I.Global megatrends shaping the future
This chapter looks to the future of healthcare and lays out one possible path forward. The impact of global megatrends, such as climate change, on global health and healthcare are examined, as well as global evidence on effective strategies to tackle those momentous challenges. More than in the previous chapters, chapter 5 features learnings from other industries, anecdotal evidence, and ideas that might work – but the empirical evidence gained so far in the healthcare context is limited.
When looking into the future of healthcare, it’s important to understand the global megatrends reshaping the world. Megatrends are structural shifts that drive large social, economic, political, environmental, or technological changes. Megatrends are slow to form, but once in place can fundamentally change how organisations, industries, and societies operate.
In the middle of this rapid change, welfare systems and governments across the world are facing greater financial pressures and stretched government resources. This underlines the need for ways to secure the sustainability of publicly funded services.
Here are some of the most important megatrends that also reinforce the need to re-think health systems to ensure the resilience of the welfare state. However, one should always keep in mind that forecasting is really difficult. The COVID-19 pandemic and its effects on everything, globally, is a perfect example of this. Understanding the forces shaping the future – and designing a strategy that takes those forces into account – is critical, as is being able to quickly adapt to change.
Climate change threatens access to clean air, safe drinking water, a nutritious food supply, and safe shelter. Climate change is already causing rising sea levels, more frequent and extreme weather events, heatwaves and droughts, forest fires, and increased spread of mosquito-borne diseases like malaria. A highly conservative estimate of 250,000 additional deaths each year due to climate change has been projected between 2030 and 2050. Of these, 38,000 will be from heat exposure among the elderly, 48,000 from diarrhea, 60,000 from malaria, and 95,000 from childhood undernutrition.
Technology is being embedded in everything, making it an inseparable part of modern society and everyday life. In addition, the rate at which new technologies get adopted by citizens is also increasing. Multiple industries are being transformed by digitalization and emerging technologies, and healthcare is no exception.
Digitalization – and especially data – is enormously important for healthcare stakeholders. From the payer’s perspective, data enables incentives to be aligned, allowing the delivering of good health outcomes to be focused on. As discussed in Chapter 2, combined data from various sources can be used in clinical decision making, population health management and research, development, and innovation.
Better use of existing health data could lower costs and improve care outcomes. According to the OECD, the digitalization of healthcare could save $600 billion USD across the OECD countries each year through improved efficiency and reduced waste – equal to 8% of current health expenditures. As acute care in hospitals is more expensive than community-driven care, the potential to proactively predict diseases and prevent future care needs though early interventions has economic benefits for payers.
The sharing and circular economy
The sharing economy is based on sharing assets that are not actively in use all the time – for example, for many people their car sits idle most of the time. In healthcare, this could include renting the services of medical personnel, facilities, and resources. A sharing economy approach could improve access to care, especially with resources that are not often used.
Even though healthcare has not had a central role in the circular economy debate, healthcare’s global climate footprint is quite significant. More than 4% of the world’s climate emissions are from healthcare activities – that means if the health sector were a country, it would be the fifth-largest emitter on the planet.
Healthcare’s transition to adopting circular economy principles provides an opportunity to create potentially substantial benefits. The benefits are both direct, such as savings due to the more efficient use of resources, and indirect, from better health and reduced environmental impacts.
Source: Health Care Without Harm 2019
Providing care for an aging population, increase of chronic illnesses, and rising costs
As we discussed in Chapter 1, rising costs are a critical issue healthcare systems face. While effectiveness has long been a major focus for healthcare organizations, a lot remains to be done. The OECD report on “Wasteful Spending in Health” presented alarming data on inappropriate care and wasted resources with estimations ranging from a conservative 10% up to 34% of total expenditure on healthcare in OECD countries.
The biggest financial challenge facing the healthcare sector in the coming years, however, is related to aging. A lot more focus should be put to prevention and care of the aging and increasingly ill people, as healthcare costs tend to rise with age, in particular those people with lifestyle-related chronic diseases.
Source: Public Health England
According to World Population Prospects 2019, 1 in 6 people in the world will be over the age of 65 by 2050, up from 1 in 11 in 2019. By 2100, older people will make up the majority of the world’s population. In Finland, the share of over-65-year-olds will increase from the current 20 percent of the population to 26 percent by 2030 and to 29 percent by 2060. In the EU, the cost of aging, including public spending on pensions, healthcare, long-term care, education, and unemployment benefits, is set to increase by 1.7 percentage points of GDP by 2070.
Aging shifts consumption from durable goods towards services. Increased demand will create new markets, accelerate service innovations, and create new healthcare professions and roles. But on the other hand, delivering care to larger populations with limited resources requires new approaches to care as only a small share of health services are paid out of pocket by citizens themselves. A reactive stance by healthcare organizations and policy makers will just accelerate the change further, which is why it is important for all parties to understand what drives change and what the concrete improvements that people appreciate and have come to expect are.
As we discussed in Chapter 3, chronic diseases (also known as non-communicable diseases or NCDs) are becoming one of the greatest challenges to global health. They are by far the leading cause of death in the world, killing more than 36 million people each year – particularly from cancer, diabetes, mental illness, heart disease, or respiratory disease – and representing 63% of all annual deaths. Some 80% of all non-communicable disease deaths occur in low and middle-income countries.
According to the World Economic Forum (WEF), one in three adults worldwide has multiple chronic conditions. Multiple chronic conditions not only have a great impact on the patient, but the cost of treating them tends to double with each additional complication. According to a study by the World Economic Forum, the impact of cancer, diabetes, mental illness, heart disease, and respiratory disease could reach $47 trillion by 2030. For example in Finland chronic diseases cause an annual burden of close to 17 billion euros, if indirect costs such as lost productivity are taken into account.
The future of work
The world of work is facing a significant change. Digitalization and technologies such as artificial intelligence, automation, and robotics will disrupt many professions. Based on estimates, demand for technological, social and emotional, and higher cognitive skills will rise in the future. While some jobs will be “lost to machines”, many new ones will be created. An aging population will most likely increase demand for healthcare services, which creates demand for more healthcare professionals – who are already in short supply.
In addition, digitalization enables the sharing of talent as well as remote and project-based work. This has accelerated the freelance economy in many specialist occupations. Even though freelance jobs are currently most common in areas such as software development, we will most likely see an emergence of freelancers in healthcare as well. The future workforce in healthcare will most likely be a combination of internal resources and people with full-time roles, as well as task-based external talent that is engaged on demand.
While an aging population and digitalization as the enabler of the workforce transition seem to offer a clear path forward, one needs to keep in mind the realities of healthcare. Particularly (and increasingly) chronically ill patient populations need long-term planning and coordination. It is therefore important to focus on how good continuity-of-care can be achieved in this increasingly fragmented healthcare landscape.
A shortage of healthcare talent
Due to a steadily increasing demand for healthcare services and the current way healthcare organizations operate, talent shortages and recruitment are a real problem. This might lead to the development of “healthcare deserts“ – areas where there aren’t enough healthcare professionals to treat the needs of the population – with a potentially severe impact on the quality and sustainability of the healthcare system. Issues may include:
- Lower quality of care
- Time constraints on doctor-patient interactions
- Overworked and stressed practitioners
- Unnecessarily long waiting times before getting care
The World Health Organization (WHO) estimates that there is a global shortage of 4.3 million physicians, nurses, and other health professionals.
The shortage is often starkest in developing nations due to the limited number and capacity of medical schools in these countries.
In addition, remote areas in developed countries commonly struggle with a physician shortage. Even in Finland there are increasing challenges to recruit practitioners. For example, the Finnish Medical Association (FMA) has reported a growing talent shortage.
The move towards the gig economy – a free market system where organizations hire independent workers for short-term commitments and in which temporary positions are common – needs careful ethical consideration. This is because freelance workers typically lack certain essential benefits such as access to occupational healthcare services (or healthcare in general, as is the case in the US), or holiday entitlements. This is especially important in countries with a limited social safety net.
Even in countries who offer comprehensive public healthcare services, such as Finland, freelancers do not typically have access to occupational health services provided by employers, which could increase the demand for public healthcare services. Due to these general challenges, concepts such as society-wide basic income are being proposed as a means to smooth the transition (for example, Finland ran a basic-income experiment from 2017-2019).
Digitalization will have an effect on the way healthcare is delivered in the future and the demand for remote services has skyrocketed with the COVID-19 pandemic. On-demand resource pools sharing specialist capabilities will be much easier in the context of remote care. Rethinking which channel to use and who does what – for example giving more power to nurses supported by new artificial intelligence (AI) powered tools and a physician via telepresence – are important factors in solving this specific challenge.
Crowdsourcing, which is the practice of engaging a crowd or group for a common goal, has the potential to change how work is organized. Crowdsourcing provides access to a larger pool of talent by using online platforms to match supply and demand.
General model for remote consultation. Based on the solution by the US based American Well.
Remote consultations have steadily gained popularity over the recent years and they are seen as one of the most important new changes to the way healthcare is delivered. Since the COVID-19 pandemic spread throughout the world in the spring of 2020, the demand for remote consultations has increased.
Several solutions currently exist in Finland and abroad, including proprietary solutions operated by private healthcare providers, such as Mehiläinen’s OmaMehiläinen in Finland, and Klinik Healthcare.
Many successful remote clinics have implemented artificial intelligence powered triage solutions that together with nursing assessment saves cost and helps the patient to find the appropriate care for their needs.
Case: Services to support living at home – evaluation and care unit
Eksote, a healthcare district in the southeast of Finland, has launched a nurse-led mobile evaluation and care unit. The mobile unit has all necessary tools, such as ECG equipment and a lab for quick tests, as well as a video consultation link to a physician.
The idea is to prevent unnecessary hospital visits and use of ambulance services by conducting triage and many acute healthcare services at the patient’s home. While the care is administered by a nurse, the possibility to consult a doctor when needed means that in most cases the entire episode can be successfully treated without a visit to the hospital.
This has dramatically lowered the cost per episode of care. In 86% of cases, an immediate visit to the emergency department was not required. Compared with the traditional service model, the costs fell by at least 33%.
The wellbeing of healthcare professionals
Another challenge that healthcare is facing is the wellbeing of healthcare personnel, which directly impacts patient care and safety. The current fee-for-service model emphasizes productivity instead of patient outcomes. This leads to increasing burnout among medical personnel, defined as “a work-related syndrome involving emotional exhaustion, depersonalisation, and a sense of reduced personal accomplishment”. A Survey of America's Physicians: Practice Patterns and Perspectives in 2018 reported that 78% of physicians had burnout. Similar numbers were reported in a British Medical Association survey, which stated that 80% of doctors were at “high or very high risk of burnout”.
COVID-19 and stress experienced by healthcare professionals
Medicine is a stressful profession under normal circumstances, but the COVID-19 crisis has caused an even greater burden on healthcare professionals working in hospitals in the worst affected areas.
As discussed in this course, most healthcare systems have placed a lot of emphasis on effectiveness and running a “lean” operation, which has led to many hospitals without the resources to quickly expand care. This taken together with the surge of global demand for personal protective equipment (PPE) and ventilators, which has made these critical supplies scarce, has placed an unprecedented burden on frontline healthcare workers causing stress, anxiety, and other more severe mental health problems.
Citizen expectations and behavior
Last but not least, the behavior and expectations of citizens represent a key force for change in the world. Based on recent surveys (for example the EY Future Consumer Index and Deloitte Consumer Tracker), the coronavirus pandemic has increased people’s concern about their own and their family’s health, as well as accelerating the demand for digital services such as home-delivered groceries and remote healthcare. Most interestingly, EY’s Consumer Index (2020) has found that healthcare providers are regarded as the most authoritative organization: 47% of consumers indicated that they trust them completely, compared to governments (28%), brands (17%), and media companies (16%). This situation highlights the central and important role of healthcare in people’s lives.
But healthcare needs to meet these rising expectations. The WHO has suggested responsiveness to citizens’ expectations be a central goal for health systems across the world (for example in the World Health Report 2000 on the performance of health systems). The expectations on healthcare are expected to grow – this is a result of how people now interact with companies, brands, and government institutions. There is little patience for poor service or products and switching between providers is common. In order to meet these growing expectations, health providers will need to become more customer centric.