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Health Consumerism


When health becomes a consumer good

Published: 2018
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Summary


… there is no doubt that health consumers create an increasingly significant market for new healthcare solutions.

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.

Short definition

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.

What is Health Consumerism

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:

“Consumerism usually follows the three Cs, right; Choice, Control, Convenience, and then sometimes people put the word Cost in, depending upon the system that you are in. Consumerism is all wrapped around sort of an expectation that things are going to be created for me, delivered to me in a personalised way…  The citizen as an individual has expectations about what a healthcare system is going to do for them. They pay taxes … The consumer will have expectations about how the capabilities will be applied to them. Is it instant? Is it quick?”(Wolf, 2018)Wolf, H. (2018, January 3). Hal Wolf. Interview performed by Health Innovation Centre of Southern Denmark

So you will see a revolution, the revolution will come from the patients and the citizens.
Peder Jest

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:

“So you will see a revolution, the revolution will come from the patients and the citizens. And I think the politicians, in fact, have seen this, they are on the patients’ and the citizens’ side if it would become a fight. I do not think it would become a fight but … a change will happen within the next five years”(Jest, 2018)Jest, P. (2018, January 2). Peder Jest. Interview performed by Health Innovation Centre of Southern Denmark.

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:


It is changing our expectation of healthcare; it is changing our expectations of working at the individual level. Consumerism is huge; it is the right thing to occur, healthcare systems now have to modify how they deliver care, not strictly from the point of view of the institution but including the point of view of the individual.
Hal Wolf
“It is changing our expectation of healthcare; it is changing our expectations of working at the individual level. Consumerism is huge; it is the right thing to occur, healthcare systems now have to modify how they deliver care, not strictly from the point of view of the institution but including the point of view of the individual. And to that end it is fantastic because it is improving care, it is improving speed, it is improving connectivity, and all of those things contribute to positive things in healthcare” (Wolf, 2018)Wolf, H. (2018, January 3). Hal Wolf. Interview performed by Health Innovation Centre of Southern Denmark.

Comparative to other industries, as a consumer I have expectations that my problems are going to be taken care of for me in a convenient manner, right in my home. Why do I even have to leave the building? Those are consumer driven issues.
Hal Wolf

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:

“So consumerism in healthcare really does have an impact on the expectations, speeds and the delivery of care and delivery of services, there is an expectation that it is going to be done at a personalised level. You will contact me and work with me where I would like that to occur versus what you may wish, except for obvious things like surgery and things of that nature … Comparative to other industries, as a consumer I have expectations that my problems are going to be taken care of for me in a convenient manner, right in my home. Why do I even have to leave the building? Those are consumer driven issues.” (Wolf, 2018)Wolf, H. (2018, January 3). Hal Wolf. Interview performed by Health Innovation Centre of Southern Denmark

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 patients are different. We know it already from the young native users of new technology that they are thinking quite differently. […] They are very visual, and they don’t care if you are in the same room or on the other side of the globe” (Jest, 2018)Jest, P. (2018, January 2). Peder Jest. Interview performed by Health Innovation Centre of Southern Denmark.

CASE:

The Digital Healthcare Centre

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:

  • Motivate citizens by designing for a good user experience (e.g. emotional appeal, usability and accessibility).
  • Consider how to include user groups with different socioeconomic backgrounds, e.g. those who are not the typical users of the healthcare services offered by the municipalities.
  • See the goals and needs of the citizens as central within the ‘near and cohesive healthcare system’ of the future, e.g. coping with their individual illness.

Read more here

Why is Health Consumerism Relevant?


… the future will bring a larger focus on delivering quality.
John Christiansen

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:

“A change of focus, from producing a lot to producing the right things, at the right time, with the right outcome. And there has been a tendency that the incentives, which have been poured down over us, have more gone in the direction of speed and increased production. Where the future will, and this is already happening, the future will bring a larger focus on delivering quality” (Christiansen, 2017)Christiansen, J. (2017, December 5). John Christiansen. Interview performed by Health Innovation Centre of Southern Denmark.

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.

CASE:

My Osteoporosis Journey

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:

  • Involve stakeholders and users from the beginning. Facilitate participation and ownership to avoid resistance.
  • Invest time in being open and curious to identify user needs, and be willing to ‘kill your darlings’.

Read more here

Health Consumerism in the Danish Healthcare Sector


There is no doubt for me that we are not thinking clearly enough on consumerism. Health consumerism is big business in the future
Peder Jest

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:

If you have some diseases, how can you still live a good life? I think that is not the way we are thinking today” (Jest, 2018)Jest, P. (2018, January 2). Peder Jest. Interview performed by Health Innovation Centre of Southern Denmark.

He continues:

“There is no doubt for me that we are not thinking clearly enough on consumerism. Health consumerism is big business in the future (Jest, 2018)Jest, P. (2018, January 2). Peder Jest. Interview performed by Health Innovation Centre of Southern Denmark.


I think everything will change. I don’t think you can even imagine how much it will change.
Peder Jest

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:

I think everything will change. I don’t think you can even imagine how much it will change” (Jest, 2018)Jest, P. (2018, January 2). Peder Jest. Interview performed by Health Innovation Centre of Southern Denmark.

Hal Wolf argues that every industry has been disrupted and influenced by the expectations of individuals as well as by technology:

“The citizen as an individual has expectations about what a healthcare system is going to do for them. They pay taxes, they have functional expectations. Those are things that they think about at a governmental level just by using the definition of citizen. The consumer will have expectations about how the capabilities will be applied to them” (Wolf, 2018)Wolf, H. (2018, January 3). Hal Wolf. Interview performed by Health Innovation Centre of Southern Denmark.

Everyone working in the healthcare sector should think of the citizens and the patient as a consumer; What is it that you want from me? What can I deliver to you right now?
Peder Jest

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:

“Everyone working in the healthcare sector should think of the citizens and the patient as a consumer; What is it that you want from me? What can I deliver to you right now? You are paying for it, you are paying in Denmark through your taxes. That is why we have a very nice high tax system, because we can offer something to you later in your life or when you need it. And I do not think that we have taught our employees enough to respect that they are here for the citizens, all the time. So consumerism is very very important in the future, and the citizens and the patients will expect it” (Jest, 2018)Jest, P. (2018, January 2). Peder Jest. Interview performed by Health Innovation Centre of Southern Denmark.

I do not think that we have taught our employees enough to respect that they are here for the citizens, all the time. So consumerism is very very important in the future, and the citizens and the patients will expect it.
Peder Jest

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:

“The patient will have a lot more abilities and possibilities to interact with the system and to go for themselves. We will see a system that is much more differentiated … where we much earlier take action in intervention … in prevention, and we support the strong patient in doing what he or she wants for themselves, and we support the weak patient much more” (Jylling, 2017)Jylling, E. (2017, December 13). Erik Jylling. Interview performed by Health Innovation Southern Denmark.

We will see a system that is much more differentiated … where we much earlier take action in intervention … in prevention, and we support the strong patient in doing what he or she wants for themselves, and we support the weak patient much more.
Erik Jylling

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:

“Ideally, if we invest in people’s health and what is health for people, I think we will come a lot closer to what is this. I’m not in favour of giving all responsibility to the citizen for living the right life, but I think freedom and autonomy to develop what is the best life for every citizen, I hope we will get closer to this. In fact going from quantified self to qualified self would be ideal in 2025” (Obel, 2017)Obel, C. (2017, December 21). Carsten Obel. Interview performed by Health Innovation Centre of Southern Denmark.

Challenges for Health Consumerism


All of us are consumers, we are also consumers of the healthcare sector. Of course it is not something that you can pick down (from the shelf) free because it is very expensive but the healthcare sector is for you as a citizen.
Peder Jest

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:

“All of us are consumers, we are also consumers of the healthcare sector. Of course it is not something that you can pick down (from the shelf) free because it is very expensive but the healthcare sector is for you as a citizen” (Jest, 2018)Jest, P. (2018, January 2). Peder Jest. Interview performed by Health Innovation Centre of Southern Denmark.

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:

“You can put health consumerism as an opportunity or a challenge. I think the conditions for health consumerism in Denmark are there. The more digitalised, and the more homogenised our healthcare system will be, the better opportunities there will be for a patient, and the well-empowered citizen to take action themselves. The challenge for the system is, however, how to support them. What tools could support their empowerment, in a suitable way, at the right time? It would be very suitable if we could support these well-empowered citizens, to be prepared in the interaction with the healthcare system” (Jylling, 2017)Jylling, E. (2017, December 13). Erik Jylling. Interview performed by Health Innovation Southern Denmark.

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.


We have to educate the people, our employees, much more in thinking differently. We have to make a cultural change.
Peder Jest

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:

“We have to educate the people, our employees, much more in thinking differently. We have to make a cultural change” (Jest, 2018)Jest, P. (2018, January 2). Peder Jest. Interview performed by Health Innovation Centre of Southern Denmark.

Seeing the patient as an active teammate, which we are already talking about today and have done for many years. We also talk about rehabilitation and utilising people’s self-care capacity.
John Christiansen

Peder Jest argues that the healthcare personnel are not prepared for the changes that will be reality in 5 years’ time:

“They don’t expect it. I expect that 70% of the employees they are not thinking about the future, they are thinking about what is happening here today and they even can’t imagine how it will be in 5 years from now” (Jest, 2018)Jest, P. (2018, January 2). Peder Jest. Interview performed by Health Innovation Centre of Southern Denmark.

According to John Christiansen the increasing demands from health consumers may affect the role of the healthcare personnel in the future:

“Seeing the patient as an active teammate, which we are already talking about today and have done for many years. We also talk about rehabilitation and utilising people’s self-care capacity. But the challenge will be making the available resources cover the demands that society poses but also the expectations from the citizens and their families. Therefore, I think that the patients will also be more their own man/woman, and at big part of our role will be to help the citizen and patient make the right choices. (Christiansen, 2017)Christiansen, J. (2017, December 5). John Christiansen. Interview performed by Health Innovation Centre of Southern Denmark.

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.


We probably have to address this long term health issue in the education system far earlier then we do now, and with far more rigor then we do now. And that is the real challenge because getting social care to talk to healthcare is really difficult. To get education to talk to social care and to talk to healthcare is a really big challenge.
Kevin Dean

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 wrong thing to do, is to ban the technologies from those who can afford it. The right thing to do is to find effective ways for everybody to access it. But just because you have access to it, does not mean that you will use it. We probably have to address this long term health issue in the education system far earlier then we do now, and with far more rigor then we do now. And that is the real challenge because getting social care to talk to healthcare is really difficult. To get education to talk to social care and to talk to healthcare is a really big challenge(Dean, 2018)Dean, K. (2018, January 4). Kevin Dean. Interview performed by Health Innovation Centre of Southern Denmark.

Opportunities and Barriers

The Health Consumerism trend in the Danish Healthcare Sector may offer the following opportunities for companies developing solutions for health consumers:

  • Designing solutions for prevention
  • Supporting the motivation of health consumers (behavioural design, nudging, instant gratification, gamification)
  • Supporting the socioeconomically disadvantaged

There are, however also some barriers for Health Consumerism solutions to overcome:

  • Financial barriers – who is going to pay for the solution? The healthcare sector or the citizen?
  • The mindset and culture in the hospitals
  • The competencies of citizens and healthcare personnel
  • Cross-sector services (and solutions) are complex

Considerations for companies

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.

 

Advice for Companies

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:

“If you accept this premise that all citizens have a mixture of intrinsic and extrinsic motivations, I think the citizen will get a better life because she/he will get more autonomy, making her/his own decision about what to do. As a citizen you will also feel more competent and feel the relation of supporting each other more than being supported by health professionals” (Obel, 2017)Obel, C. (2017, December 21). Carsten Obel. Interview performed by Health Innovation Centre of Southern Denmark.

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.

Values and Risks of Health Consumerism

Health Consumerism may add value for the citizens, healthcare personnel, healthcare sector and society as a whole in relation to:

  • Informed, involved and empowered citizens
  • Higher quality healthcare services
  • Health promotion – healthier population

However there are also potential risks to consider:

  • New roles and responsibilities and a cultural change in the healthcare sector
  • Supporting the socioeconomically disadvantaged citizens

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