Geography Reference
In-Depth Information
the developing world that have limited facilities and where only the affluent get
adequate care. In addition there are increasing worries about accelerating health
care costs, with ever more technical procedures and longer treatments for the new
chronic diseases. Some indication of the escalation of costs can be seen by the fact
that the budget of the National Health Service in the U.K., which provides universal
coverage for all citizens, was originally close to $15 billion (οΎ£9 billion equivalent)
when adjusted for inflation to provide current value in 1948 when the programme
began. But the budget is now is now more than 12 times this original amount and is
a growing at 4 % a year, with increasing needs from an aging population. Although
more careful administration and costs savings in hospitals or in care facilities may
reduce the figure, the size of the budget and its growth make it unlikely that they
will do more than modify the total, meaning that new ways of funding the system,
perhaps by larger tax increases will be required. These costs are more difficult to
absorb in the less developed world, where access and availability to care is limited.
Indeed globally, health care availability is inversely related to need (Howatt et al.
2012). This is leading to the development of so-called frugal technologies to solve
medical problems at lower costs, using less sophisticated techniques, in order to
increase availability in low income areas. Another problem that has emerged is the
corruption and fraud in some countries. For example the U.S. system is largely a
private one, although there are government agencies that provide care and subsi-
dies for the aged (Medicare) and the poor (Medicade). Recent reports suggest fraud
could be as high as $ 272 billion annually, which is around 10 % of U.S. medical
spending (TE 2014). The health care fraud comes from many sources that include:
suppliers charging Medicade for non-existent supplies; patients claiming benefits
to which they are not entitled; doctors or health clinics charging for extra or non-
essential services, and filing prescriptions for painkillers and then selling them;
people stealing medical cards and using them to bill Medicare for services that they
are not entitled to. Steps are being taken to reduce this enormous leakage of funds,
including simplifying the claims systems and providing more vigorous checking.
This problem of wasted money may be more obvious in the complicated U.S. sys-
tem but certainly exists in other jurisdictions and must be reduced so that health care
money can be spent more wisely and fairly.
13.5.2
Life-style Choices
The fourth determinant contributing to the health or ill-health of populations come
from the life-style choices that people make, although these effects are often cu-
mulative and take place over decades. The strong adherence to the principle that
a population in democratic countries should be able to make their own choices re-
duces the ability to create quick solutions, especially of a coercive nature, so multi-
pronged approaches are usually needed. It has already been noted that the popula-
tion in the developed world in particular spends too much time indoors. There is a
need to redesign areas and to provide leisure spaces where more outdoor activity
