and to God, to be good stewards of our mind, body and soul/spirit as best we can. This includes exercise, rest, eating healthily, feeding our minds and developing our spiritual life [28]. However, God does not require anything specific about our physical body to permit his Spirit to dwell within us. Even if our lifestyle negatively affects us, God is still within us.

In Galatians 6:10 the Bible tells us to “do good to all people, especially to those who belong to the family of believers” (NIV). Similarly, the parable of the Good Samaritan illustrates a stranger from a different (despised) culture helping a man who had been attacked; including funding his longer term care.

Conclusion

In looking at health provision (or indeed the provision of any public services) we have to recognise that there is a finite budget to be distributed—even if governments continue to borrow/create money through mechanisms like quantitative easing [29] (i.e. printing more) because tax revenues are insufficient. Political parties have different approaches to prioritising budgets and certainly understand that you cannot please all the people all the time.

Whilst it is not acceptable to put a value on a person’s life, there are practical decisions that are being made daily in hospitals and GP surgeries about the forms of treatment that can be afforded given the differing situations of the range of patients needing and receiving treatment.

In many parts of the world, just as in the past, often no treatments are available and people sadly have to live with untreated conditions or die earlier than they would if they lived somewhere else. Part of our expectations of living in a modern civil society are that common conditions will be treated in a reasonable timeframe and at a bearable cost to the rest of us. The challenges really come for those who are affected by very rare conditions where treatments are few and drugs are correspondingly expensive—sometimes running to many multiples of national average earnings.

Questions:

What are your views on the issues raised in points 1 to 3 above? Is anything missing, if so what?

Have limited resources in the NHS (or your own country’s health provision) affected you or your family? If you are a Christian, how have you managed such a situation? Has knowing Jesus affected how you have coped/are coping with it?

If society cannot put a value on someone’s life, should it put a limit on the level of investment in improving someone’s health or life expectancy?

When is it right to fund expensive treatments and when to withhold?

Is there a cost beyond which we should not expect society (i.e. us) to pay?

[1] - https://www.cnbc.com/2017/09/12/maps-show-obamacares-big-on-americans-health-insurance-coverage.html

[2] - https://www.cbsnews.com/news/more-americans-are-going-without-health-insurance/

[3] - https://en.wikipedia.org/wiki/List_of_countries_with_universal_health_care

[4] - https://www.mirror.co.uk/news/uk-news/knee-replacement-operations-cost-nhs-6009303 - 2015 figures

[5] - https://www.statista.com/statistics/533916/cost-of-a-hip-replacement-on-nhs-in-united-kingdom-uk/ - 2015 Figures

[6] - https://www.theguardian.com/society/ng-interactive/2016/feb/08/how-much-have-i-cost-the-nhs

[7] - https://www.pharmaceutical-journal.com/publications/tomorrows-pharmacist/drug-development-the-journey-of-a-medicine-from-lab-to-shelf/20068196.article?firstPass=false

[8] - http://www.worldometers.info/world-population/uk-population/

[9] - https://www.bbc.co.uk/news/business-40117521

[10] - https://www.statista.com/statistics/284314/united-kingdom-hmrc-tax-receipts-national-insurance-contributions/