The importance of developing a sustainable healthcare system

Access to healthcare is not equal, with some people becoming ill due to where they live, in other words due to their country of residence, whether they reside in an urban or rural area and/or the subsequent level of pollution in their living environment. Place of residence also impacts the quality of and speed of access to healthcare, with certain populations being better served by the current ecosystem than others. Other social determinants of health include a person’s socioeconomic status and employment status.

To put this into perspective, when comparing the lowest income quintile of the Belgian population to the highest income quintile, we see that people in the lower income group have:

• 50% higher mortality rate

• 20% more admissions to hospital 

• 25% more psychiatric admissions

• 18% fewer screenings

• 38% less dental care

At the EU level, almost 44% of low-income adults report a chronic health problem (such as a long-term illness or disability) versus 29% among the top quintile. Specific diseases, such as cardiovascular conditions, diabetes, respiratory illness and mental disorders, are more common with socioeconomic disadvantaged populations. 

According to EU survey data, the share of people with at least moderate depressive symptoms is three times higher in the lowest income quintile, at close to 11%, than in the highest quintile.

Data showing unmet healthcare needs further illustrates these gaps. In 2019, about 3.2% of low-income EU citizens reported needing a medical examination or treatment but not receiving it, compared to only 0.7% in the high-income group. Financial difficulty was cited as the most common reason for this difference.

VBHC aims to enhance outcomes for individuals seeking care, regardless of their place of residence, making it a better approach for ensuring access to healthcare.

Our actions have an impact on our society and planet, thus indirectly on our own health. The cumulative effect of our actions has led to climate change, with extreme weather events, such as heat waves, wildfires and flooding becoming increasingly common and reported, certain tropical diseases moving out of the tropics and populations suffering from increased (immunology) stress. The World Health Organisation (WHO) estimates there’ll be 250,000 additional deaths annually from 2030 to 2050 due to climate change impacts such as heat stress and infectious diseases, with people in low-income and disadvantaged communities disproportionately impacted.

While this is serious, we shouldn’t be downhearted: we can also generate a positive impact. Prevention starts with daily actions that boost our immunity with healthy food and create a positive living environment. How we feed, live and move will make us more resilient and happier, with a positive feedback loop on our health as a bonus.

Western European healthcare systems are facing constraints that add complexity to any potential solution or change. Due to longevity and other associated factors, there is a rising number of individuals suffering from (multiple) chronic disease. This adds more stress to existing healthcare systems, which are already under pressure from the high use of medical resources, a prevalent issue with hospital-acquired infections and critical staff shortages. The issue of rising healthcare costs to treat increasing numbers of patients are compounded by the sector’s closed budget.

When people were asked to rate the Belgian healthcare system, they identified the following elements as (not) working well:

• Good availability and quality of health insurance coverage (74%)

• Good availability and ease of accessing healthcare services (65%) 

• Challenges related to the ageing population and rising demand for healthcare services, particular for chronic disease management (56%)

• Limited focus and relatively scarce resources dedicated to prevention and early intervention initiatives (41%)

Building a resilient, value-based healthcare system requires us to reinvent present healthcare and its current operating model(s), transforming them to enable and encourage integrated care centred around the individual seeking care.

By 2035, the care domain will contribute an estimated €8 trillion to global GDP - 7% of total output.  Recent changes include rising awareness about the need for diversity in clinical trials to cover wider populations, new treatments such as CAR-T that are creating additional opportunities for individuals and increased focus on payments and profitability. The sector is also exploring the value of new care trajectories that empower healthcare providers to deliver care that is more preventative and personalised, with more attention paid to the care offered outside hospitals.

Large and familiar value pools - such as health insurance and medical data - will grow and evolve significantly, and more nascent sectors, like personalised medicine and B2B-focused medtech, will gain momentum. Evidence generation can be considered as a continuum along the lifecycle of medicine. The Belgian evidence platform that is currently being set-up will enable early dialogue, facilitate access to high quality data and support close collaboration between all involved stakeholders, hence creating the environment to accelerate access to innovative treatments. By 2035 the care ecosystem will have started to transform into VBHC.

The past few decades have seen significant changes in the healthcare sector landscape with new stakeholders joining the ecosystem and other stakeholders seeing their roles evolve. New prominent stakeholders include the medtech sector with their remote monitoring solutions, applications and wearable devices (e.g. glucose sensors for diabetics and portable ECG cardiology devices), alongside Garmin and Apple watches that are well-known by the general public for gathering health data. As these companies also specialise in data analytics, they are helping the sector to gain new insights from the data generated by their devices. The market of remote patient monitoring is rapidly expanding and currently forecasted to grow from close to €15 billion to €50 billion in 10 years’ time. 

Evolving roles for stakeholders include those of healthcare professionals (HCPs) as they prepare for integrated care that crosses disciplines and lines of care, with an expected trend towards more care at home settings. This implies that the lines of care will also evolve to include new roles, such as telemonitoring and ambulatory procedures. There will also be changes for public / private health insurance funds, HCPs and others, shifting away from a fee-for-service model to more outcome-based approaches. Moreover, a change in the way of working is expected for procurement and contracting departments, with the normalisation of value-based procurement that favours pathway outcomes and lifecycle costs over unit price as well as the move towards risk-sharing deals, with the need for real world data routinely embedded in contracts, which fosters outcome-based models.

Finally, as part of an integrated supply chain, pharma companies are adding prevention and health promotion to their services, empowering healthcare professionals to flawlessly deliver advanced therapies.