R. Pumputienė. The future of healthcare: how should policymakers prepare? 

2017-09-01

R. Pumputienė. The future of healthcare: how should policymakers prepare? 

2017-09-01

This article has been featured in the Women Lawyers’ Interest Group of the International Bar Association

The world’s healthcare systems continue to face major challenges. Therefore, it is sometimes hard to think, speak and be understood when talking about the future of healthcare.  However, what seemed impossible a few years ago is now a widely discussed reality, with everyone, including the mainstream media, joining in the miscellaneous conversations about artificial organs, artificial intelligence, human body enhancement and improvement on an almost daily basis.

The much talked about Fourth Industrial Revolution will connect the physical, virtual and biological worlds, affecting all areas of the economy and state. The new inventions and technologies this revolution will create will bring with them many ethical, technical and regulatory challenges for policy makers. In order to find the right answers to these challenges, first we need to know what questions to ask.

Main healthcare tendencies in the future 

Many different opinions exist on the subject of where and how healthcare systems will move in the future. However, all prognoses can be grouped into six major areas or tendencies.

The first tendency: wearable or implanted medical devices. These devices can either be worn (such as the widely popular ‘Fit Bit’) or implanted into organs, teeth, jaw etc. The common added value uniting all of them is a motivation to voluntarily monitor and improve one’s health. It is also an important technology for doctors and other healthcare workers, as it will allow easier monitoring of patients’ health and treatment.

The second tendency: body enhancement or cyborgisation. Artificially grown organs and body parts printed using 3D printers is already a reality. It is thought that in the future people will not only use body enhancement techniques in response to illnesses or trauma, but will also do so simply because of a desire to become stronger and/or faster.

The third tendency: robotization. It is generally thought that nurses will be replaced by robotic assistants in the future. Smaller robots – the so-called nanorobots – will also assist doctors and surgeons from within the human body where they will function autonomously, working on such techniques as restoring tissues and monitoring physiological indicators.

The fourth tendency: virtualization. Virtual medical consultation, diagnostics and even dissection will be possible in the future. Another important area of virtualization is the scanning of people’s neurological information and transferring this data to the cloud, thus possibly fulfilling the sci-fi dream of the eternal life of human consciousness online.

The fifth tendency: do-it-yourself type biotechnology, medicine and biomaterials 3D printing. Healthcare futurists such as Dr. Bertalan Mesko believe that biotechnologies are the IT of the 21st century in terms of decentralization and eventual accessibility for everyone. It is thought that technological progress in this area will eventually allow people to do many things themselves, such as printing medicines and even body parts.  Large laboratories will become obsolete.

The sixth tendency: precision medicine. In 2015, US President Barack Obama created the foundations for the idea of precision medicine. Precision medicine is a model that ‘proposes the customization of healthcare, with medical decisions, practices, or products being tailored to the individual patient’. In other words, precision medicine adapts the treatment according to the needs and genetic information of the patient. In order for this model to be implemented, scientists will need a lot of information about people’s health history and genomic information.

Challenges for policy makers

The first challenge: adapting regulatory processes. If policy makers want to make new healthcare inventions and make new technologies accessible for the masses, they will have to find ways to modify the current regulatory processes to fit these new needs. What worked with simpler technologies and processes in the past will not necessarily work with new technologies and treatments in the future.

Policy makers will also be forced to find new ways to foster dialogue. Decision-making regarding new medicines, medical device pricing, compensation, volume of healthcare services and overall healthcare expenditure will need to include patients and the industry, which will be able to provide much needed big data.

The second challenge: data privacy. An inevitable part of all new technology is the collection of and analysis of data.  Undoubtedly, storing information leads to issues of privacy, hacking and leaking which can be harmful not only for people themselves but also for individual countries. Experts admit that it is virtually impossible to fully ensure, for example, genetic privacy, but countries will nevertheless have to create new means to safeguard and protect it as much as possible, and to also adopt a legal system to meet this challenge.

Bioprinting, precision medicine, collecting and keeping people’s health history in the cloud, wearables which track virtually all movement, the list of areas which need special attention and preparation on the part of policy makers is seemingly endless.

The third challenge: ethical issues. Ethical arguments will become a huge point of debate not only in countries where religion plays a big part but also in secular countries which will be concerned with the threat of inequality and discrimination. Alexander Stubb, the former prime minister of Finland, recently announced that the Fourth Industrial Revolution can bring a class-based society of the kind that hasn’t been seen for over a century. If adequate measures are not taken, this will be especially visible within healthcare, where the rich will have access to use the latest technology, thus enhancing their lifespan and improving their quality of life, whilst the poor will have little or no access to it at all.

Countries will inevitably have to set the boundaries for human body enhancement, genetic engineering and the chance to have ‘designer babies’ (when genetically selected genes for an embryo will not only prevent certain diseases or dysfunctions, but will also determine how the baby will look). These technologies could potentially bring about not only ethical problems within families, but also a large disparity between families who can and who cannot afford them.

Genetic discrimination is also a concern. Although many regulations and agreements already exist, it is hard to predict for example how states will tackle the leaking of genetic information into the hands of unfriendly and uncooperative countries or corporations. If data is leaked, it is almost impossible to prevent its commercialisation, for example, by selling it to insurance or recruitment companies.

Policy makers will be required to answer if and how much to compensate such technology to make it accessible to the majority of people, how to adapt regulations to new technology, how to ensure international cooperation and make sure that the same standards (such as data privacy standards) are kept in different countries around the world.

The fourth challenge: fostering competition. One of the most, if not the most important vehicles for economic progress, as well as driving prices down thus making it more accessible for more people, is competition. Policy makers have to come up with a model that ensures equal access to the market, compensated medicine and medicinal device lists. Besides ensuring competition between old and new players, policy makers will need to face the challenge of ensuring competition between already existing players in the industry, promoting investment and innovation.

This article is based on ‘Healthcare Futurist’ by Dr. Bertalan Mesk.