People in the Netherlands are in relatively good health. Our lifespans are increasing and the majority of people feel relatively healthy and aren’t held back by health restrictions. However, we are also facing a number of major healthcare challenges in the future. These are the findings of the seventh Dutch Public Health Foresight Study (PHFS), which was published this summer by the RIVM (The Netherlands National Institute for Public Health and the Environment). One thing is clear: technological developments will play a key role in improving and streamlining health care.
The PHFS is a study commissioned every four years by the Ministry of Health, Welfare and Sport. It outlines how public health and care will develop over the next 25 years if we do not take action as a society. In the 2018 edition, the Netherlands National Institute for Public Health and the Environment (RIVM) highlighted a number of developments that may impact the current state of public health and care. The most important developments include:
The percentage of elderly people in society is increasing. People are also reaching advanced ages more often. As a result, the number of people with a chronic disease will increase, and people will often also be suffering from several illnesses at the same time. Ageing is not just a medical issue, it is also a social problem: the number of lonely elderly people is rising. More and more elderly people are living independently and on their own. These developments will put more pressure on formal and informal health care. Healthcare services will face the most strain in areas where the population is shrinking.
Life expectancy will increase from 81.5 years in 2015 to almost 86 years in 2040. We will stay in relatively good health across almost every year we will gain. However, because people with health conditions such as cardiovascular diseases and cancer are more likely to survive, they will have to deal with the long-term effects of these diseases. In addition to ageing, this will be an important reason for the rapid rise in dementia as a cause of death.
Society is facing increasing pressure in different areas, which is causing stress and health issues. The ever-growing influence of the 24-hour economy and the continued increase in flexible employment is causing stress in many people, particularly among those who need to balance work, child care and caring for family members. Extensive urbanisation is also leading to more stress and pressure.
A percentage of elderly people will find themselves in a vulnerable situation due to an accumulation of chronic diseases and other medical and social problems. This group will continue to grow in future. People with a lower socio-economic status often lead unhealthy lives. They also have to deal with social problems more often, which add to their levels of stress. Negative effects of developments on the employment market, such as robotisation and digitalisation, primarily affect less skilled workers. This can exacerbate social problems and stress in this group. These underlying social issues must be resolved first, before creating room to work on a healthy lifestyle.
According to typical government jargon, in order to overcome these issues, ‘an integral approach with input from a range of parties’ and ‘a different way of working’ is required ‘with new roles and skills for policy makers, professionals, researchers and citizens.’ However, if you read between the lines, you will see that the RIVM expects a great deal from technological innovations.
‘Technological developments may have a significant impact on our public health and care’, according to the authors of the PHFS. ‘Examples of this include eHealth, artificial intelligence, robotisation, gene technology and virtual reality. Technological applications, such as apps, sensors and alarm systems appear promising in regard to the approach towards a number of future tasks, including caring for people with dementia and supporting people to self-manage chronic diseases. Innovative technologies will make personalised medicine a reality. When it comes to cancer, it will be possible to determine the genetic characteristics of a tumour, which will help to predict the best type of treatment. By using personalised medicine, more and more unique care pathways will be created, whereas nowadays, it is predominantly standard care processes that are used.’
However, the RIVM does state that although many innovative technologies are being developed in the healthcare industry, the application of these technologies is lagging behind in comparison with other sectors. According to the authors of the report, several factors are behind this. ‘Healthcare service providers and buyers experience obstacles, patients and healthcare experts are often conservative in their choices and not everyone possesses the necessary digital skills. Information systems that do not align with each other are another problem. In addition, new technologies involve risks, such as privacy violation and dependence on the internet. Ethical dilemmas are also involved, such as issues on the right not to know things. Considering all these factors, the roll-out of technology in the healthcare sector is a very complex issue.’
Another relatively important aspect to consider is the increasing cost of care. Since new technology may result in advances in efficiency, the development and implementation of this technology is often linked to high costs. According to RIVM, the costs for care will increase by an average of 2.9% per year to €174 billion in 2040 (or €9,600 per person). A third of these costs will be attributed to the ageing and growing population. The remaining percentage will be due to factors such as technological upgrades, including the latest medicines and equipment, such as operating robots. Technological innovation in health care is also a ‘double-edged sword’, as the RIVM puts it. ‘Trends in the past have shown that it results in higher healthcare costs, but implementing technology can also save costs. A prerequisite to achieving this is to shift towards cost-effective interventions and stop using outdated technology in time. This requires an active policy. The latest technologies can also save costs by offering options to replace expensive second-line care with cheaper first-line care. This will not happen on its own and demands a great deal from the healthcare sector.’
In conclusion, (public) health care is a sector which offers plenty of scope for technological innovation in the years to come. However, not only will it need to prove its added value in terms of the quality of treatment, it must also decrease care costs.
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