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Dramatic projections

Five decades ago people could expect to live an average of 58 years, today the life expectancy in Europe is approaching 78 years. According to a report released at the end of August 2008,¹ Europe’s population is continuing to age. The report’s analysis focuses on the current 27 countries that make up the European Union and considers a time period from 2008 to 2060. The main trends highlighted in the report are:

• From 2015, the number of deaths will exceed the number of births.
• The population will continue to grow until 2035, increasing from 495 million to 521 million people; it will then begin to decrease until it reaches slightly more than 505 million in 2060.
• In 2060, the countries with the highest populations will be: United Kingdom (UK) (77 million people), France (72 million), Germany (71 million), Italy (59 million) and Spain (52 million).
• The over-65 segment, which in 2008 represented 17.1% of the total population, will reach 30% in 2060; in the same period the over-80 segment will increase from its current 4.4% to be 7.9% in 2035, and will reach 12.1% in 2060.

Italy is leading this ageing demographic trend and will be followed by other European countries with high populations. Currently, Italy’s over-65 segment constitutes 20.1% of its total population (this compares with 16.1% in the UK, 16.5% in France, 20.1% in Germany and 16.6% in Spain). This percentage is expected to increase to 28.6% in 2035 (forecast to be 21.9% in the UK, 24.4% in France, 30.2% in Germany and 24.8% in Spain). In 2060, the over-65 segment will further increase to 32.7% (projected to be 24.7% in the UK, 25.9% in France, 32.5% in Germany and 32.3% in Spain).

Evolving device needs

Already in Italy the increase in the average age and the progressive ageing of the population have resulted in an increase in the illnesses and medical treatments that are typical for this phase of life. The pharmaceutical industry is achieving sales volumes that are consistent with treating patients older than 65 years and the medical technologies field is also experiencing expansion in this direction.

Some types of medical technologies that were developed for acute patients are evolving to meet the needs of chronic patients; the goal is to keep the patient as autonomous as possible and maintain a high quality of life. Technologies that have great potential for growth include

• orthopaedic technology such as prosthetic knees and hips and customisable semifinished products, and more generally, the development of biomaterials to be used in the manufacture of specific prostheses, foams for bone replacement and artificial tendons
• health care products such as canes, crutches, orthopaedic and physiological footwear, stockings, belts, elastic bandages, cervical pillows, cervical collars, corsets, knitwear, and materials and products to prevent bedsores
• personal hygiene products such as incontinence products made with polymers that prevent odour
• aids and tools for the home to facilitate patients and the elderly living at home and being independent for longer, and technologies for communication, hearing, personal care and protection
• products for physiotherapy as well as wellness monitoring
• cardiovascular products to treat heart disease such as drug eluting stents and heart valves
• minimally invasive surgical devices
• dentistry equipment
• active implantable devices
• electrodiagnostic and diagnostic imaging technologies
• health care information technology such as telemedicine and mobile point of care.

New products and services will make greater use of research and innovation in bionics, electronics, mechatronics, innovative materials with a high degree of biocompatibility, nanotechnologies and artificial organs.

The health care expenditure by Italy’s national public health service, Servizio Sanitario Nazionale, will be approximately €100.6 billion in 2008. This represents an increase of €3.6 billion over 2007 and €9.6 billion over 2006; a large portion of the increase (approximately €3 billion) is being used to improve medical technologies and health care facilities for the elderly. According to Istituto Nazionale di Statistica, Italy’s national Institute of Statistics, health care expenses were 7% of the gross domestic product in 2005, with a per capita spend of €1624 per year.

The ageing of the population is also creating a need to invest in home care; the chronic nature of many diseases, especially cardiovascular diseases, increases the cost of treatment and rehabilitation. Enrolment in heart attack and tumour screening programmes is also experiencing an increase, as a result of the change to a culture of prevention.

Finding positive outcomes

An ageing society must find a balance in the challenge of increasing health care costs. The Italian Government’s primary goal is to continue to reduce waste and increase efficiency so that it can provide its citizens with a service that meets expectations. This approach is particularly necessary in periods of economic downturn. However, it should not be forgotten that the consumption of health care products, which is an expense for the Government, is a source of revenue for the public and private enterprises that supply health care goods and services. It creates wealth, increases employment and provides companies with the possibility of improving their technological and competitive positions.

It will be extremely important to avoid health care consumerism and over “medicalisation.” Current examples of this in Italy include the typical drug blister pack that contains 24 pills, but the treatment only requires 12; the Government pays for 24 and 12 will be wasted by the expiry date. It is also the case that some young children are now patients of the pharmaceutical industry because they are considered to be “potentially aggressive” or suffering from so-called attention deficit disorder; they are given medication to keep them calm and relaxed. Furthermore, sometimes unnecessary analysis is prescribed by doctors. The new generation of doctors often do not visit their patients or use the traditional diagnostic methods of touching, listening and talking; they do not have time to visit and instead ask for additional and often expensive analysis.

The main goal of medical technologies must be to provide benefits that cannot be immediately measured in terms of money; these include healing, years of life gained with an adequate level of quality, reduction of invalidity, and physical and mental well being.

Paolo Galavotti Nexion srl, Via 2 Giugno 111, I-41037 Mirandola, Italy, tel. +39 0535 27880, e-mail: paolo.galavotti@nexion.ws