Equal care for the elderly: A swing and a miss?

This month the Equality Act 2010 was accepted by the Department of Health here in the UK, with no amendments. The NHS can no longer discriminate based on age (aside from a few reasonable exceptions). But can this new legislation actually make any difference? An interesting article from Age UK suggests possibly not.

Why are the elderly treated so badly?

I agree with Age UK. Legislation is not what was lacking; the NHS as an organisation does not promote age discrimination. As an institution it does not provide incentives to discriminate by age (not that I know of anyway). I believe the problem exists on a personal level, in the attitude of health care professionals. The elderly are perceived as being less deserving of care than their more recently born counterparts. In fairness to said health care professionals, I don’t think they are entirely to blame for this. Society values the elderly less. From a human capital perspective the elderly are certainly less valuable to society. Caring for the elderly is also far less efficient; they require greater care, at a greater cost, with a reduced capacity to benefit. They might also have fewer family and friends around them; we might expect a young mother to attract a greater standard of care than an old lady with no dependants. So why should we treat the elderly equally? Well, because it’s right, it’s fair, it’s equitable. Efficiency is not paramount when it is at the expense of equitable outcomes.

The effect of legislation

But the legislation will not work. Legislation CAN change attitudes, but not nearly quick enough. I’m sure many of you have read Freakonomics and its sequel, Superfreakonomics. The latter draws attention to the effect of seat belt legislation in the USA. Most US states introduced seat belt legislation around 1987, when usage was about 42%. 5 years later, in 1992, seatbelt usage was only 62%. 20 years later seat belt use in the USA was still only 82%. And putting on a seat belt is a behaviour that is far more easily changed than your attitude towards care for the elderly.

So, while this legislation is a nice thought, what we really need is a program of education and training for health care professionals, that shows them the importance of good care for the elderly. Even more effective might be a set of incentives, possibly financial, to encourage a high standard of care for the elderly in order to level the playing field. EVEN MORE effective might be a set of disincentives to prevent negligence.

Implications for health economics

I feel that this is a difficult area for health economics; a study so ardently striving for efficiency in health care. Clearly an analysis of the impact of this legislation would be of interest in the future. More generally I think there is a need to develop methods that are able to incorporate the importance of a good standard of care, regardless of treatment outcomes. It would also be good to see health economists evaluating the impact of possible interventions to really improve standard of care of the elderly; such as incentives and training for health care professionals.

So, is this the right course of action? Or is it another useless government PR move? What do you think health economists should be doing to help combat this problem?

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3 thoughts on “Equal care for the elderly: A swing and a miss?

  1. Why do you believe health economists should do something to “combat this problem?” The decision not to discriminate against the elderly in healthcare is a value judgement, just as a decision to discriminate against the elderly is a value judgement. There are sound ethical arguments for why the elderly should receive less priority in healthcare (I’m thinking particularly of fair innings, but there are others). If, as you suggest, society does not value the elderly, giving priority to “the more recently born” would seem to be a rational and defensible allocation of public healthcare resources. It is not clear why your reasonable value judgement should outweigh another reasonable value judgement.

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    1. @hcprefs

      I certainly agree with you; my judgement is only as valuable as anyone elses. However, I wasn’t really trying to get across the fact that I see this as a problem, but more the fact that public opinion sees it as a problem… Which I think makes it one! I believe equity concerns fall within the remit of health economists and as such we should be involved in remedying this problem, whether we see it as one or not.

      The current consensus in health economics is to value health using public preferences… Until we see some hard evidence that public preferences favour poor treatment of the elderly, this will remain an unsolved problem. Regardless of my opinion. If some people see the solution as convincing the public that it is a good thing to treat the elderly badly then so be it!

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  2. I do agree with you Chris on that it’s not a legislation problem because neither law nor any organization is supporting this kind of discrimination but still these cases are happening in our society. Like you, I also think the the root of this problem lies in our society and caregivers are the people who are part of this so called civilized society. In our society we have dual standards like most people think that elders are a real headache and they should have no right to receive care but their thoughts change at the time when they gets old self.

    Home Help Dublin

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