How can we combine the ambitious goals of achieving equity and high performance under increasing economic constraints? This is probably the main challenge of health policy in the future.
At the Blavatnik School’s 2013 Challenges of Government Conference, I attended a session on “Innovations in healthcare” to explore what kinds of challenges and solutions we can expect in healthcare delivery in the coming decades. The speakers, Prof Gwyn Bevan (Professor of Policy Analysis at the London School of Economics and Visiting Professor at the Blavatnik School of Government) and Prof Lionel Tarassenko (Professorial Fellow in Electrical and Electronic Engineering at the University of Oxford ), generated a very stimulating and diverse debate.
The panelists explained why they expect a tremendous rise in healthcare cost. This trend will not only reflect the increasing costs induced by the ageing population, but also its interplay with technological advancements and issues like the current obesity epidemic, which will have dramatic consequences on costly chronic conditions (e.g., diabetes, osteoarthritis) within the next couple of decades.
Both speakers emphasized how inclusiveness is the key for future innovations to be successful. Clinicians, engineers, designers, and patients need to work on the solutions together. A better understanding of each other’s views and needs is crucial to achieve better quality and more efficiency.
Professor Bevan remarked how healthcare provision is particularly challenged by many drivers of market failure, such as the principle-agent problems and the strong asymmetry of information between clinicians and patients. Among other things, we will need to find better ways of empowering patients and fighting the vast sources of medical disinformation on the internet.
e-Health will offer new solutions, but currently we face what Professor Tarassenko called the technology gap. Most of the technology that is an integral part of our generation’s every day life is entirely alien to most of our grandparents. How many of them know how to use a smartphone, say, or initiate a videoconference through Skype? 25 to 30 years may pass until the first cohort of truly tech-savvy individuals will reach the age in which they might need many of the possible applications of technology for the elderly. Designers need to come up with ideas on how to bridge this gap. Furthermore, he stressed how health services, including eHealth, need to become more personalized. He gave examples of studies showing that patients are more likely to take their medicine when they receive a reminder per text message that is signed by a doctor they know and trust compared to an anonymous message. Another study proved that people suffering from chronic lung diseases were more likely to perform their breathing exercises when following a guidance video featuring a nurse they personally know.
The discussion converged on the need of decentralized healthcare. Take end of life treatment for instance: a majority of individuals would prefer to die at home rather than in an anonymous clinic. And yet this wish remains vastly unfulfilled. Considering that we incur on average 30% of our lifetime healthcare cost in the last six months of our life, we could not only improve patient’s quality of life, but arguably also help save the high cost associated with hospitalisation. But what are the metrics currently used to conduct benefit-cost-analyses? The QALYs (Quality Adjusted Life Years), for instance, are based on the claim that quality gain and time gain from any medical intervention is equally valued. Professor Bevan noted the need to reflect upon that assumption – and others, such as the question of whether or not we value the last years of a person’s life as much as another’s first years?
Taken together, the centre of gravity needs to move away from big hospitals towards primary healthcare and prevention. The development of mobile technologies will help bring the skills of experts closer to patients without requiring them to physically go to a clinic. But in the meantime we need short-run solutions to address the technology gap. And so one thing is for sure: there will be more and exciting challenges ahead for health researchers and policy makers.