LB: Welcome, everyone. We are standing at a fascinating crossroads. Thanks to incredible medical breakthroughs and better healthcare, people across Europe and here in Slovenia are living longer (and in some cases due to medical innovation also healthier lives) than ever before. But, too often, the conversation around aging populations focuses strictly on the immediate threat of rising costs. Today, I am joined by a Professor of Economics Jože Sambt, to challenge that narrative. Jože, you are researching the impact of demographic change on the long-term sustainability of public finances. From an economic standpoint, why is it dangerous to look at aging purely as a fiscal burden?
JS: Thank you, Lauren. It’s a pleasure to be here. The danger lies in our timeline. When policy makers look at healthcare solely through the lens of annual budget cycles, they see older generations needing more care for chronic conditions as a drain on resources—especially when, over the next 25 years, we will see a record number of retired individuals and a proportionally smaller working-age population paying employment taxes. But this is a narrow view. If we change our strategy and use health innovation to keep people healthy and active for longer, longevity shifts from a threat to an opportunity for economic growth.
LB:I completely agree—they are inseparable. And when we look at that intersection of health and economic policy, we see a massive gap between what is scientifically possible and what healthcare systems currently deliver. I have often heard this referred to as 21st century medicine trying to be used within a 20th century system. Narrowing this gap requires us to change how we define the "value" of innovation. When a new medicine or diagnostic tool is introduced, the immediate reaction from payers is often focused entirely on the upfront acquisition cost.
JS: Exactly, and that is where the economic math falls apart. Traditionally, we rely on Health Technology Assessments (HTA) to evaluate the medical and economic value of treatments. While HTA aims to prove if a drug is worth its cost, it usually operates from a very restricted payer perspective.
In our recent 2026 meta-analysis on the economic prudence of new therapies, we looked much broader—at Social Return on Investment (SROI). This requires us to weigh the initial cost against all benefits to the patient, the healthcare system, and society. When you apply this broader societal lens, it reveals a significantly higher value. Why? Because it captures saved hospitalizations, reduced rehabilitation, prevented disabilities, and less reliance on informal family care. Most importantly, it keeps people in the workforce. On any given day, an average of 53,000 people are on sick leave in Slovenia, according to data from ZZZS. This high rate costs the public insurance fund approximately €660 million annually.
LB: That concept of keeping people in the workforce is huge. It underscores why a proactive approach—built on robust prevention, early detection, and timely treatment—is so critical. This full continuum of care is what directly yields healthier, more active working members of society, keeping them earning and contributing.
The macroeconomic data backs this up completely. A landmark PwC study tracking a ten-year period across Europe showed that innovative medicines added two million healthy years to people’s lives. Those health gains alone injected a massive €27 billion boost back into the economy. Jože, how does this societal return manifest in your own recent meta-analysis?
JS: Absolutely. The strongest signals come from chronic progressive diseases, rare diseases, and cardiometabolic conditions. Take Multiple Sclerosis (MS) as a concrete example: our meta-study shows that for every €1 invested in effective therapy, it generates €1.83 in broader societal value. That explicitly proves that pharmaceutical investments pay off economically, not just clinically, by preventing long-term functional limitations.
LB: And what about areas like oncology, where costs are a frequent talking point? Meanwhile recent WiFOR data shows in 2027 alone HER2+ breast cancer will be costing European economies €24.3 billion in lost productivity.
JS: In oncology, the economic efficiency improves drastically when three conditions are met: the treatment is precisely targeted to the right population, advanced diagnostics are used early to eliminate ineffective treatments, and the economic models account for long-term survival. Similarly, with cardiometabolic therapies, the return is highly stable and repeatable, frequently translating into direct, net savings for the system by preventing catastrophic events like heart attacks or strokes.
LB: It’s clear that infrastructure and policy matter just as much as scientific discovery. We can create the most groundbreaking, targeted oncology treatments in our labs, but if the local health system isn't set up to adopt them quickly, patients suffer and the economy loses out. What systemic shifts or financial frameworks are required to stop measuring healthcare by the immediate cost of delivery, and start valuing it by the long-term return on investment (ROI) of a resilient, productive society?
JS: Right now, we mistakenly treat healthcare as a short-term expense rather than a long-term investment in human capital. To shift this perspective, we need two systemic changes:
First, we must bring societal value into HTA. We need to look beyond immediate medical bills and measure broader economic returns—like a patient returning to work or a caregiver freed from full-time duties. That is direct productivity injected back into the economy.
Second, we need to track 'disappearing' system costs. Innovative therapies often have high upfront price tags, but they can eliminate a lifetime of chronic disease management or emergency room visits. Multi-year financial modeling shows that investing today actively defunds systemic waste tomorrow.
When our accounting captures both societal productivity and disappearing legacy costs, healthcare stops looking like a liability and becomes our most powerful economic engine.
LB: Industry cannot solve this alone, and governments cannot solve it alone. We need a shared vision across sectors and borders to put innovation to work.
JS: Exactly. To wrap it up from the economic perspective: decisions about health investments should never be based on the short-term pressure to limit spending. They must be grounded in the comprehensive, long-term value a treatment creates for patients, the health system, and society as a whole. We need to collectively recognize that a healthier society is not only wealthier due to these massive economic gains, but fundamentally stronger and more resilient against future demographic shifts or global shocks. All stakeholders—from industry to policymakers, clinicians, and patient organizations—must act together to modernize care delivery. Let’s stop looking at healthcare as a cost to be cut, and start treating it as the ultimate strategic investment for a stronger, more sustainable future.
LB: Looking at Slovenia specifically, what do you see as the biggest opportunity? Where could Slovenia make the greatest progress in strengthening both health outcomes and economic competitiveness?
JS: Slovenia has many strengths: a well-educated workforce, a strong scientific base and a high-quality healthcare system. The opportunity lies in connecting these strengths more strategically. Health should not be viewed only through the lens of healthcare expenditure, but also as part of Slovenia's broader development strategy. Investments in innovation, prevention and timely access to new treatments can generate benefits that extend well beyond the healthcare system.
LB: Professor Sambt, thank you so much for joining me today and sharing these vital insights.
JS: Thank you, Lauren.
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