This web article is based on the Trend Scenario and the Thematic Foresight Studies. The substantiation for the texts, numbers and figures presented here can be found in these documents, unless indicated otherwise. The Trend Scenario and Thematic Foresight Studies show how our public health situation and health care sector will develop over the next 25 years if we pursue our current course and do not take any additional measures. This approach makes it possible to map out the societal challenges for the future.
Health care is changing because of technology and the changing role of the patient
Technology can make a huge difference for our public health and could radically change health care. The use of technology in health care is increasing, but digitisation in particular is proceeding at a slower pace than in other domains of our day-to-day life. This slower pace can be attributed to a number of causes, within the field of health care as well as outside of it. That makes it complicated to expand the adoption of technology in health care. Patients are doing more and more themselves, and their range of options is expanded by new technological possibilities. That requires new and different skills from health care providers and patients, but it also requires a stronger focus on groups who have difficulty adapting.
Technology can change health care dramatically...
In future, technologies such as robot-based automation, 3D printing, gene technology and virtual reality (VR) can make a huge difference to our public health and could radically change health care. That also applies to data-driven technologies such as eHealth, Big Data, and Artificial Intelligence. Innovative techniques are being developed in many fields, and the health care sector is no exception. For instance, VR applications are being used successfully to treat post-traumatic stress disorder and anxiety disorders. Gene technology could play a hugely significant role in the diagnostics and treatment of many diseases. In cancer treatment, for instance, it is possible to determine the genetic markers of a specific tumour, which makes it possible to predict which treatment will be most successful. This will make it possible to provide patients with tailor-made health care (personalised medicine). eHealth applications such as sensors and wearables will also facilitate personalised medicine.
This means that diagnostics and treatments will become increasingly specific in the future. That will lead to an increase in the number of unique treatment tracks. Just like in many other countries, health care in the Netherlands is set up based on the concept of reaching the largest possible group to provide the best possible treatment. To that end, medical treatments, logistical processes and infrastructure are often standardised. The way that the health care sector is organised will therefore have to be adapted to the increased use of personalised medicine.
As technology offers more and more possibilities, health care is increasingly shifting to the patient’s own home. For example, it is expected that some aspects of health care for people with cancer will shift from the outpatient clinic to the patient’s own home. This requires adaptations in the health care system and changes in the skills of health care professionals and patients alike.
….but implementation and wide-ranging application in health care will not happen automatically
Although technology is being used more frequently in health care, there is still a wealth of untapped potential. In particular, digitisation is proceeding at a slower pace than in other domains of our day-to-day life. It seems that multiple factors play a role in this. Health care providers and purchasers experience obstructions in health care purchasing, cost control, and laws and regulations. Moreover, they are also not up-to-date on all the possibilities. There are also obstructing factors in the health care sector itself. The application of technologies such as eHealth demands a great deal from how the health care sector is organised. For instance, health care providers as well as patients need to have the correct digital skills. That will be difficult for some people, such as people who are semi-literate, or older people. That is why these groups require special attention from the health care sector and from health care providers. There are also people who might have the skills, but who do not want to follow in the wake of ongoing digitisation. Patients and health care providers are often conservative (‘status quo’ bias) and often do not learn from successful examples (the ‘not invented here’ syndrome). Another obstruction is that IT systems do not always interface easily. Taking all these factors into account, the expanded involvement of technology in health care is a very complex issue.
In addition to opportunities for public health, these new technologies also go hand in hand with risks. Consider for instance privacy violations if the increased volumes of health data are used for unauthorised purposes. The increasing use of technology may also encourage inactivity and increase our dependence on internet and electricity. The use of new techniques also raises ethical dilemmas, such as issues about the right to decline to know specific information, as well as the ability to manipulate genetic information and design the desired outcome. Another issue that emerges with the use of new technology is who is responsible and liable if things unexpectedly go wrong.
Patients are increasingly taking an active role
Living with chronic disease places huge demands on patients. In the next few decades, the number of people with chronic diseases will increase and self-management will become increasingly important. Self-management is the active role that people with chronic disease adopt to avoid complications and to integrate their disease properly into the routines of their day-to-day lives. In future, it is likely that people will be expected to take on a more active role themselves. It is expected that new technologies such as eHealth applications will support this trend.
Self-management will lead to stress in the relationship between patients and health care providers. What health care providers consider important may very often not be as important to the patient. Having to deal with these differences, and the liberties patients might take when they have to manage their disease themselves, may be difficult for health care providers at times. Autonomy also means that patients also have the freedom to deviate from treatments that have been proven to be effective. Patients want health care providers to acknowledge that they also have specific and useful knowledge about their condition as ‘experience experts’. These trends will change the role of the health care provider. In future, patients will increasingly interact with these professionals for coaching, brainstorming, or as a source of information. Supporting patients and their friends and family in making choices and formulating their preferences and needs will therefore be part of the new skill sets of health care professionals.