We will see a revolution when it comes to healthcare, and it will come from the patients and the citizens. As health consumers they will make demands on the healthcare services that are provided for them. Consequently, the healthcare sector will need to change the way in which they deliver services, and the focus will switch to the needs of the citizens.
This paradigm shift will require political support, cultural change, and adaptability regarding roles, methods and responsibilities, as well as education of all users. Companies may take advantage of opportunities within e.g. motivating citizens and supporting prevention. It is, however, also necessary to be aware of the barriers relating to whether the healthcare sector is ready for the changes and new solutions, as well as the question of who will pay for them – the citizens or the healthcare sector. But there is no doubt that health consumers create an increasingly significant market for new healthcare solutions.
Health Consumerism in the future
Will we move from patient-centered to patient-driven care in the future? How do we meet the needs of the future patient? The experts give their bids on how health consumerism is changing our healthcare system in the future.
Inspired by Hal Wolf we define ‘Health Consumerism’ as a movement towards citizens demanding involvement, influence on treatment and high levels of information when it comes to healthcare. ‘Health Consumerism’ concerns a change of expectations from citizens of healthcare and what it will do for them. There is, for instance, an expectation that healthcare services will be created especially for me and delivered in a customisable, personalised way. Health consumers expect their problems to be solved in an immediate and convenient manner that fits to the given circumstances (Wolf, 2018)Wolf, H. (2018, January 3). Hal Wolf. Interview performed by Health Innovation Centre of Southern Denmark.
Health Consumerism concerns a demand for personalised healthcare and solutions. The citizens are the drivers of this demand, and thus healthcare moves closer to the citizens and their local environment, in accordance with their preferences.
Health consumers are people with individual goals and preferences. People who are not only living healthily but also see being healthy as part of their identity. People have individual perceptions of what health actually means, and the overall concept of health has changed from a focus on health in order to prevent death and illness to health in order to have a good and improved life (Copenhagen Institute of Future Studies, 2017)Copenhagen Institute of Future Studies. (2017). Fremtiden for det danske sundhedssystem (2030). Retrieved from http://iff.dk/fremtiden-for-det-danske-sundhedssystem-2030/p: . . Carsten Obel agrees that the concept of health has shifted; people prioritise health to a higher degree, and they consider health to be much “more than smoking, physical activity, it might actually be the better life” (Obel, 2017)Obel, C. (2017, December 21). Carsten Obel. Interview performed by Health Innovation Centre of Southern Denmark. Mandag Morgen and Trygfonden expand this evolving health concept even towards, e.g. a good night’s sleep, having good friends and a nice family (Mandag Morgen & TrygFonden, 2017)Mandag Morgen. & TrygFonden. (2017). Mellem Broccoli og Bajere – forebyggelse ifølge danskerne. Retrieved from https://www.trygfonden.dk/viden-og-materialer/publikationer/mellem-broccoli-og-bajere.
The preferences and expectations of health consumers will influence how healthcare services are delivered in the future. Hal Wolf explains:
Health Consumerism is driven by the citizens who make demands on the healthcare services that they receive. Peder Jest argues that the patients and citizens will drive the changes in the healthcare sector, and that they have the support of the politicians:
Hal Wolf also underlines that Health Consumerism, driven by the citizens, will alter the way in which healthcare is delivered and actually improve the quality of care:
The classical roles of citizens/patients and the healthcare sector will change as healthcare moves closer to the citizen and puts their needs, choices and everyday life at the centre, based on their personal choice.
With the development of technology and the global economy, citizens will have information at their fingertips. Citizens will expect the same when it comes to healthcare information and resources (Coughlin, Wordham & Jonash, 2015)Coughlin, S., Wordham, J. & Jonash, B. (2015). Rising consumerism: Winning the hearts and minds of health care consumers. Deloitte Review, 16. Retrieved from https://www2.deloitte.com/insights/us/en/deloitte-review/issue-16/consumerism-health-care.html. As consumers the citizens will therefore expect more from their healthcare providers, private as well as public; such as instant access and solutions that match their needs. Hal Wolf describes how the patients to a large extent will decide how and where they receive healthcare:
Peder Jest agrees that the patients have and will continue to have different expectations, e.g. a wish to receive healthcare where they are:
The Digital Healthcare Centre is a digital platform aimed at developing, testing and expanding the use of different digital solutions. It enables municipalities to make their health services more accessible and flexible. The digital platform support the citizens in making lifestyle changes by utilising motivational elements and effective learning/support tools.The Digital Healthcare Centre is a partnership consisting of 9 municipalities, the Danish Heart Association, the Danish Diabetes Association, the Region of Southern Denmark and Health Innovation Centre of Southern Denmark.
One of the first sub-projects for the Digital Healthcare Centre was “Digital Patient Education”, which targets citizens with type 2-diabetes and heart disease.
The Digital Patient Education guides citizens with a chronic disease to a better life via e-learning; a self-study and online education offer, which consists of multiple short webinars.
This case recommends researchers and developers within the area of digital patient education to:
Health Consumerism as a concept is influenced by the megatrends of democratisation, increased health focus and a paradigm shift in patient groups. The trends of acceleration and digitalisation enable solutions that have the potential to fulfil the demands of health consumers.
According to John Christiansen healthcare is moving from a focus on volume towards a focus on value:
The increased focus on quality will impact how patients are cared for, how physicians and hospitals are paid, and how life sciences companies approach the market (Coughlin, Wordham & Jonash, 2015)Coughlin, S., Wordham, J. & Jonash, B. (2015). Rising consumerism: Winning the hearts and minds of health care consumers. Deloitte Review, 16. Retrieved from https://www2.deloitte.com/insights/us/en/deloitte-review/issue-16/consumerism-health-care.html. In Danish Regions, a number of projects have already been initiated to develop the foundation of a more value-based healthcare system (Danske Regioner, 2018)Danske Regioner. (2018). Danske Regioner. Retrieved from http://www.regioner.dk/ (Mandag Morgen & Danske Regioner, 2017)Mandag Morgen. & Danske Regioner. (2017). Sundhed i Skyen – Et kig ind i den digitale fremtid på sundhedsområdet. Retrieved from https://www.mm.dk/artikel/sundhed-i-skyen-et-kig-ind-i-den-digitale-fremtid-paa-sundhedsomraadet. The buzzwords are: patients’ needs. In line with the demands of the health consumers, value-based healthcare may set new standards for how healthcare providers fulfil their tasks and deliver services.
The change is driven on the one hand by the citizens. Another driver towards this change is that we all generate massive amounts of data every day, for example sensor-based data collected through Smart Health Technology. There is a strong indication that this data and the analysis of it will empower citizens and enable them to make knowledge-based decisions about their health. From a health consumer perspective, health data goes beyond the realms of the healthcare sector and into the private sphere.
My Osteoporosis Journey is a Ph.D. study aimed at designing and developing an mHealth app to support women in treatment decision-making and self-management, when they are diagnosed with osteoporosis without preceding fractures. The app is currently (August 2017 till February 2018) being tested in the Department of Endocrinology at Odense University Hospital.
When diagnosed with asymptomatic osteoporosis, studies have shown that women feel that they are between sick and healthy and need to be better prepared for the treatment decision-making when visiting the General Practitioner after their scan. They need support in self-management of the disease with a focus on the advantages of detecting osteoporosis before a fracture occurs.
A participatory design process was employed. Involved were researchers, women newly diagnosed with osteoporosis, physicians, the OUH osteoporosis department, The Osteoporosis Association and app designers. An mHealth app prototype was developed and tested in three phases. The mHealth app provides the women with the result of the scan within 24 hours. Through the app they can prepare for the GP visit in their homes. After the treatment decision-making process at the GP the women can be supported in self-management of osteoporosis by using the app.
The study shows that participatory design is a viable approach when developing an mHealth app for women with asymptomatic osteoporosis and the importance of feedback from users in an iterative process is highlighted. The participation of users and app designers in workshops and laboratory tests enables mutual learning. Regular user-feedback in the design and development process is suitable to identify challenges associated with providing healthcare services through an app in the field of osteoporosis.
In general, the study recommends m-Health App designers to:
We see a definite trend towards Health Consumerism in Denmark today. Health Consumerism in a Danish context differs from countries with more privatised healthcare systems such as the United States. In Denmark the focus of the healthcare sector is on the empowerment of citizens to benefit from healthcare and on equal healthcare service offers (Regionsrådet, RSD)Regionsrådet, RSD. Det gode liv som vækstskaber – Region Syddanmarks Vækst- og Udviklingsstrategi 2016-2019. Retrieved from https://detgodeliv.regionsyddanmark.dk/vaekst-og-udviklingsstrategi/. Hal Wolf argues that equality is extraordinarily important in a Danish context (Wolf, 2018)Wolf, H. (2018, January 3). Hal Wolf. Interview performed by Health Innovation Centre of Southern Denmark.
The Danish Healthcare Sector is interested in accommodating health consumers, however the solutions are not fully in place yet, and the mindset of the healthcare providers is not yet tuned into the citizens as health consumers. Peder Jest explains:
The accommodation of health consumers in the healthcare sector is happening but there is still a long way to go. There has been a general focus on empowerment and patient involvement, and we are beginning to e.g. use personal health data collected by the citizens, even if the quality is not quite adequate. Health Consumerism and related adjustments in the healthcare sector will continue and increase in the future in Denmark.
Peder Jest argues that the nature of healthcare will change beyond our imagination:
Hal Wolf argues that every industry has been disrupted and influenced by the expectations of individuals as well as by technology:
Peder Jest agrees that in a Danish context Health Consumerism will be increasingly important. Citizens will have expectations of and make demands on their healthcare services, and the healthcare sector needs to keep this in mind and learn that the healthcare sector exists for the citizens:
Erik Jylling argues that in 2025 citizens will both have better abilities and more opportunities of interacting with the Danish Healthcare Sector and take an active role themselves (Jylling, 2017)Jylling, E. (2017, December 13). Erik Jylling. Interview performed by Health Innovation Southern Denmark. Particularly those citizens who are able and interested in influencing their own healthcare; the health consumers. The healthcare system will organise itself accordingly, taking the capabilities of the individual citizens into account. Erik Jylling explains:
Kevin Dean argues that there will be a focus on prevention in the future: ”We will have to shift from treatment to prevention at some point in the next 10 years” (Dean, 2018)Dean, K. (2018, January 4). Kevin Dean. Interview performed by Health Innovation Centre of Southern Denmark. The citizens will have a significant role in the promotion of health and preventive initiatives.
Carsten Obel has an aspiration for Denmark in 2025 of a healthcare system that supports the citizens in their health-related decisions. The healthcare sector should invest in individual health, whatever that may mean for the individual:
We have to acknowledge that in the future health services will be seen as goods in line with other consumer goods (Mandag Morgen, 2006)Mandag Morgen. (2006). Patienten som forbruger. Retrieved from https://www.mm.dk/pdffiles/2994a-22200605.pdf and the consumers will have demands regarding these health service goods accordingly. Peder Jest underlines that healthcare is for “the patient’s sake” and the meaning of the healthcare sector is to give patients and citizens a good, long life, as free as it can be from diseases (Jest, 2018)Jest, P. (2018, January 2). Peder Jest. Interview performed by Health Innovation Centre of Southern Denmark. He agrees that citizens are consumers and that healthcare services are for them:
The healthcare sector will need to prepare itself for the opportunities and challenges brought about by Health Consumerism. Erik Jylling gives his perspective on the potential opportunities and challenges within Health Consumerism:
The challenges are related to how we change the system to accommodate the health consumers, and how we prepare the healthcare sector and healthcare personnel for this change.
Carsten Obel argues that Denmark needs to develop and invest in an even better frame for citizens’ health, rather than implementing cost reductions (Obel, 2017)Obel, C. (2017, December 21). Carsten Obel. Interview performed by Health Innovation Centre of Southern Denmark. There is a need to focus on co-responsibility, and for this we need political support, integration, cultural changes and education of all users. Peder Jest advocates the needs for education and a cultural change:
Peder Jest argues that the healthcare personnel are not prepared for the changes that will be reality in 5 years’ time:
According to John Christiansen the increasing demands from health consumers may affect the role of the healthcare personnel in the future:
The healthcare personnel need to build up their competencies to become better at assessing and targeting the individual needs of citizens (McDonagh, 2017)McDonagh, N. (2017, November 28). Niall McDonagh. Interview performed by Health Innovation Centre of Southern Denmark. Some healthcare personnel may resist the new roles and responsibilities. Peder Jest gives an example: “The GPs, though they do not like it, will have to work with telemedicine and virtual systems too, they are still old-fashioned in their way of thinking that they have to meet the patient” (Jest, 2018)Jest, P. (2018, January 2). Peder Jest. Interview performed by Health Innovation Centre of Southern Denmark. It may be difficult to see patients as partners in health. For example, healthcare personnel often raise concerns about the quality and reliability of the health information that patients find themselves e.g. on the Internet.
The healthcare sector will need to support the healthcare personnel in taking ownership, accepting and adapting to the changes in the nature of healthcare services.
While the health consumers should be supported in managing their own health, not all citizens will have the capabilities or desire to be a health consumer and take an active role in their health. Some may prefer the healthcare sector making decisions for them (Coughlin, Wordham & Jonash, 2015)Coughlin, S., Wordham, J. & Jonash, B. (2015). Rising consumerism: Winning the hearts and minds of health care consumers. Deloitte Review, 16. Retrieved from https://www2.deloitte.com/insights/us/en/deloitte-review/issue-16/consumerism-health-care.html. These citizens need the support of the healthcare system, the healthcare personnel, society, relatives etc., e.g. to identify the relevant health information (Camerini & Schulz, 2015)Camerini, A. & Schulz, P. (2015). Health Literacy and Patient Empowerment: Separating Con-joined Twins in the Context of Chronic Low Back Pain. Retrieved from http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0118032. Educating citizens in health management as early as primary school may be a good step (KORA, Højgaard & Kjellberg, 2017)KORA. , Højgaard, B. & Kjellberg, J. (2017). Fem megatrends der udfordrer fremtidens sundhedsvæsen. Retrieved from https://www.kora.dk/aktuelt/nyheder/2017/fem-megatrends-vil-forandre-fremtidens-sundhedsvaesen/.
According to Kevin Dean the challenge is to design a system that is able to support long-term health across sectors, at an early stage:
The Health Consumerism trend in the Danish Healthcare Sector may offer the following opportunities for companies developing solutions for health consumers:
There are, however also some barriers for Health Consumerism solutions to overcome:
When developing solutions for healthcare, particularly solutions that handle personal data, the following aspects will be relevant to consider.
In May 2018 the General Data Protection Directive from EU (GDPR) will enter into force in the EU (European Council, 2016)European Council. (2016). The General Data Protection Regulation. Retrieved from http://www.consilium.europa.eu/da/policies/data-protection-reform/data-protection-regulation/. The purpose of the directive is to strengthen citizens’ fundamental rights when it comes to data, privacy and digitalisation – but also to simplify rules for companies and thereby facilitate growth. Some of the more noteworthy changes enforced by the directive are the possibilities of issuing fines amounting to up to 4% of a company’s annual turnover.
In order to adhere to the GDPR, companies may look at the Guidelines for Cybersecurity (ISO 27032).
The regulation regarding data subject consent has been further strengthened and clarified. Consent must be explicit and the citizen must be clearly informed of the precise and defined purpose of data collection. Furthermore the citizen has the right to revoke consent. If consent is revoked the data must be deleted and proof that it has taken place presented to the citizen. This will affect all companies handling data pertaining to the citizen’s health.
Data portability is a new topic introduced by the GDPR. With GDPR the citizen will have the right to data portability. This means that if you collect personal data the citizen has the right to receive the personal data concerning him or her in a structured, commonly used and machine-readable format. They also have the right to transmit those data to another organisation that collects data about the citizen. The purpose of this obligation is to limit the number of times citizens have to answer questions about the same subject matter, e.g. age, height, gender etc.
This is particularly interesting from a healthcare perspective because data might be required to be shared across different organisations in the healthcare sector to a much greater extent than they are today. This might also prove a new business opportunity for companies, since there may be a whole new market emerging for solutions to support data portability, e.g. by providing system integration or sharing information between different IT systems.
In addition to the more general GDPR directive, an updated directive on Medical Devices will enter into force in the spring of 2020 and 2022. The two directives (EU) 2017/745 “MDR” & EU 2017/746 “IVDR” – (European Parliament & European Council, 2017a)European Parliament. & European Council. (2017a). (EU) 2017/745. Retrieved from http://data.europa.eu/eli/reg/2017/745/oj/eng and (European Parliament & European Council, 2017b)European Parliament. & European Council. (2017b). (EU) 2017/746. Retrieved from http://data.europa.eu/eli/reg/2017/746/oj/eng heavily regulate what is defined as medical devices, and how such devices can be tested and used within the boundaries of the EU. This is central for especially Data Analytics and Smart Health Technologies. ‘Medical purpose’ is defined as any type of diagnosis, prevention, monitoring or treatment or alleviation of disease or disability. The vast majority of devices which collect health information are likely to be considered medical devices, even if they do not process or analyse the data. Companies operating within the domain of health should proactively investigate compliance with these regulations and adjust development processes accordingly.
Bringing technology into the sphere of healthcare services brings with it relevant ethical considerations. The Health Innovation Centre of Southern Denmark has developed two videos that illustrate the expectations and challenges that may arise when new technology meets the healthcare sector. The videos focus on the perspectives of the patients at home and the clinicians working across sectors, respectively. Companies may consider these ethical aspects in their development process.
Companies developing solutions for the Danish health consumers of 2025 should particularly consider the following:
For citizens to take an active role in their healthcare and choose their own care plan, companies are advised to consider solutions that have a built-in motivational aspect. Carsten Obel argues that it is necessary to support the individual motivation of citizens:
Gamification and game theory, amongst others, can help to conceptualise potential solutions, as these approaches have the ability to activate citizens and make them responsible for their health choices (Deloitte, 2016)Deloitte. (2016). Boosting patient empowerment and motivational pull. Retrieved from https://www2.deloitte.com/de/de/pages/strategy/articles/boosting-patient-empowerment-and-motivational-pull.html. Peder Jest agrees on the potential of gamification:
[/iquote]“What we see in the play and the game industry are also possible to use in the healthcare sector” (Jest, 2018)Jest, P. (2018, January 2). Peder Jest. Interview performed by Health Innovation Centre of Southern Denmark.[/iquote]
Similar to what consumers do in other situations, health consumers may compare stores, products and services and choose providers on the basis of their reputation. It is therefore important for companies to build and nurture their reputation.
Health Consumerism may add value for the citizens, healthcare personnel, healthcare sector and society as a whole in relation to:
However there are also potential risks to consider: