Biomedical Engineering Reference
In-Depth Information
Conclusion
In the future, cancer will become incidental to day to day living; although not erad-
icated it will cause less anxiety for patients who will also be much better informed.
How true this picture will be will depend on whether the technological inno-
vations will emerge. Will people, for example, really live in smart houses where
their televisions play a critical role in monitoring their health and well being? For
this to be a reality health care professionals will need to work in multidisciplinary
teams in collaboration with caregivers and voluntary support groups to provide for
an increasing older population in the context of a diminishing number of working
age who pay taxes. Old people, having been relatively poor all their lives, may suffer
from cancer and a wide range of co-morbidities that will limit their quality of life.
Looking after everyone, rich and poor, will place great strains on healthcare funding
and its provision.
As with all health issues the question of access will be determined by cost and
political will. In 2005 about 70% of cancer care was incurred in the last six months
of patients' lives and costs are set to rise about fourfold by 2025 as patients live
longer and new therapies emerge. Recent surveys appear to support this level of
spending, but is it likely to be affordable?
Expenditure at such levels will inevitably create tensions between appropriate
levels of taxation and provision of health care. To some extent this will be mitigated
by better targeting of expensive therapies, less use of hospitals beds in favour of
home based care. However as patients live longer, life time costs will increase so
that the prospect of rationing will remain.
One dilemma for the future will be the political power of old people. As more
people live longer, this increasing gerontocracy will wield considerable influence
and will have higher expectations than the level of care now offered to many old
people. Will a tax-based health system, in the context of a decreasing number of
people working and paying taxes, be able to fund their expectations or will a system
of co-payments and deductibles become inevitable.
Figure 6 shows the four components of cancer's future — innovation, delivery,
finances and society. Whatever system is put in place there is the prospect of a
major socio-economic division in cancer care. A small percentage of the elderly
population will have made personal provision for their retirement, in terms of health
and welfare, but the vast majority will rely on state provision. Policy-makers need to
start planning now as they are doing for the looming pensions crisis. Cancer patient
and health advocacy groups need to be involved in the debate to ensure that difficult
decisions are reached by consensus.
Societal changes will also create new challenges in the provision of care. A
decline in hierarchical religious structures, a reduction in family integrity through
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