Starzenie się człowieka i starzenie się populacji. Podział odpowiedzialności za skutki finansowe w systemie opieki zdrowotnej

The adverse consequences of an aging society for the stability of health care financing systems are superimposed on the natural inequality of the distribution of health needs, and consequently, expenditure for health services in the life cycle of man. How long, under such conditions, will financial security systems based on the mechanism of PAYG (pay as you go) be able to guarantee all of its citizens, including the oldest ones, broad access to medical care? The debate brought about by D. Callahan in 1987 on “age-based rationing of benefits” for many years focused on trying to find ethical and economic rationale for limiting the scope of benefits guaranteed to the oldest citizens (eg A. illimas, F. Breyer, D. Brock, N. Daniels, P. Dabrock). Age-based benefit rationing from public funds, however, may soon become a reality if we do not manage to break ties, within the public system, with the idea of full socialization of the costs of old age at the expense of future generations. Maintaining fundamental fairness towards the future generations requires an equal sharing of the financial consequences of aging, and this means taking on more responsibility of every individual for himself. A good practice of substitute private health insurance in Germany is the mandatory creation of individual financial reserves for old age which allows avoiding an excessive rise of equivalent risk premium in old age. Another solution for social health insurance might be reserves built by each generation, or a general public reserve. The transition from the purely PAYG system to a more capital one, however, will require the construction of functional solutions for the transitional period in which we have yet to build reserves and fund services for older generations who have not yet built reserves for themselves. An apparent increase of the country’s debt seems therefore inevitable, but also present older generations must be held financially accountable through higher premiums or payments for benefits.