Abstract
Advances in health and healthcare have added about 35 years of life expectancy worldwide over the last century alone. This success has come with a rising cost that is quickly becoming unsustainable. Efficiency gains in our current system, while absolutely necessary, are in themselves insufficient. Our future healthcare system needs to be an actual ‘health’ system rather than a ‘disease care’ system – and it needs to be financially sustainable. Such a transformation requires new ideas, structures, mindsets, and actions. Across the world we see increased investments in prevention, growing innovation and entrepreneurship in public and private sectors in health tech, health data, and health culture, and shifts towards value-based and outcome-based health systems.
Keywords: health system, prevention, disease care, value-based healthcare, patient-focused care, healthcare innovation, future of health
The evolution of the healthcare system
Advances in health and healthcare have been significant during the last two centuries. Over the last 100 years we have gained worldwide about 35 years of life expectancy as a result of increases in sanitation, decreases in poverty, the lowering of child mortality, and evolutions in medicine and healthcare systems.
These successes have not come without cost. For example, in 2016, OECD countries spent an average of 9 per cent of our gross domestic product (GDP) on health, with wide variations from country to country. The US, for example, spent 2.5 times the OECD average. Over the past decades total healthcare expenditure in OECD countries has climbed faster than GDP. Projections for the coming 20 years suggest that the cost of healthcare will rise by another 50 to 100 per cent. Outside the OECD costs are also expected to rise. Some forecasts suggest that the BRICS countries will more than double their healthcare costs over the next 40 years. This increasing cost is driven by both demand and supply factors.
An ageing population
By 2030, people aged over 60 are expected to account for one in six globally, which is a 56 per cent increase from 2015 – 1.4 billion people. In Europe and North America people over 60 will comprise more than one in four of the total population. The global population of people over 80 years is rising even faster and is expected to increase by 61 per cent between 2015 and 2030 to nearly 202 million people.