How Much Do We Really Know About the Implications of Demographic Change for Future Health and Social Care Costs? Articulating a Research Agenda

Projections of health/social care spending highlight risks to future fiscal sustainability. This concern is based, in part, on six assumptions, which we argue are uncertain: (1). Populations will continue to age; (2). Health is a function of age; (3). Health/social care need is driven by health; (4). Health/social care spending is driven by need; (5). Inequalities are unimportant; (6). Increasing dependency ratios risk fiscal sustainability. We propose three hypotheses which reframe the debate: (1). Health/social care spending primarily results from political decisions on supply; (2). Prevention policies alone are unlikely to reduce fiscal pressures; (3). Fiscal sustainability is best achieved by combining prevention with decommodification and ‘realistic medicine’.