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Healthcare systems are complex, enormous and unwieldy, whether they are state-managed monoliths such as the UK's, or dominated by the private insurance sector, as in the US. They are traditionally slow to adapt to change, but now those immovable objects are being forced to confront not just one, but several irresistible forces: demographic (ageing populations), epidemiological (increasing incidence of chronic diseases), technological (more expensive drugs and technologies) and economic (global recession, high public debt, smaller pensions). The price for ignoring these forces could be disastrous - the US president, Barack Obama, has warned that if it is allowed to continue down its present course, the US healthcare system will bankrupt the entire country.
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