Artikkelen tilhører Health and biotechnology, postet 16. mar 2017
Making a sustainable health and care sector in the future will be an important task for policy-makers worldwide. We have made three scenarios which address both possibilities and challenges.
In conjunction with an expert group, the Norwegian Board of Technology has developed three scenarios, which, in different ways, provide a picture of how citizens, industry and the public sector can meet the health challenges of 2030.
The purpose of the scenarios is to create awareness surrounding the choices we can make today to be prepared for the future. The scenarios are not an attempt to predict the future. They should rather form the basis for discussion of the choices we face today and future policies in the area of health.
Scenario 1: Home Field Advantage
Digital technology is cheap – the gold is to be found in how we use it to organise ourselves and create good services. In this scenario, citizens are continuously involved and are given many opportunities to quickly utilise new technology.
Local authority freedom. Together with users, local authorities have the greatest responsibility for the health and social care services. There is a lot of freedom to try out new solutions locally, whether this concerns Oslo or Oppdal. This leads to major differences between local authorities, but also for learning and imitating successes.
Entrepreneur nation. This local freedom gives space for testing and rapid adoption of new technology. Close collaboration between the municipalities and industry provides Norwegian companies with the opportunity to develop themselves on the home market. National politicians have prioritised setting open standards, establishing seed funds and ensuring a good digital infrastructure. This makes it easy and predictable for private players to develop health services.
Flexible. There is a strong desire to involve citizens in voluntary work in the local community. Several of the voluntary services have been incorporated into the local authorities’ time bank, so that volunteers get something in return for their efforts. Some local authorities have gone even further and outsourced certain core tasks to sharing services. Nonetheless, it is expected that as many people as possible will use the technology to actively participate in following up their own health.
Scenario 2: World Class
Global health services. As a consequence of digitalisation, health services have also be-come global. In the same way that Google, Amazon, Apple, IBM and Baidu dominate the Internet economy, some major companies also lead the way in a health sector characterised by big data, artificial intelligence and network effects.
It is about health, not Theodore Rimspoke. The government believes that the most optimal health outcomes per krone will be achieved by managing citizens’ health services through service providers who are good at prediction, prevention and follow-up. Based on population and health service data, Norwegians are offered world-class services, including for rare ailments and types of cancer that only a few people are afflicted by in Norway. This also provides better negotiation power with the pharmaceutical industry. Norway is attractive, since we can offer good data and a techno-savvy population.
From «sickness service» to «health service». The high volumes of data being collected enable very accurate preventive measures. Citizens can choose how much data they wish to share with the companies, but it is no secret that the services will maintain the highest level of quality if users share as much data as possible – both health data and other information.
The whole family put out to tender. Through tendering schemes, the authorities have selected four consortia who will offer health services in Norway. Citizens can, in turn, choose who they wish to belong to. In addition, Parliament requires the Ministry of Health and Care Services to take direct responsibility for psychiatric and care services for severe cases, following a record volume of inquiries, as well as social media campaigns, prior to the decision.
Platform economy. The companies that win the tendering schemes operate mainly with their own digital platform, in which the companies they collaborate with can contribute to delivering solutions. Some of the best Norwegian companies and research communities are also included, thus affording them greater opportunities to promote themselves internationally.
Scenario 3: Knowledge Nation
New diagnosis. Now everyone can test and measure themselves, receive an immediate interpretation and receive multiple diagnoses. The consequences are a situation in which many citizens want treatment and many treatment providers want to earn money. At the same time, health budgets must also be restricted. Following consultation with the Norwegian Medical Association, the Norwegian Nurses Organisation and the Norwegian Directorate of Health, health politicians have therefore committed themselves to a new and more stringent path for the public sector health services.
Evidence trumps everything. Stringent requirements are in place to ensure that quality and effect are sufficiently documented before new solutions are offered on a national level. The authorities have made a conscious choice to only use relevant and verified health data, and not other data about citizens such as, for example, from social media.
QALY. It is an expressed goal that services and quality shall be equal – regardless of where you live in the country. Prioritisation is more important than ever before, as there are so many possibilities and diagnoses. The Norwegian Directorate of Health has ruled out an extensive system of person-specific health checks. The most innovative solutions are not coming as quickly as some would like, but the Norwegian Directorate of Health is determined that quality adjusted life years shall form the basis for these solutions.
And what comes first is research. With its well-organised health service, Norway has been competent in the field of register research for a long time. This has now been up-graded: All data from the health service is raw material for research and the research is returned to the health service so that quality is constantly improved. There is simply an obligation to contribute, since all citizens also benefit significantly from the services. The Norwegian health sector does well from a research perspective, but scores low on innovation.
Family silver. The health authorities are concerned about information security – data shall be stored safely within the country’s borders and not shared with players who have commercial interests. Health data is regarded as a national resource, but citizens have no control