On the face of things, the Dutch health system does a lot right. It holds the top spot in the latest Euro Health Consumer Index and spends more on health as a share of GDP than the OECD average (10.5% to 9.0%) and is usually in the discussion when the question of the world’s best healthcare system is raised.
However, about 32% of Dutch citizens currently live with a chronic disease. By 2030, this will rise to 40% of the population as life expectancy continues to increase. While the Netherlands does better than many other western countries in this aspect – in the US, for example, about half of all adults have one or more chronic health conditions – chronic diseases are a big financial burden and account for between 70% and 85% of all healthcare costs in OECD countries. The corresponding cost amounts to more than €700 billion every year in the EU alone.
There are pressures on both the demand and supply sides. Alongside the rise in chronic disease and an aging population, patients increasingly see healthcare as a right and demand value for money. On the supply side, new technologies and research methods are often expensive, while volume incentives are combining with sluggish productivity to cause difficulties.
The general direction is positive and the country is showing signs that it is preparing for change. In fact, Philips Future Health Index research ranks the Netherlands highly compared to other countries when it comes to the adoption of connected care, thanks to its above-average spend on IoT for hardware for healthcare as a percentage of GDP. The Royal Dutch Medical Association (KNMG) recently issued a guide to help health professionals evaluate mobile medical apps and use them in treatment and monitoring. The Royal Dutch Academy (KNAW) also acknowledges the potential of e-health and apps in its field guide on evaluating new health technologies.
Wearables – the next generation
But these are early steps and the use of longitudinal monitoring at home must increase if the system is to improve the health of the patient groups that are contributing most to the Netherlands’ pressures. Patients suffering from congestive heart failure, for example, would benefit from a wearable and an app that tracks fluid build-up in the lungs. Currently, this can only be assessed via x-ray in hospital.
Sleep apnea patients would benefit from broader screening since currently, this condition is significantly underdiagnosed. In research, it has been shown that relevant parameters can be measured by means of a wearable patch on the chest. The 22% of Dutch men and 14% of Dutch women who have high blood pressure need something better to manage their condition than the current cuff-based measurement. Only 12% of all diagnosed hypertensives worldwide change their lifestyle today. Research has shown that continuous or semi-continuous blood pressure tracking is possible with a wrist-worn wearable device.
The next generation of wearable health monitoring is being brought about partly by nanoelectronic innovation. It is currently possible to shrink an entire wireless vital sign monitor in a single chip measuring a few square millimeters without sacrificing signal quality. This enables the creation of low-cost single-use wearable diagnostics in the form factor of a simple Band-Aid that can perform screening, diagnosis and disease-management tasks. These tiny devices should also soon be able to run advanced diagnostic algorithms (either locally or in the cloud). This kind of device, which assists both the patient and his or her caregiver, has the potential to dramatically affect the health issues of a country like the Netherlands.
It’s not just wearables that can help improve the way patients are monitored. An app that recently won the Maria ter Welle prize, an annual Dutch award for health innovation, by successfully applying serious gaming to improve the dietary compliance and active knowledge of dialysis patients.
The prevention revolution
True change that will really address the challenges of the future requires something more disruptive. Cardiovascular disease, for example, causes 29% of deaths in the Netherlands, with chronic respiratory diseases behind 6%. The country won’t be able to make real steps towards transforming its health outlook unless we can prevent today’s young adults from becoming tomorrow’s chronic patients. After all, there is a clear recipe for success – all you need to do is lead an active life, eat a balanced diet, avoid cigarettes and alcohol and manage your stress.
While the solution sounds simple enough, this is obviously insufficient. We’re all different and have different needs, so generic advice just won’t cut through to everyone. The situation demands innovation in behavioral technology that goes beyond motivation and focuses on an individual’s personal ability to change and adds personal triggers that suits the way they’re best motivated.
This means moving to systems that are personalized and fully context aware. This is becoming possible as apps begin to combine the data collected by patients’ smartphones and wearables. This is known as digital phenotyping and will help device manufacturers and health providers to learn an individual’s behavior, habits, cravings, and triggers, in order to provide the right feedback at the right time and in the right tone.
This highly personalized behavioral app approach has the greatest potential to help people stop smoking, eating healthier and manage their stress better – three areas that are essential to address if the Netherlands is to reduce its chronic disease burden.
Finding ways to manage chronic diseases better for those that already have them and prevent younger generations from obtaining them at such high rates is crucial for the Netherlands to significantly reduce health costs over the long term. If nothing is done to lower these costs, the country could be spending as much as a quarter of its GDP and a quarter of its working population on curative and long-term health care. Preventative health powered by advanced technology, along with dramatic leaps in our ability to make tiny smart devices for health monitoring, must – and will – be a big part of any solution.