Passage 7 Health Care for Ageing Populations
老年人的医疗保健

[00:01]Over the past few decades all OECD countries
[00:06]have seen their health spending grow considerably faster
[00:10]than their economies. Ageing populations will add further momentum to
[00:16]that growth. Howard Oxley, a health-care expert at the OECD,
[00:24]reckons that increased spending on health
[00:27]and long-term care for the elderly could amount
[00:31]to an extra three-and-a-half percentage points of rich countries' GDP
[00:38]by the middle of the century-and a lot more
[00:42]if spending on medical technology continues to go up at current rates.
[00:48]President Barack Obama is determined to reform his country's health care system
[00:56]to improve coverage and, eventually, drive down costs.
[01:02]More money does not always produce better results.
[01:07]People in America are less healthy and die sooner than in Britain,
[01:13]which proportionately spends little more than half as much on its health care.
[01:20]According to David Cutler, an economics professor at Harvard
[01:26]who has advised the president on the reform,
[01:29]even doctors believe that around 30% of the money spent on health care
[01:36]in America is wasted.
[01:40]The trouble with health care in America, says Muriel Gillick,
[01:45]a geriatrics expert at Harvard Medical School, is that people want to believe
[01:52]that "there is always a fix." She argues
[01:57]that the way Medicare is organized encourages too many interventions
[02:03]towards the end of life that may extend the patient's lifespan only slightly,
[02:10]if at all, and can cause unnecessary suffering. It would often be better,
[02:17]she thinks, not to try so hard to eke out a few more hours or weeks
[02:23]but to concentrate on quality of life.
[02:27]But long before they get to that point, growing numbers of old people
[02:33]will become less able to look after themselves and need more care.
[02:39]Across the OECD, spending on long-term care
[02:44]is already equivalent to around 15% of total health spending
[02:52]and is rising fast. The great bulk of that care-an estimated 80%
[02:59]is still provided by family and friends,
[03:02]the traditional source of support for the elderly.
[03:07]But more women are going out to work,
[03:10]so fewer of them have time to look after old folk and formal help
[03:16]is becoming increasingly important.
[03:20]In most developed countries only a small minority of the over-65s-between 3%
[03:27]and 6%-live in institutions. Keeping old people in nursing homes or hospitals
[03:36]is expensive, staff is hard to find,
[03:40]and in any case most people would much rather be looked after at home.
[03:47]Many countries are now providing grants to adapt homes,
[03:51]paying families for the care they provide
[03:55]and supplying helpers to give a hand with things like dressing and bathing.
[04:01]With far more people reaching a great age,
[04:05]a lot more such care will be needed in the future.
[04:09]How will it be paid for? A few far-sighted countries-including Germany,
[04:16]the Netherlands, Luxembourg and Japan
[04:21]have already introduced mandatory long-term-care insurance schemes.
[04:26]Others may have to follow.