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?