Digital healthcare is around the corner. It will bring a sea change to our health care systems, in principle positive change, provided that a few basic political choices are made at European level before it is too late. This was the main conclusion of an own-initiative opinion entitled Impact of the digital healthcare revolution on health insurance, adopted by the European Economic and Social Committee (EESC) on 21 September.
The digital revolution will radically change the way healthcare is provided in the next few years from a system based on cure to one focused on participatory, preventive, personalised and even predictive medicine, the so-called "4P medicine". Technology will sweep across the sector and change the way all players work – health professionals, pharmaceutical industries, hospitals, medical research centres, health insurance (such as mutual organisations) and of course citizens. In 5 to 10 years' time diagnoses will be made by machines, allowing doctors to focus on the relationship with their patients. People will be more and more in control of their health, thanks to a wealth of applications and devices providing information about health status. Genome mapping and other major scientific breakthroughs will make people aware of their genetic risks and able to adapt their lifestyles accordingly.
All this is - in principle - good news. Yet there are some potential threats lurking behind this revolution – first and foremost the risk that it may exacerbate social differences and widen the digital divide between those who have access to digital health and those who do not. This is why it is vital to act today to shape the healthcare systems of tomorrow. "Solidarity is the cornerstone of European healthcare systems, whether in old or new Member States. Health must continue to be seen as a common good– a good belonging to the public as a whole", said opinion rapporteur Alain Coheur, director of European and International Affairs at Belgium's National Union of Socialist Mutual Health Funds. "It is important that we retain our national health services and this will only happen if digital technology is used to activate our fundamental rights – the right to information, the right to healthcare: these are the keys to our social welfare systems."
Currently European healthcare systems are based on the pooling of risks and the fact that so far it has been impossible to predict when a risk would become a reality. People pay based on their means and receive according to their needs. This is particularly true of public healthcare. Tomorrow, however, all this could change, especially in private insurance, which is based on risk selection. With predictive medicine, profit-making insurance companies might want to personalise someone's risk profile, for instance on the basis of the likelihood that they will contract cancer in 5 or 10 years' time: "That is why we need to ask ourselves the question: what kind of health system do we want to have in Europe tomorrow?", argued the rapporteur. "Do we want equal access for all European citizens or are we going to go down the road that the USA has taken, where insurance dominates the market and, once you have had two illnesses, you will no longer be covered? If that is not the model we want, we need to state it clearly, because this is what could happen with digitalisation."
Mr Coheur also warned against the danger of transferring too much responsibility to patients as a result of the digital revolution: with all the information made available, they will end up being totally responsible for their own health. "That may be a valid objective, but we can't possibly be in charge of all the things that contribute to our health. There are personal life choices we can make, but there are also many external factors over which we have no control – for instance the use of pesticides in farming or exposure to air pollution", stressed the rapporteur.
Finally, another key issue that the EU needs to address, in the EESC's view, is the protection of health-related personal data. Sharing a patient's data with and between health professionals can help improve treatment. But, to be able to share their health data, people must themselves have a proper understanding and be able to give their informed consent to healthcare professionals for use of the data. This informed consent is vital, but there is still a lot of vagueness as to how healthcare data can be used. There are also digital disruptors like the so-called "Big 5", which are now collecting data on individual behaviour and processing it (data mining): "These big digital players are all outside Europe, so we must ensure that we are able to protect the sovereignty of Member States, but also the healthcare systems themselves. Unfortunately in Europe today we are unable to stand up against these digital challenges. Europe has an essential role to play in putting in place a regulatory framework for that."
Europe also has a role to play in providing the means to meet the challenge: "At European level – as have seen with Airbus and Galileo – we need to provide the resources for health and digitalisation. Even big countries like France and Germany are not able to address the issue of digitalisation on their own. Look at the USA or China. We don't have such resources at Member State level anymore. The response must come from Europe, so that a real overall health and digital plan can be drawn up," concluded Mr Coheur.
The EESC opinion can be found here. There is a list of websites providing supporting background material at the end of the opinion.