Trends in Health Care: A Global Challenge

By Iris Efthymiou-Egleton

The book you are holding is an introduction to the questions which arise when considering the future of healthcare. It tackles the history of healthcare systems and their complex evolution, focuses on new trends and increasingly sophisticated technology while acknowledging that health is one of the highest human values.

It sets out the main trends in the field of global health which will shape future healthcare systems. It reviews their development and specifies the major factors leading to their evolution by trying to answer the question Which global trends affect our health and healthcare services and how do they change over time? The writer also studies ways of managing changes in the demand for health services and aims to provide a tool for a fruitful dialogue concerning methods of adjusting supply.

Prevention lies at the base of every successful health system. It is the key to a more healthy society and the reduction of healthcare expenditure. In a new era when everything is changing, the health sector cant remain unaffected; for example, have you ever heard of personalised medicine, evidence-based medicine, synthetic biology, or genetic aristocracy and many more new approaches?
How is nanotechnology, the evolution of biotechnology, or the use of exoskeletons going to help us? Which are the new Amazons of the health and pharmaceutical sector and what good practices should policymakers can adopt? What new potential do we get from 3D printing? How are mobile technologies, location-based services, and advanced generation sensors going to change the way we demand and receive healthcare, and what challenges are we going to face?
If you want to understand how healthcare systems operate, or what new trends are going to change the provision of health services? We must remember, however, that in suggesting solutions, those which are not affordable are not solutions.

• Language: English
• Publisher: Xlibris UK
• Release date: Jun 16, 2016
• ISBN: 9781514499313

Iris Efthymiou-Egleton

Iris Efthymiou Prior to starting a family, Iris had a successful career in public affairs and business consultancy. For the past four years, Iris has focused her attention on the health sector and, in particular, the future of global healthcare including what she believes is the link between ancient ‘holistic’ methods and modern ideas for the delivery of inclusive care often ‘branded ‘ by the prefix ‘Community’. As well as undertaking the comprehensive research necessary for her new series of books, she has completed a ‘Masters’ and numerous other upgrades with major academic institutions including Johns Hopkins University, Harvardx, and the Karolinska Institute. Her work with healthcare professionals has given her an in-depth understanding of current needs and, from that, the insight required to create solutions for a rapidly changing future. These have to take into account the giant impact of innovative technologies and how they will affect ‘human to human’ care, with particular attention being paid to the imminent exponential growth in AI. Iris has the ability to be able communicate complicated ideas in simple, understandable English (‘Globeish’!). This ability derives from her varied International business and consultancy career where her experiences included organising business and academic conferences and being one of the keynote speakers along with numerous well-known public figures. Her combined knowledge base in healthcare, business, and economics make her uniquely qualified to help create and develop innovative solutions to the challenges facing healthcare and its ‘humanity’ in the new technological age. Her ability to ‘speak the same language’ in medical, political, and governmental ecosystems is a tremendous advantage. During this latter period, Iris has also been travelling between Switzerland, UK, Greece, and USA with her Anglo-Swiss businessman husband and their son.

Book preview

Copyright © 2016 by Iris Efthymiou-Egleton. 731484

Library of Congress Control Number:   2016909909

ISBN:   Softcover         978-1-5144-9929-0

             Hardcover       978-1-5144-9930-6

             EBook             978-1-5144-9931-3

All rights reserved. No part of this book may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission in writing from the copyright owner.

Rev. date: 06/15/2016

Xlibris

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CONTENTS

AUTHOR’S NOTE i

PROLOGUE

Chapter 1   Introductory evidence and cognitive background

1. Introduction

2. Cognitive background—notions and definitions

3. Recapitulation

Chapter 2   Health systems

1. Introduction

2. Models and types of health care systems

2.1. Criteria for classification and assessment

2.1.1 Classification systems

2.2 Private system

2.3 State system

2.4 National insurance systems

2.5 Bismarck model

2.6 Beveridge model

3. Structure and operation of health systems

3.1 Economic problem

3.2 Brief review of the progress of health systems

3.3 Global public health

3.4 Health policy in Greece

3.4.1 The foundation of NHS/ΕΣΥ

3.4.2 The form of the market for health services, the example of Greece

3.4.3 The example of Singapore

4. Recapitulation

Chapter 3   Trends of health systems

1. Introduction (the agenda of global health)

2. A review of future trends

3. The world in 2030

4. Change in demographic data and consequences

4.1 Population ageing and consequences

4.2 Environmental challenges

5. Cuts in expenditure in the health sector

5.1 Keeping the cost of healthcare low, a value-based health system

5.2 Prevention

5.2.1 Mediterranean Diet

5.3 One-day clinic

5.4 Decrease in prescriptions

6. Change in the way of providing health services

6.1 The medicine of the future

6.2 Evidence-based medicine

6.3 Personalised medicine

3.6.4 Disease management—molecular diagnosis

6.5 Tackling incidences not only on the part of doctors

6.6 Medical humanitarian organisations

7. Strengthening of innovation—which will be the new Amazons?

7.1 Technological development and increase in patients’ say in their treatment

7.2 Theoretical background

7.3 Mobile computing

7.4 E-health

7.5 m-Health

7.5.1 Categories of m-Health applications

7.5.2 Future trends

7.6 Cloud computing

7.6.1 Examples of applications in the sector of health

7.7 Big data and applications in health

7.8 3D printing

8. Developments and trends in the sector of medicine

8.1 Streamlining of pharmaceutical expenditure

8.2 Change in the picture of the pharmaceutical market

8.3 Examples of innovation in the field of medicine

8.4 Synthetic biology

8.4.1 Genetic aristocracy

9. Medical tourism

10. Health Technology Assessment (HTA)

11. Bioethics

11.1 Research and ethics

11.2 The ethics of information

11.3 Nanoethics

12. Mental health

12.1 Mental health and promotion

12.2 The future of mental health

13. Health and socio-economic factors

14. Religion and spirituality in medicine

15. Recapitulation

CONCLUSIONS

GREEK BIBLIOGRAPHY

INTERNATIONAL BIBLIOGRAPHY

URLS

AUTHOR’S NOTE

WHY DID I WRITE THIS BOOK?

I decided to start on the path which led to this book following the death of my father, Theocharis. For twenty years he had suffered from various conditions which culminated in cancer of the colon; the fact that he had followed all medical instructions to the letter, even religiously, made no apparent difference. It led him to becoming an organic farmer producing the family’s own food which, later, led to my own interest in how the food we eat affects everything we do. This thought has also led me to look at the role of food in ancient civilizations and their ‘medical’ theories and practices because, I believe, we cannot manage the future without understanding the past. My work commenced when, using my existing interest in the effects of the environment on human health and behavior, I took on a ‘Masters’.

Since then, I have spent the intervening years investigating the various parameters which appear to be guiding the future direction of Healthcare in all its guises. The subject as a whole is so enormous and hugely complicated that it is not possible to give a detailed explanation in a single volume, if at all.

The purpose of this book is to raise awareness of the issues to be faced as we move into the age where Artificial Intelligence, Robotics and ever more powerful Companies and NGOs influence the type of Healthcare which will be available to us as human beings.

Raising awareness is the first step which will enable us to understand the potential issues that need to be addressed by all and allow for knowledgeable discussion. This is what I intend this book to promote.

Writing it has not been easy as all sorts of sad memories have been revived at various stages and I am grateful for the help and support of my family during some very difficult periods. My team, especially Kyvelle Diareme and Dimitris Thanasoulas deserve special thanks. Penguin and the group there have been extremely helpful as has Professor Yianni Kyriopoulos who provided much of my inspiration without realizing it.

I hope you find the book helpful.

Iris Efthymiou Egleton

PROLOGUE

This book explores the future of healthcare and our role in it. It tackles the history of healthcare systems, their complex evolution, and focuses on new trends and the use of increasingly sophisticated technology.

I believe that health is one of the highest human goods, and all citizens of all countries should be able to have access to high-quality healthcare services. These services are specifically provided to citizens through the health system of the country where they live or reside temporarily. Starting with a brief introduction on the theory of healthcare systems, the cognitive and theoretical background, the models of healthcare systems, and the economics involved, I also provide examples/case studies for an easier understanding.

The book sets out the main trends in global health which will shape future healthcare systems and presents the way in which various healthcare systems work, whilst reviewing their development and delineating the major factors leading to their evolution by answering the question, ‘Which global trends affect our health and healthcare services and how do these systems respond over time?’ Amongst other topics, I describe ways of managing changes in the demand for health services, as well as the factors that lead to the changes necessary. Particular emphasis is placed on new technologies and the development and implementation of innovative solutions within future healthcare systems as well as their economic impact.

We are now at the point where those involved and interested in the health sector will need an in-depth understanding of the forces that have to be brought together in order to achieve positive results so that the technological possibilities can be harnessed to enhance the process of learning and upgrade heath systems to create the flexibility required to meet fast-changing demands.

I try to demonstrate that the advance of technology seems to indicate a future in which, paradoxically, the highly qualified specialist may play a comparatively reduced role and the old fashioned ‘community’ is, once more, able to be a major healthcare provider.

Thus, within the framework of collaboration, communities will be able to actively participate in the planning, monitoring, and assessment of the health system through the empowerment and mobilisation of social capital and community capability. All governments, doctors, researchers, health scientists, economists, those deciding on health policies, patients, and society generally must look ahead and consider that changing trends are not a threat but an opportunity. Only with this kind of collaboration will the latest techniques and technologies be able to be harnessed efficiently for the benefit of all. The end results are not guaranteed, but if the world of healthcare understands the future trends and is flexible enough to meet the challenges, it will be in everyone’s best interests and create a patient-centric system to replace the old fashioned doctor-centric one.

Prevention lies at the base of every successful health system. It is the key to a healthier society and the reduction of healthcare expenditure. In a new era when everything is changing, the health -sector cannot remain unaffected; for example, have you ever heard of personalized medicine, evidence-based medicine, synthetic biology, or genetic aristocracy and many more new approaches?

A few years ago, it would have been hard to imagine the myriad effects of all the new technologies available now: the impact of the Big Data provided by billions of users of social media on smart phones with medical apps; a world that can now be seen through Google glass; the Watson supercomputer being used in medical decision making; exoskeletons allowing the paralysed to walk; printing medical materials and bio-materials in three dimensions.

This list represents a tiny section of the impending changes which will also include questions such as: How are nanotechnology and the evolution of biotechnology going to help us? What about bioethics? Is there religion and spirituality in Medicine? Which are the new Amazons of the health and pharmaceutical sector and what good practices can policymakers adopt? What is happening now with mental health? What is the full potential of 3D printing?.

This work is not a guess, it was completed using Gestalt theory, in which we see an organised whole as more than the sum of its parts, which is a combination of inherent causative factors considered together to determine whether a particular situation could be possible, what psychologists refer to as ‘the depth of the search’.

After conducting a thorough review of scientific literature and the publications of numerous global organisations and consultancy firms as well as a series of communications and correspondence with members of the international scientific community, I hope that this book will serve as a tool for a fruitful dialogue concerning methods of adjusting the supply of health services to the requested levels, both quantitatively and qualitatively.

Do you want to understand how healthcare systems operate, or what astonishing new trends are going to change health services? Can you imagine wearing a second skin full of sensors instead of having a checkup? How are mobile technologies, location based services, and advanced generation sensors going to change the way we demand and receive healthcare and what challenges are we going to face?

These are some of the questions that I answers.

This is not science fiction, but a new world that requires the acquisition of new and, in most cases, previously unknown skills.

This book will help the reader to track and understand the changes that are either here but unseen by most or are on their way at breakneck speed and which are going to revolutionise the way health services will be provided in the future.

Chapter 1

INTRODUCTORY EVIDENCE A Nd cognitive background

1. Introduction

A ccording to World Health Organisation (WHO) (1948), health should not be defined simply as lack of disease or disability, but as a condition of full physical, mental, and social well-being.

Treatment of disease, relief from pain, and protection of health have always been at the centre of human activity and every organised society. The tendency of humankind to combat disease and enjoy health and longevity, albeit a reaction that stems from self-preservation instinct, proves timeless. The timelessness of these issues dates back to the era of Hippocrates, father of medicine, among others. It is evident in the work of Johan Peter Frank (1779), in which there are recommended interventions and actions for the protection of world health by means of measures for personal hygiene, medical care, environmental management, and health mechanics, as well as on the basis of goals set by the World Health Organisation at the turn of the century (1990–2000) (Millennium Development Goals—MDGs) with regard to the health sector presented in the following chapter.

It is generally accepted that health and education constitute fundamental requirements for the preservation and improvement of human, mental capital in modern societies and, as a result, are defined as high social priorities. In this direction, the article 25 of the Universal Declaration of Human Rights (1948) posited that "everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control’. Furthermore, as stated by the World Health Organisation Charter, ‘ensuring the highest standard of healthy living is one of the fundamental rights every human being is entitled to, irrespective of race, religion, political convictions, and financial or social status’. Finally, European Union, through the Maastricht Treaty (article 129), acknowledged that ‘the Community shall contribute towards ensuring a high level of human health protection by encouraging cooperation between the Member States and, if necessary, lending support to their action’, and ‘health protection requirements shall form a constituent part of the Community’s other policies’.

More specifically, according to WHO (http://www.who.int/), a health system must improve the health of the population which it addresses, provide economic protection to cover the cost of the disease, and live up to citizens’ expectations. What is more, a primary objective is the improvement of health, but since the expenditure of a health system can prove detrimentally exorbitant, it takes special mechanisms to provide economic protection to the patient or his or her family, with respect for every individual’s ignite and independence. As one can find in the site ‘Exponential Medicine’ and some parts of the conference ‘Exponential Medicine 2013’, there are only five health systems on the planet, which means we need a change. At the same time, payments from third parties keep the patient away from the health system, which has an impact on future expenses. Nowadays, the patient’s experience has begun to influence/pierce through the health system, and it will grow more and more in importance as we start to redefine his or her significance to the healthcare system.

Today, the current prolonged depression and certain fiscal potentialities, the widespread slump on the market, and increased unemployment constitute a difficult economic climate in many countries across the globe. At the same time, there lurk the rapid advances of technologies in the fields of interactive services and medicines, the ever-increasing surge of interest in developing countries, the intensification of efforts to eradicate diseases, as well as population ageing. All the abovementioned factors and others, in conjunction with a plethora of other components, alter the way in which markets work, without leaving the health sector unaffected.

According to Harvard Business Review and Karen Dillon and Steve Drokesch, the cost of healthcare is increasing and poses a huge challenge, while in the future, it will only deteriorate. According to John Mattison of ‘Exponential Medicine 2015’, there are five points that increase the cost of health systems: disorders that pertain to lifestyle, failure to implement well-documented medicine and prevention, the ‘Free-for-Volume’ payment model, health expenditure incurred by terminal diseases, and the influence of pharmaceuticals. Population ageing, advances in diagnosing and curing diseases, lack of fresh air and water, and the exponential increase of populous cities will further compound the problem. For instance, the USA, nowadays, spend more than 100 billion dollars for the needs of 2.5–4.5 million patients diagnosed with Alzheimer’s disease, while this percentage is expect to increase. Around 1 billion people, or one sixth of the global population, do not have access to adequate drinking water, and it is estimated that 2.6 billion languish in inadequate hygiene. While these numbers are cause for concern, the good news is that wealthy organisations saw in these conditions huge opportunities.

On the other hand, information technology and new innovative technologies promise new ways of combating diseases. As mentioned by Peter Fitzgerald, some points of ‘Exponential Medicine 2015’, and Tom Main and Adrian Slywotzky, as well as international analysts, there will be a trillion-dollar disorganisation in the field of health, in the sense that trillions of dollars will be ‘transferred’ from the traditional models to new health systems. This is expected to happen mainly because of the dominance of a patient-centred healthcare model, the model of patient-consumer, as well as the science of prevention. More specifically, in the following graph, there is presented the redistribution of a trillion dollars, according to Tom Main and Adrian Slyqotzky.

Imagine a world where doctors will not be paid for their patients’ treatment, unless this follows a statistically proven protocol. A combination of developments makes it possible that there will be an explosion of detailed information with regard to the alterations of patients, patients who suffer from them, and the efficacy of the methods regarding the treatment of these diseases. These developments include the drop in the cost of decoding the genome of these individuals, as is mentioned in the following chapters, the increasing knowledge of how these genes cause the disease, and the application of informatics in healthcare.

Indisputably, health systems come up against a critical circumstance. The problematique that arises consists in the degree of maturity of the new viewpoint of public healthcare and, like every decision, its success relies on the degree and intensity of fruitful scientific deliberation, the assessment of needs, modern challenges, and international trends. In the sector of health, there does not seem to be any leeway for piecemeal and fragmentary programmes. After all, as is analysed in the following chapters, health depends on many factors that interact with one another.

Current trends and their future developments in the fields of personal, social, and health services lay the foundation for the provision of high-standard health services, taking into account the rational and prudent management and exploitation of resources. At the same time, they constitute complete efforts towards the quality upgrade of the extant health services provided, the development of health system viability, decrease in inequality, display of social solidarity in practice, and attest to the problems that will have to be tackled in the future. Finally, it is noteworthy that the European Union (EU), as reported in the ‘Annual Review of Development 2013’, acknowledges that investment in health will contribute to the objective ‘Europe 2020’ for a clever, sustainable development, with no restrictions, with a view to paving the ground for a recovery rich in job openings, as well as promoting social inclusion and combating poverty.

2. Cognitive background—notions and definitions

Health services

The term ‘Health Services’ or ‘Healthcare Services’ includes the total of services, through which are provided medical care, preventive and curative, as well as mechanisms of production and distribution of these services. This term includes the notion of healthcare, as much as that of nursing (Boursanides, 1993).

Healthcare refers to primary health services offered to healthy individuals and often to the total of the population of a community or country, while nursing refers to health services provided to individuals that have displayed either subjective or objective symptoms of a specific health issue (Sarris, 2001).

For instance, healthcare services of presymptomatic control and public hygiene are services of healthcare, while health services provided to individuals for the sake of dealing with their healthcare problems fall under nursing services. Treatment of individuals’ health issues by dint of admitting them to nursing units (hospitals or clinics), such as the hospitalisation of individuals diagnosed with Mediterranean anaemia, as a rule comes under nursing services (Sarris, 2001).

Hospital

During the Middle Ages, hospitals acted as poorhouses, guesthouses for pilgrims, or as medical schools. The name 29789.png comes from the Greek word 29791.png (‘disease’) and the verb 29794.png , which meant ‘take care of’ in the Ionian dialect. According to National Legislation, as is recorded in the Government Gazette (GG) 711/B’/1998, the purpose of hospitals are

the provision of medical, in general, hospitalisation services and, more specifically, the provision of primary, secondary, and tertiary healthcare, equally to every citizen, irrespective of his/her financial, social, and professional status and, according to the provisions of NHS, as far as this is possible, laying emphasis on the efficacy, efficiency, and quality of its services;

the implementation of new methods and forms of hospitalisation and medical care, in general;

the research on medical and, in general, scientific issues pertaining to the provision of medical and nursing services; and

any other task congruent with the goals of a modern and fully