Healthcare Landscapes 2015

Healthcare in Europe is under a lot of pressure. The upcoming aging population, better medical treatments, leading to increased amounts of people with chronic illnesses, create a challenge for Europe to deliver its citizens healthcare at affordable costs. This creates high pressure on the European healthcare system to change. A lot of trends and issues come into play that may encourage or stall a change in healthcare. Whether a change in healthcare will happen or not, is uncertain. If it will change, how will it change? All of this is uncertain and depends on many factors that will in turn be influenced by many issues and trends. Whatever Europe will look like in the future, whatever the future of healthcare in Europe will look like, this will influence the way healthcare concepts and their business models will be shaped and have to operate. To get a better understanding of possible healthcare futures, to build potential businesses while dealing deal with uncertainties, four healthcare landscapes were created. The healthcare landscapes are a set of provocative but relevant future contexts in which personal healthcare systems might operate. These landscapes apply generically with a focus on the European context. They have been developed specifically for the MyHeart concepts. The aim of the future landscapes is to make the MyHeart vision & solutions for personal healthcare enabled by technology more robust and capable to thrive in different possible futures. By placing the four different MyHeart concepts in the four Healthcare Landscapes for 2015, verification and validity are tested and strengthened in terms of business models and concept propositions and stakeholders involved. The key questions posed in this context of healthcare landscapes 2015 include: What will be the future of healthcare in 2015? How big will the prevention market be in 2015? What will be the ratio between/private and public/state healthcare expenditure? This raised many more specific questions such as: How much will public procurement become risk taking? One of the participating experts stated that the current risk-averse attitude leads to stagnation, a continuation of this attitude will cause a considerable delay of more than ten years of preventative concepts like MyHeart. The well-being vision at the base of this landscape exercise for MyHeart can be summarised as follows: Towards a new standard of healthcare habits. What are possible drivers, inhibitors, trends and issues that might shape this vision? This vision can be illustrated with the oral care evolution that has taken place between the 1930's and 2005. Enabled through education, change of lifestyle and insurance, a shift from no awareness of oral healthcare to oral healthcare as an integrated part of daily life has been made. The technique used to create the landscapes was based on the well-known scenario planning methodology as developed by Peter Schwartz1. His methodology can be described as a strategic planning tool, which enables businesses to create alternative future environments in order to create solutions that can survive the changes and challenges of tomorrow's market place. To create the landscapes, participants from different areas of expertise relevant for the future of healthcare were invited to a one day workshop. Their backgrounds ranged from new business development, technology, and cardiology to end user understanding. This resulted in the creation of four extreme, but plausible landscapes. The second step was to place the MyHeart concepts in each landscape. In this way the concepts and their appropriate business models, relevant stakeholders and market dynamics could be tested for viability and further explored. The third step was to aggregate the learnings from the four concept champions across the four landscapes in order to capitalize across the potential contexts in which the business propositions might have to thrive. The main focus for the development of the landscapes is Europe. The chosen timescale was set to 2015, eight years from the finalisation of the MyHeart project, a predevelopment research project. This allows for time to bring the concepts to market and possibly gain some momentum and market share. At the same time this is not so far in the future that too many dramatic changes can be expected.

Trends and issues on which the landscapes are based

 In the landscape creation workshop, each individual contributed their key trends and issues with regards to the future of healthcare. This led to the generation of more than 80 trends and issues. In a plenary session these 80 trends and issues were condensed into 29 main themes considered relevant for the future of personal healthcare. In lively discussions each of the 29 themes were mapped onto a matrix of uncertainty and importance. The uncertainty axis indicates how certain or uncertain the participants of the workshop estimate a trend or issue to occur by 2015. The Importance axis indicated how crucial the participants considered the impact if the trend or issue to be in 2015 for healthcare. The plenary nature helped to calibrate the true risk for each theme based on the expert views of the participants. 

Landscapes

The key axes that shape the landscapes and also the assumptions on which these landscapes were based were defined using the Importance and Uncertainty Mapping (mentioned in the previous chapter). In the upper right quadrant, the trends and issues can be found that are seen as most uncertain and of high importance. Therefore these trends and issues are key in order to define plausible as well as provocative possible futures that are relevant. The more certain issues and trends form the basis of the landscapes and the assumptions on which the landscapes are based. Each landscape is shaped around a core of main issues and drivers. The roles of stakeholders such as citizen, state, insurer, healthcare service providers are described. Expert participant quotes are used to illustrate and underpin each landscape. The key questions posed in this context of healthcare landscapes 2015 include: What will be the future of healthcare in 2015? How big will the prevention market be in 2015? What will be the ratio between/private and public/state healthcare expenditure? This raised many more specific questions such as: How much will public procurement become risk taking? One of the participating experts stated that the current risk- averse attitude leads to stagnation, a continuation of this attitude will cause a 16 years delay of preventative concepts like MyHeart.

Landscapes axes 

The two axes, the key factors determining the healthcare landscapes 2015, defined in the plenary workshop, are: - responsibility and payment in healthcare - attitude towards healthcare and degree of innovation. The vertical axis represents responsibility and payment of healthcare costs. The scale ranges from the state having primary responsibility to the citizen having primary responsibility and accountability for payment of healthcare costs. Please be aware of the emphasis on the word primary, this means that neither the state nor the citizen will be solely responsible and paying. When the state is primarily responsible, aspects such as awareness creation, possibly in the form of education and procurement, meaning buying in of healthcare, come into play. When the citizen is primarily responsible the empowerment, motivation and education or understanding of the citizen and their informal care networks are key. "It is more important for the future of healthcare to know if the development of the private market is in place and how it has been materialized than the size of the healthcare budget. " Expert Quote For the horizontal axis, both the attitude to healthcare and the degree of innovation allowed were selected as the most important issues. This degree of innovation includes medical innovation, technological innovation as well as stakeholder collaboration, knowledge and attitude. The scale ranged from a more reactive or passive stance (taking an as per today 2006 perspective) to a more proactive stance from the stakeholders. This proactive stance includes non-invasive, personalised and assumptive healthcare as well as more knowledgeable and better informed, more collaborative stakeholders. "From my experience I can tell you that since the 80's there haven't been reorganizations in the way stakeholders collaborate in healthcare, however I see this as essential, otherwise it will not happen." Expert Quote 

Key assumptions on which the landscapes are based 

Key assumptions for people in 2015 

  • There will be more singles 
  • Peoples healthcare attitude and ownership of health are increasing clearly and positively 
  • People will be more tech savvy (including elderly and patients) 
  • People will no longer perceive a barrier towards healthcare solutions due to privacy issues and trust related to technology, is has been resolved by 2015 
  • People will be Increasingly compliant related to the unobtrusiveness of solutions 
  • Stress management will become increasingly important Key assumptions for technology in 2015: 
  • Implants and on-body energy scavenging will be a fact 
  • There will be a development of low-cost, non-invasive sensors (however the more rapid and qualified the response has to be the more uncertain it will be ) 
  • Responsive infrastructure e.g. Continua (standardization for healthcare devices) will be highly successful in setting a standard, Standards (enabler) and interoperability add to the data compatibility 
  • Global digital data movement, standardization and interoperability, generally will be slow

Landscape One: Care Handcuffed 

The state has primary responsibility for healthcare provision and pays. Healthcare is focused on reactive cure solutions with a focus on critical event intervention. "If we continue to adhere to current high standards of quality of care and safety coupled with risk aversion we know this will lead to stagnation in care development of up to 15 years." Expert Quote "Panic on cost management in care can lead to total care neglection by illiterate consumers and risk adverse healthcare systems." Expert Quote This landscape is called care handcuffed because healthcare in this landscape has a problem to maintain itself, let alone develop further. There are two key aspects that cause this. 

Main issues / drivers: 

The state is subject to a cost efficiency drive. The State is aware of increasing financial pressure on healthcare due to an ageing population and the need to operate within a restricted healthcare budget In addition, the state is trapped in a cycle of maintaining current quality standards and risk aversion. However, maintaining existing quality standards in healthcare using trusted care delivery, while having many more people to care for, while treating everybody as equal, only allows a more narrow focus on critical event management and crisis event management of people actively seeking help (note that not all people are able to seek help due to knowledge and cost limitations).

Main characteristics: 

  • Government / state is held responsible for people being ill 
  • All patients should be treated as equal 
  • Standard care package with limited choice; extra's to be paid via private insurance 
  • Passive care: relying on patients to come with symptoms, so symptoms have developed to a more advanced stage, complicating and increasing cost of treatment and possibly leading to irreversible damage to the patient. 
  • Care is institutionalized and due to the efficiency drive that results in a diversification of options between high intensity and high quality versus low intensity and sub standard care. 
  • Chronic disease management is minimally available, only on critical humanitarian grounds (in further future chronic disease management may disappear from the state's radar.) 
  • Non-profit organizations get a pivotal role in education and marketing with state and insurers knocking at their door. 

The role of health insurance 

  • Insurers will maintain a clinical care focus as in current models and will remain sceptical towards prevention-centred solutions for the time being. In the further future (2025) they will only be interested in preventative care coverage once thoroughly proven (clinically as well as economically). 
  • The insurance model is based on a model of 'per hospitalization' due to the efficiency drive and thus not patient-based. Insurers harness the power of non-profit organizations and their wide knowledge base for marketing purposes as they are not allowed to actively 'advertise' by current regulations.

Landscape Two: Care Hand Holding 

The State has primary responsibility of healthcare provision and pays. Healthcare is focused on proactive cure and prevention with a positive climate for innovation (medical, technical, personal, noninvasive, personalized, collaborative). 

"Innovative technology, education, collaboration and organizational changes are all equally important factors to the success of personal healthcare systems." Expert Quote

 This landscape is called hand holding as this landscape is shaped by the fact that the state keeps an eye on and has the final responsibility of healthcare. It operates like a conductor of all healthcare stakeholders, like a parent, truly trying to materialise a healthcare that is best for each citizen and the society as a whole. This approach can be enabled either in a more prescriptive or a more seductive way. Care can be more incentive-based, people who comply pay less (dental care model), or more punitive, people who disregard the system totally, risk being excluded form care (e.g. car insurance).

Main issues / drivers:

  • The state is on a care efficiency drive and promotes preventative care based on rich healthcare insights. These are gathered through medical research combined with extensive monitoring of citizen's health and risk factors. 
  • The state budget for healthcare has increased to 12% of the GDP. Of this budget, EU countries currently invest around 6%-9% of GDP on prevention solutions. 
  • Procurement has become more geared towards risk taking. Public authorities are risking more and becoming actively involved in the development of new solutions. EU member states and doctors have to use these solutions and as infrastructure issues have been solved sufficiently, local entities operate with a risk taking mentality as well. 
  • The state now mediates a diversified landscape of care. There is collaboration between the state, private insurance and other stakeholders to define and deliver targeted care packages. Knowledge on health leads to a diversification of care for risk factors and diseases.

Main characteristics:

  • Social responsibility is key 
  • Electronic health records are a reality. The content is continuously gathered and used for population analysis to improve on personalized and contextualized health. 
  • Monitoring is key to the efficacy of healthcare, (fraud can be an issue and compliance can be low) 
  • Cross boarder care is becoming reality within Europe. This is already attracting the wealthy from abroad

The role of health insurance 

  • In 2015, insurers will start to become a partner. The state provides insurer with mechanisms to force people into a proactive attitude based on financial incentives. 
  • Laws protecting citizen's privacy might block insurers from crossing ethical boundaries but in the further future ethical boundaries will shift. 
  • The spectrum of care coverage from prevention to aftercare will be based on citizen health profiles (in the further future, a possibly profound change of insurance model is envisaged). Insurance models in this landscape have shifted from 'based on per hospitalization' to 'a health progress driven' model.

Landscape Three: Care Hands Full

The patient is apprehensive (fearful) and has primary responsibility of his or her own healthcare provision and pays for it. Healthcare is focused on reactive cure and intervention-centric solutions.

 "A well informed / educated, worried citizen, with money to spend on healthcare & access to services & products may still choose NOT to act & may still feel overwhelmed & VULNERABLE! Even these citizens will need a support network to take action." Expert Quote 

"Personal involvement and motivation in managing one's own health is the key factor in staying healthy but this also means that the populations will be divided into two camps: the one that invest in their own health and the ones that are not motivated and do not have the means to do so." Expert Quote

 This landscape is called 'hands full' as in nine years time the responsibility of healthcare will be pushed in peoples hands regardless if they like it or not, regardless if they are knowledgeable, informed and motivated enough or not. Although this landscape includes the very motivated, able and informed it s most likely this will be a minority group at least for the coming years. Most people will have their hands full, trying to handle healthcare themselves, trying to make the right decisions.

Main issues / drivers: 

  • Patients have control over their own health, but it depends heavily on education and spending power. Patients are in control of disease event management and chronic disease management. Insurance companies, through a portfolio of different cost packages, offer personalization of care. Citizens need trusted guidance and knowledge to make decisions. Internet services offer customer-rated comparison tools for treatment plans and healthcare purchasing options. 
  • Patients demand personalized, comfortable, non-intrusive solutions and are willing to pay more for convenience. When patients feel no pain there is no priority on health, only with pain healthcare is taken seriously, even when (chronically) ill. 

Main characteristics: 

  • Patients may see this new primary responsibility as a burden and may find it difficult to distinguish between trusted and not trusted information and may feel the pressure of needing to make decisions with or without knowledge.
  • Marketing (not knowledge) is used to understand where the patient has to be for what ailment.  Patients get more involved in healthcare decisions. Second and third opinions are every day practice. 
  • Alternative medicine flourishes (but there are no clear regulations governing this development) 

The role of health insurance 

  • Insurers and citizens control market-funded (low expenditure) innovation 
  • A spectrum of care coverage is provided with some (endorsed) prevention but with a primary focus on care and aftercare based on the superficial and intuitive level of patient's / citizen's preference and judgment (defined by demand) 
  • Private companies must fund innovative solutions 
  • Citizens (possibly via their insurance) are willing to try new solutions if medically endorsed and affordable 
  • The insurance model has shifted from 'based on per hospitalization' to 'discouraging reimbursement' and towards 'self-pay' model

Landscape Four: Care In Your Hands

People are confident in their role of being primarily responsible for their own healthcare provision and financing. Healthcare is focused on proactive cure and prevention with a positive climate for Innovation (medical, technical, personal, non invasive, personalized collaborative). 

"Own your health in any phase of life" ? being empowered to pick the most comfortable and personal effective preventive or cure measures." Expert Quote 

"As the industry, we should pick up our responsibility and create (public) awareness about moving from treating, to managing and to prevention. We shouldn't wait for anyone else but ourselves to act." Expert Quote

This landscape is called care in your hands as the citizen, the people themselves, take control of their health actively. There is a catch, the diamonds held in the hands as seen in the picture, can be real or can be fake as in this landscape there is not necessarily a lot of true quality control happening.

Main issues / drivers:

 o There is a flourishing but chaotic healthcare climate. There is an abundance of opportunities for entrepreneurial innovation and they are not being blocked by rules and regulations. This offers freedom for creativity as well as for abuse of power and trust and violation of ethics. A plethora of options is offered around the most profitable and popular solutions. Less popular diseases can be overlooked. There will be people who lose out in this landscape. 

o There is an active intelligent health society and a commitment to a new level of healthcare as the norm. There is a new level of engagement and commitment to personal health & well being with incorporated healthcare rituals and solutions into everyday life. Solutions include functional foods, monitoring systems, stress and sleep management. People are free to experiment with their bodies with under-the-skin implantables as the norm. Foresighting is an integral part of healthcare. People bundle forces to address issues on understanding and buying. Health Consumer becomes an entrepreneur, possibly joining forces with non-profit organizations. 

Main characteristics: 

  • There has been a boost in effective business models 
  • Branded cross-border care 
  • Capitalism rules, there is an open market, private investments, a general 'free for all' 
  • Market-driven solutions could neglect the real needs of whole population 
  • People are health connoisseurs 
  • There is an increased understanding, control and manipulation of their own body and health 

The role of health insurance 

  • Insurers provide a spectrum of care coverage from prevention to aftercare based on citizens preference and judgment (defined by demand) 
  • The insurance model is focused on prevention-driven and less cure-driven models 
  • Insurers promote responsible behaviour and will allow reimbursement of prevention related costs (e.g. dental care in Germany, discounts). 
  • Insurance models will also demand proof of compliance that the citizen has not been guilty of 'preventative health negligence' before covering critical event / cure related costs.