Preventive Care And Health Insurance: European Approaches To Promoting Wellness – As Europe emerges from the pandemic, investing in health can not only save lives and build greater resilience but support economic growth and prosperity.
As devastating as the COVID-19 pandemic has been, it offers important lessons as Europe looks forward to economic recovery, especially now that mass vaccination is gaining momentum. Health and economy are inseparable. While the final health and economic toll is still unknown, in the first year of the pandemic more than half a million people died in Europe, and European GDP fell by 7.5 percent. But what is not widely appreciated is that every year, poor health costs the European economy an average of twice as much or about 15 percent of GDP due to reduced quality of life, premature deaths, and lost productivity. As Europe emerges from the current health crisis, there is an opportunity not only to fix the problems seen by the pandemic but also to save lives, improve the overall quality of life, and build greater resilience against future health crises, all while promoting economic growth and more prosperity.
Preventive Care And Health Insurance: European Approaches To Promoting Wellness
Our analysis consisted of two main steps. First, we assess the potential to reduce disease burden from known interventions as well as innovations. Second, we quantify the impact of reducing the burden of disease on the economy.
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We source disease burden projections to 2040 for each European country from the Global Burden of Disease dataset developed by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington. This data set includes diseases that cause death and contribute to years lived in poor health. We define illness broadly as health conditions that affect quality of life, including infectious diseases, chronic conditions, and injuries.
To estimate possible disease burden reductions under healthy growth scenarios, we conducted a detailed review of clinical evidence and guidelines to identify interventions, currently available and in the pipeline, with the greatest potential to reduce current disease burden. . We systematically looked at the top 52 diseases, which account for nearly 80 percent of the global disease burden and 75 percent of the US disease burden, and relied on clinical guidelines and evidence from leading institutions such as the WHO, the Disease Control Priority Network, and The Lancet to estimate the potential for health improvement. . In all cases, the goal is to identify a basket of highly effective interventions with broad applicability, about 150 in total, rather than to catalog all interventions that can be found in a well-resourced and well-equipped health system.
For each individual intervention for the 52 diseases, we followed three steps. First, we measure the potential for health improvement. This is an estimate of the portion of the disease burden that could be prevented through the application of rigorous interventions that affect people with the disease. Second, we estimate the potential to increase adoption from the current level in countries that are in four income archetypes (high, upper middle, lower middle, and low), with the United States considered part of the high income archetype. For interventions that require ongoing adherence to the treatment program, this estimate of adoption includes ongoing adherence and not just initial uptake. Third, we estimate the time needed to achieve full impact. This includes two considerations: the time required for implementation, and the delay between delivering the intervention and receiving health benefits from it. Where evidence on current or potential adoption rates is limited, we make reasonable assumptions.
To calculate the economic impact of these health improvements for Europe, we rely on population and labor force forecasts until 2040 by country and combine the impact of health improvements by age group for each year. We then translate improvements in population health into labor force participation and labor productivity and GDP through four channels: less premature death; lower disability rates among the working population; higher labor market participation among healthier parents, informal caregivers, and people with disabilities; and higher productivity from a healthier workforce. The assumptions used to estimate the impact on each of these channels are taken from available academic research and tested with a group of consulting economists.
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Some uncertainty exists in the quest to understand how European health can be improved and what the benefits will be in 20 years. This arises from the uncertainty about the evolution of the European disease burden, the availability and effectiveness of different interventions (both currently used and those being developed) in different populations, and the impact of health improvements on society and the economy. We manage this uncertainty at each step of the analysis in the following way:
This study does not predict health trends. The aim is to give a sense of the magnitude of the potential health and economic benefits that can be achieved by using more general interventions. Our estimates are not predictions, and we recognize the significant changes needed to achieve the identified health benefits in just two decades. We also identify risks and threats that may alter the underlying burden of disease and the validity of our estimates. In particular, the near-term and long-term consequences of new diseases, such as COVID-19, and our response to them, will affect this basic burden in ways that cannot be trusted today.
This research does not assess current and future health costs. Instead, we provide a high-level estimate of the cost implications of a shift to a healthy growth path by drawing on published research to assess the net costs for countries to implement the identified interventions. These implementation costs are additional to current health spending but could be offset by productivity gains in health spending in middle- and high-income countries.
This study does not make recommendations on spending by governments or organizations. It is intended to provide insight into what can be done with the improvement of global health. While our study provides guidance on how to improve the health of the world’s population, each country in Europe has unique local health and economic conditions that must be considered to determine the most effective interventions in each case.
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For more details on our methodology, see the technical appendix Prioritizing health: A prescription for prosperity (MGI, July 2020).
, to take a closer look at Europe and identify what will be done to improve the health of the European population and what the benefits are for individuals, the economy, and society. (See sidebar, “Our methodology.”) We focus on the 27 member states of the European Union, Switzerland, and the United Kingdom. We analyze disease burden and economic projections over the twenty years to 2040 to identify challenges and opportunities at the country level and aggregate findings for the region.
The COVID-19 pandemic is an extreme example of how health, and measures taken to control and prevent the spread of an infectious disease, can affect the economy. However, even before the pandemic, poor health costs Europe an average of $2.7 trillion, or 15 percent of GDP a year, with lost economic opportunities, equivalent to $5,000 per person (Exhibit 1).
Poor health reduces economic potential by keeping people out of the workforce, reducing productivity, and reducing earning potential. For example, people may leave the workforce temporarily or permanently due to poor health, or move to a less physically or emotionally demanding role with lower remuneration. Others may reduce work-related commitments to care for dependents living with health and disability. Premature death, in addition to being a tragedy, affects the size of the labor force and therefore economic output.
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Our analysis looks exclusively at economic opportunities lost from poor health in the labor market, including labor supply, unemployment, underemployment, and productivity. Poor health also affects people’s lives in non-economic ways, by causing pain and anxiety, reducing independence, and limiting people’s capacity to participate in daily activities, enjoy life, and realize their individual potential.
Three conditions have a disproportionate economic impact and are collectively responsible for more than half of all economic potential lost due to poor health in Europe. These are: musculoskeletal disorders, especially back pain and neck pain, account for 24 percent of the total economic losses due to poor health; mental health disorders, such as depression and anxiety, accounting for 18 percent; and neurological disorders such as migraines and headaches, about 13 percent.
These three conditions are relatively common, mostly affect people of working age, and have a relatively high impact on daily life and productivity because they tend to be associated with chronic pain and distress. A longitudinal study conducted in England found that these conditions were a significant predictor of early retirement, with more than half of early retirees reporting one or more. A similar pattern was found in Germany.
Contributing to the overall burden of disease are the high levels of preventable health risks, particularly overweight and obesity, which exist across Europe and affect all social groups, although disproportionately in lower socioeconomic groups. A survey of older people (aged 50+) in 20 European countries found that four out of five respondents
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