Can a number on an ID card determine what treatment a patient is entitled to? The question is becoming increasingly urgent as Greece ages and advances in medicine expand treatment options, while also bringing new — and often extremely expensive — therapies to the forefront.
Emmanouil Saloustros, associate professor of oncology and President of the Board of Directors at the Hellenic Society of Medical Oncology, recently described a real dilemma from everyday clinical practice: “I was recently asked to respond to an application for the administration of a very expensive drug to an 80-year-old man with metastatic, incurable disease.”
If the decision were based solely on a numerical criterion — age — it could lead to a different judgment from the one dictated by the patient’s actual biological and functional condition, he explained. The example captures one of the major challenges demographic aging poses to the health system: it is no longer enough to know how old a person is. We also need to know how they have aged.
Greece’s Over-65 Population
Aris Alexopoulos, head of the OECD Crete Centre on Population Dynamics and a professor of Public Policy Analysis at the University of Crete, presented the broader demographic picture.
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The trend, he said, is twofold and difficult to reverse: fewer people are being born and people are living longer.
“This is the gift of science, that we live longer, meaning life expectancy is increasing. Of the children born today, 50% will live beyond the age of 104, and this creates new conditions in the demographic pyramid,” he said.
In Greece, people aged 65 and older already account for about 24% of the population, leading Alexopoulos to describe the country as “super-aged.” The outlook for the coming decades will reshape the age pyramid even further. According to the figures he presented, by 2050 Greece will have about 2.5 million people over the age of 65 and 300,000 fewer young people.
The consequences extend beyond demographics. They affect the labor market, the social security system, public revenues and, above all, the healthcare needs of a population that will live longer and require care for a longer period.
“We have added years to our lives; we must also add life to our years,” Alexopoulos said emphatically.
According to his presentation, OECD studies show that roughly five years toward the end of life are accompanied by some form of limitation. Cardiovascular disease, obesity, cancer and dementia are among the leading challenges facing an aging society. A significant part of the risk, however, is linked to lifestyle and can be influenced much earlier.
Prevention Starts Long Before 65
This is where Alexopoulos says the health system needs a major shift in philosophy: moving from treating disease after it appears to prevention, beginning in the earliest years of life.
The figures he presented show that Greece has already closed much of the gap that once separated it from other OECD countries in prevention spending. In 2013, prevention accounted for 1.1% of health spending in Greece, compared with an OECD average of 2.8%. By 2024, Greece had reached 3.1%, compared with 3.4% across the OECD.
“We have converged. This means we have received the message,” he said, while stressing that prevention “does not start after 50. Prevention starts when you are young.”
What matters, moreover, is not only how much money is spent, but who ultimately has access to prevention. For Alexopoulos, mobile health units and expanding access points are particularly important precisely because they can reach people who otherwise would not visit a doctor or undergo even a basic preventive examination.
The 80-Year-Old Who May Be Biologically Much Younger
For Saloustros, however, aging creates a second major need: medicine itself must change the way it assesses older patients.
“The way we treat people as they grow older and the way we manage their disease should not be determined solely by their age,” he stressed.
The medical community, he explained, needs tools capable of distinguishing between an older person with significant functional impairment and someone who, despite their chronological age, is in much better biological condition.
The problem is not theoretical.
“Every day, as a doctor, I find myself facing this reality,” the professor said, pointing out that he is often required to make treatment decisions for older people without sufficiently clear tools to distinguish between these different patient groups.
The Treatments That Will Pressure the System
The dilemma is becoming even more difficult because medical progress is creating possibilities that did not exist until recently — but they often come with extremely high costs.
Saloustros said he believes one of the biggest challenges in the coming years will be how health systems cover the increased demand for innovative treatments that comes with an aging population.
The issue is not limited to cancer. New and expensive treatment options are beginning to emerge for neurodegenerative diseases, cardiovascular conditions and a range of other chronic diseases.
That is why, in his view, the medical community’s response cannot be limited to treatment. A greater shift toward primary prevention and early diagnosis is needed.
In oncology, moreover, many interventions take years to deliver their full benefit. Smoking cessation, for example, may take one or two decades before its impact is reflected in a reduction in the incidence of lung cancer, he noted, while the cardiovascular benefits appear much sooner.
“Give Life to the Years”
Demographic change is therefore becoming both a healthcare and an economic challenge. As life expectancy increases, the question of whether those additional years will be lived in good health, with independence and functional ability, becomes increasingly important.
That also requires changes within medicine itself. In his closing remarks, Saloustros identified three priorities: developing new tools that address the different needs of an aging population, training healthcare professionals, and much closer cooperation among different medical specialties.