Why healthcare matters

Digitisation is impacting almost every sector and healthcare is no exception. Health ecosystems have amazing potential for breaking down the barriers that currently reinforce health inequalities and contribute to poor health outcomes.

The ideal health ecosystem brings together multiple stakeholders onto one platform, all working for the good of the patient. They combine a variety of data sources for a comprehensive overview of the patient and a disease, they can stop the progression of conditions and they can inform prevention efforts for other patient groups.

There are a few hurdles to overcome before society reaches this Utopia of interconnected health stakeholders prioritising patient good over all else. In today's climate, we see the politicisation of healthcare erecting barriers where we would like to see them to be torn down. What does this mean for the future?

There are some huge healthcare challenges that we are facing right now, like antimicrobial resistance and displacement of large groups of people. We need to adapt current systems to meet these challenges head on. Health ecosystems may be the viable solution.
Corinne Fitzgerald, Researcher, Swiss Re Institute

The politicisation of healthcare

In the US, maternal mortality is increasing.1 There is a significant difference between the maternal mortality rates for white women and for women of colour and Native American women, with the latter two groups having worse outcomes.2 From detention centres in the US to refugee camps for Rohingya Muslims fleeing persecution in their home country of Burma, health outcomes are worse for the displaced than they are for the settled people of the host country.3 For people with mental health conditions or those battling addiction, wait times for treatment can be prohibitively long. For other vulnerable groups such as the elderly, or the homeless, there are significant barriers to health care. At the country level, lower socio economic groups have consistently worse health outcomes than those in higher groups in the same country. Those people most in need of healthcare, whose lifestyles are often the most detrimental to long-term health, whose habits and behaviours can be fatally destructive, are currently the group who are being let down.

The politicisation of healthcare has seen restrictions on women's reproductive rights across the US, with several states imposing restrictions on abortion that directly challenge Roe vs. Wade. Abortion is a contentious issue in the US; federal funding – under Title X – has very recently been restricted to prevent any medical centre that offers abortion services (including signposting and referrals) from accessing the funding. This stance on abortion means that Planned Parenthood facilities, for example, who offer a variety of medical services to vulnerable groups including cancer screenings and sexual health services, will now have to source funding to cover this deficit from elsewhere. If they cannot cover the deficit, they will not be able to operate.4

In the UK, the NHS is one of the biggest political points for any party. In the recent Brexit campaigns, NHS funding and the alleged extra '350million' pounds per week that was going to be taken from the EU and pumped into the NHS was a major campaign slogan.5

Highly digitally integrated health ecosystems will allow better outcomes, and higher quality for lower costs.
Evangelos Avramakis, Head Digital Ecosystems R&D, Swiss Re Institute

Politicisation can halt progress, but can also contribute to successes. In Africa Polio has been almost completely eradicated. Nigeria is the final country left to declare itself Polio free. Politicisation was a contributory factor in it taking so long; politicians and imams fanned the conspiracy that the polio vaccine was part of a Western plot to sterilize Muslims. This rumour became so pervasive that it had to be debunked by Nigeria's president in 2015, when he immunized one of his grandchildren on television.6

Breaking barriers

When healthcare is politicised, people don't just miss out. They contract or develop diseases, they see symptoms progress and they can lose their lives. Health ecosystems are one way to combat the current system. They remove the inconvenience of travelling to doctor's offices, for example, and instead provide consultations on video chat that are often just as effective as a face to face appointment. It enables doctors to work from home, increasing the availability of physicians. It eases wait times, increasing parity of treatment for patients. They're connecting people.

Loneliness and social isolation have often been indicators for people at risk of developing depression as a comorbidity, and have been associated with poorer adherence to treatment and worse health outcomes7. Patients with support networks are more engaged; platforms are connecting people in ways that they're unable to connect at the community level. People with rarer conditions, or who have conditions currently affected by stigma such as sexually transmitted diseases, mental health conditions or addiction problems, can find other people online to speak to and share their journey. They can offer and receive advice, thus increasing the knowledge they have about their own conditions, share experiences and connect to people.

There are myriad opportunities for various ecosystem players when they join a network, with the most important being the connecting of people to better services, to fellow patients, to increasing equality and improving health outcomes.

Healthcare and ethics

Advances in technology have us looking at new ethical issues. Gene editing in babies has been tried in China. CRISPR (clustered regular interspaced short palindromic repeats) technology8 enabled biologist He Jiankui to manipulate the DNA of two baby girls to make them less susceptible to HIV9. China has responded with stricter regulation that now makes anyone who manipulates DNA in an individual responsible for whatever happens to that person. Is this enough?

Crowdfunding has become a way to source funding for operations not covered by governmental healthcare systems or insurance. New innovations are often on the list of prohibited treatments because they are unproven and/ or are still in clinical trials. There are ethical concerns about forcing people to campaign this way – perception is important. People who aren't comfortable with asking for help will miss out. People without sympathetic backstories will miss out. Healthcare risks becoming a popularity contest. Pages need millions of followers to raise high donations, or there are PR firms who will help with a campaign for a cut of what is donated.10

Health ecosystems

Health expenditure is projected to increase across countries at all income levels. Our current approaches are not working. From popular literature on polypharmacy, the plight of the aged, the current status quo for women, over medicalisation and the 'sick note' system, we see that there are myriad problems with almost every sector of healthcare. Patients are being failed across the board. Yet digitisation and ecosystems are a ray of hope.

In the above diagram, we see how an ecosystem looks, which makes it easier to see the benefits. All the life cycle phases of healthcare – from wellness and prevention to therapy/ treatment and re-integration – are brought together in one place. Currently services in these areas are segregated, which means that no one person – often not even the patient – has a complete picture of their health. Medical professionals often don't have access to wellness information, which can be an excellent early warning indicator for problems before they even develop. People who are incredibly inactive or whose diets are lacking in certain nutrients can be at risk of developing certain conditions – in an ideal world, this risk could be easily mitigated with lifestyle adjustments. Even within the medical world, there can be a lack of communication. Within the mental health sphere, for example, you may see your GP, a therapist and a psychiatrist. Each has access to different information, while none of them may be aware of the digital mood tracker the patient keeps on their phone, which provides a more complete picture than a 20 minute snapshot of the patient sat in the GP's office.

The interface we imagine is user friendly and seamless, with multiple stakeholders plugged in so the consumer can benefit. Insurance is just one of many stakeholders, but is of vital importance.

Health ecosystems have the chance to make life better for many and to reduce much of the damage done to groups that are the most vulnerable. For insurers, they will aid in the shift of perception, with insurance no longer a cumbersome, resented fail safe but as a service with tangible value, improving health outcomes for the patient.

An increase in data sources and improvements in both variability of patient data and collection methods have offered insurers the chance to stay relevant. Gathering multiple stakeholders onto one platform ensures cross- industry collaboration that can put industry interests alongside patient outcomes as a priority. It also means that different types of data can be pulled in for a more holistic approach to healthcare. Wellness data and the ubiquity of devices means that a large majority of the population are tracking something – be that steps, calorie intake, bpm (beats per minute) or respiratory rate. There's also the next generation of implantable devices; these devices are implanted in the patient's body and are usually less preventative and more focused on tracking a disease or dispensing medication.

Sensor/biosignal (selection)

Activity parameter (selection)

  • Blood oxygen
  • Blood pressure
  • Blood sugar
  • Brain activity
  • Circulation
  • Electrocardiogram (ECG)
  • Electrodermograph
  • Electromyograph (EMG)
  • Electroencephalogram (EEG)
  • Energy consumption
  • Eye movements
  • Heart frequency
  • Nutrition/weight/size
  • Obesity
  • Respiratory rate
  • Skin pressure
  • Skin temperature
  • Sleep levels
  • Stress levels
  • Sweat
  • Gradient
  • Speed
  • Orientation
  • Direction
  • Route
  • Movement
  • Acceleration
  • Breaking
  • Locality
  • Altitude
  • Distance
  • Type of activity

Data is integral to the success of healthcare ecosystems and is currently under- utilized. International Data Corporation (IDC) estimates that health data volumes are growing 48% annually, at which rate the volume of global healthcare data will balloon to 2 314 exabytes (EB) by 2020, from 153 EB in 201311. Although this presents huge potential, at the moment there are headaches to be worked through first. Data is often presented in a non-standardized format; varying at a basic level, for example, from the handwritten (clinician's notes) to the computer generated. The same hospital can use systems that do not interact well and do not allow the easy transfer of information; at the higher level, these data silos present an intimidating problem of information breakdown.

These information breakdowns are affecting people's experience of healthcare systems but can also cost lives12. Information about a patient's state and care plan is often lost as a patient moves across various health care providers. In a recent survey, nearly one-third of individuals who had been to see a doctor in the prior 12 months reported a breakdown in information exchange. About one in 20 reported having had to redo a test or procedure because their prior data was missing, and about one in five had to carry previous test results with them to appointments.13

With an increasing focus on prevention from health, wellness and public health perspectives, digital ecosystems also have a role to play in this emerging field. Early identification of some of the biggest health burdens – diabetes, cardiovascular disease and mental health conditions – can improve health outcomes and lower expenditure per patient.

Data privacy and data ethics are very important; often even the perception of impropriety can have long lasting trust implications for institutions. Trust is especially important for insurance companies who often feature on lists of most disliked industries, so are already at a distinct disadvantage with their customers. Transparency about what data is being used and what is being done with it would go a long way to improving the relationship.

Health ecosystems and insurers

In the future Swiss Re will consider what these developing ecosystems offer for re/insurers, not just for the patient and for the healthcare field. There is the possibility of both incremental change, as seen in the past with other technologies, or transformational disruption should someone solve one of the big barriers to innovation like data interoperability to help assess risk better.

It is also necessary to consider the emerging risks sector, such as the development of new protection gaps and cyber or IoT risks. We need to look at how the relationship between consumer and insurer will change as health ecosystems become not just tools for engagement, but platforms that help us understand risks more dynamically and offer improved or new services based on the individual.

In the future, with data collection so instantaneous and feedback loops seamless, dynamic pricing will be the new normal; consider the potential impact on product composition and dynamic underwriting.

Healthcare is an issue that every country is facing, with demand burdening systems that are often already overworked and stretched to breaking point. It is contributing to economic worries, political polarisation and is dividing people more than ever into the 'haves' and 'have nots', with the people in the latter category, often already vulnerable, experiencing worse healthcare outcomes, which impacts their work prospects, which impacts quality of life, etc. When it comes to healthcare, it is not just health services and the individual that have a stake in success. It is society, big business and governments. Now, more than ever, as technology allows breakthroughs on a global scale, we should be coming together and thinking how to use this power for the good of many, rather than the enrichment of the few. Health ecosystems should break down the barriers we have seen erected in so many other areas; entitlement to a good quality of life is not based on gender, or bank balances. It is based solely on the virtue that we are human, and it is what we all deserve. 

References

1. R. Jones, "Why giving birth in the US is surprisingly deadly", NatGeo, January 2019, https://www.nationalgeographic.com/culture/2018/12/maternal-mortality-usa-health-motherhood/
2. Ibid.
3. 10 things to know about the health of refugees and migrants, WHO, 2019
4. J. Ducharme, "Planned Parenthood faces an uncertain road without title X funding – and patients may struggle to get care", time.com, 19 August 2019, https://time.com/5655500/planned-parenthood-title-x-funding/
5. J. Stone, "British Public still believe Vote Leave '£350m a week to EU' myth from Brexit referendum", The Independent, 2018
6. Vanquishing the Virus, The Economist, 2019
7. C. Henning-Smith, I. Moscovice, K. Kozhimannil, "Differences in social isolation and its relationship to health by rurality," Journal of Rural Health, 4 Jan 2019, https://www.ncbi.nlm.nih.gov/pubmed/30609155
8. A. Vidyasgar, "What is CRISPR?", livescience.com, 21 April 2018, https://www.livescience.com/58790-crispr-explained.html
9. Next time, Ask First, The Economist, 2018
10. N. Heller, "The Hidden Costs of GoFundMe Health Care", thenewyorker.com, 24 June 2019, https://www.newyorker.com/magazine/2019/07/01/the-perverse-logic-of-gofundme-health-care
11. An exabyte (EB) is a unit of digital information storage used to denote the size of data. It is equivalent to 1 billion gigabytes (GB). See Driving data growth in healthcare, EMC2, 2014, https://www.emc.com/analyst-report/digital-universe-healthcare-vertical-report-ar.pdf
12. Medical Adherence, Swiss Re, 2019
13. Gaps in Individuals' Information Exchange, Health IT Quick-Stat #56, Office of the National Coordinator for Health Information Technology, June 2019, https://dashboard.healthit.gov/quickstats/pages/consumers-gaps-in-information-exchange.php

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