Research methodology and sources

Research overview and objectives

In the first chapter of the 2018 FHI, 45 different
metrics are analyzed and grouped together in key
pillars:

1. Value Measure
2. Current State (of Data and Care Delivery)

The Value Measure is the first pillar. The Value Measure is a new indicator of the value delivered by healthcare systems of developed and developing markets. It combines factors associated with value based healthcare and access to care, arguably the ultimate goals of modern healthcare. It consists of
three parts:

1. Access (i.e. how universal, and affordable, is access to healthcare in the designated market?)

2. Satisfaction (i.e. to what extent do the general population and practitioners in the designated market see the healthcare system as trustworthy, and effective?)

3. Efficiency (i.e. does the system in the given market produce outcomes at an optimum cost?)

The second pillar, Current State measures current levels of adoption of key digital enablers:

1. Data (collection and analytics) (including wearables, Electronic Health Records (EHRs), Intelligent Care)

2. Care Delivery (Telehealth and Diagnostic & Treatment Solutions)

Each pillar consists of several sub-metrics (see metrics graphic on pg.26). Within each pillar, the metrics are normalized to ensure comparability across countries and are scored to fit onto a 0 to 100 scale. Specifically, metrics related to market size are normalized per capita, per hospital bed or per physician in each country. The market size metrics were scored relative to the highest scoring country (with a population over 1,000,000) among the available dataset. For other metrics, including those for the Value Measure and technology infrastructure metrics, scoring is either relative to the highest scoring country (with a population over 1,000,000) among the available dataset, or based on any optimal baseline number set by global authorities e.g. standards/goals set by the United Nations Sustainable Development Goals (SDGs). By excluding countries with populations of less than 1,000,000, we exclude outliers that may create unrealistic potential to reach 100.

A metric which does not follow this pattern of normalization is:
• The risk of impoverishment due to surgical care – this metric is reported as a percentage, so it is simply inversed and no further normalization is needed.

In a next step, the scores for each metric are then averaged to calculate each sub-index score and those sub-indices averaged to create each pillar. The 45 different metrics analyzed use a combination of third party data and original research collected via a survey in partnership with a global market research firm.

The survey data was collected January 18, 2017 to March 3, 2017 for 15 of the 16 countries analyzed in 2018 (Australia, Brazil, China, France, Germany, Italy, The Netherlands, Russia, Saudi Arabia, Singapore, South Africa, Spain, Sweden, the UK and the US) in their native language. The survey had an average length of 25-30 minutes. A combination of online, face-to-face (computer-assisted) and phone (computer assisted) interviewing was used. Survey data for India was collected during February 16, 2018 to March 26, 2018 in a manner consistent with the other countries in 2017.

The total sample from the survey includes:

• 3,244 healthcare professionals (defined as those who work in healthcare as a doctor, surgeon, nurse practitioner, registered nurse, licensed practical nurse or nurse across a variety of specializations)

• 24,654 adults (representative of each country’s respective adult population).Third-party data was sourced from a number of organizations including the World Health Organization, The Commonwealth Fund, and the World Bank. A full list of sources is available below.

Sources

Value Measure:

Access Reality

World Bank. (2014). Risk of impoverishing expenditure for surgical care (% of people at risk).

World Health Organization – Global Health Observatory data repository. (2009-2015). Hospital bed density: Data by country.

World Health Organization – Global Health Observatory data repository. (2013-2016). Skilled health personnel: Data by country.

Satisfaction

Future Health Index. (2017, 2018). 2017 Future Health Index Report.1

Efficiency Ratio

World Bank. (2014). Health expenditure, total (% of GDP).

World Health Organization – Global Health Observatory data repository. (2016). Global Strategy for Women’s, Children’s and Adolescents’ Health (2016-2030).

World Health Organization – Global Health Observatory data repository. (2016). Healthy life expectancy (HALE): Data by country.

World Health Organization – Global Health Observatory data repository. (2016). Life expectancy and Healthy life expectancy: Data by country.

World Health Organization – Global Health Observatory data repository. (2015). Maternal mortality ratio (per 100 000 live births) (Global strategy for women’s, children’s and adolescents’ health).

World Health Organization – Global Health Observatory data repository. (2016). Mortality between age 30 and exact age 70 from cardiovascular diseases, cancer, diabetes or chronic respiratory diseases: Data by country.

World Health Organization – Global Health Observatory data repository. (2016). Tuberculosis: Incidence: Data by country.

World Health Organization – Global Health Observatory data repository. (2015). Tuberculosis: Treatment success: Data by country.

 

Current State of Data:

Data Collection

Grand View Market Research. (2016). Electronic Health Records Market Report.2

Grand View Market Research. (2016). Medication Management Market Report.3

Grand View Market Research. (2016). Wearable Medical Devices Market Report.4

Statista. (2016).5

The Commonwealth Fund. (2010-2015). What is the status of electronic health records?

World Health Organization. (2010-2015). Atlas of eHealth country profiles – The use of eHealth in support of universal health coverage.6

Data Analytics

Allied Market Research – Healthcare Artificial Intelligence Market Report. (2016).7

Global Market Insights – Healthcare Artificial Intelligence Market Report (2016).8

Current State of Care Delivery:

Telehealth

Grand View Research. Remote Patient Monitoring Devices Report. (2016).9

Grand View Research. Telemedicine Market Report. (2016).10

Statista. (2014).11

Diagnostic & Treatment Solutions

Allied Market Research. Global Surgical Robotics Market Report. (2017).12

Grand View Research. Image Guided Therapy Systems. (2016).13

Grand View Research. Medical Imaging Market. (2016).14

 

Infrastructure:

Policies

Australian Government, Department of Health. (2017). Complying with Wearable Health Device Regulation.15

Australian Government, Department of the Prime Minister and Cabinet. Data Sharing Release Act.16

Center for Disease Control and Prevention. (2015). Federal Public Health Laws Supporting Data Use and Sharing.17

Commonwealth Fund. (2010-2015). What is the status of electronic health records?18

EMI – eHealth mentor Institute. (2016). Brazil eHealth – Overview, Trends & Opportunities.19

Emergo Group. (2016). Classification of Medical Devices and IVDs.20

European Patients Forum. (2016). The new EU Regulation on the protection of personal data: what does it mean for patients?.21

European Union – Public Health. (2014). Overview of the national laws on electronic health records in the EU Member States.22

European Union – Law. (2014). Data protection: Rules for the protection of personal data inside and outside the EU.23

Food & Drug Administration. (2016). Digital Health.24

Government of India – Ministry of Electronics & Information Technology. White Paper on Data Protection framework for India – Public Comments Invited. (2018).25

ICLG. (2017). Data Protection | China.26

Data Protection | India

Data Protection | Germany

Lakemedelsverket. (2013). Legislation – Medical Devices.27

Latham & Watkins LLP. Data Protection in the Kingdom of Saudi Arabia: A Primer.28

OECD. (2013). Strengthening Health Information Infrastructure for Health Care Quality Governance.29

Official Journal of the European Union, (60). (2017).30

Thomson Reuters. (2018). Data protection in Brazil: overview.31

World Health Organization. (2015). Atlas of eHealth country profiles – The use of eHealth in support of universal health coverage.32

 

Technology Infrastructure

Open Signal. (2016). Global State of Mobile Networks.33

Statista Market Indicators. (2016). Average Speed of Internet in Kbits/sec.

The World Bank. (2016). Secure Internet servers.

The World Bank. (2016). Individuals using the Internet (% of population)

The World Bank. (2016). Mobile cellular subscriptions.

 

The 2018 report was referenced for India. The 2017 and 2018 Future Health Index Reports were referenced for all metrics in the satisfaction category.

2 The 2016 Grand View Market Research – Electronic Health Records Market Report was referenced for the following metrics: Hospital use EHRS (USD Millions) and Ambulatory use EHRS (USD Millions).

3 The 2016 Grand View Market Research – Medication Management Market Report was referenced for the following metrics: Clinical decision support system solutions; Computerized physician order entry; Electronic medication administration record; and Inventory management solution.

4 The 2016 Grand View Market Research – Wearable Medical Devices Market Report was referenced for the following metric: Global wearable medical devices market, by region/country (USD Millions).

5 Statista was referenced in 2016 for the following metric: Fitness wearables users.

6 The Commonwealth Fund and World Health Organization were both cited for the following metric: Existence of a universal EHRs.

7 The 2016 Healthcare Artificial Intelligence Market Report by Allied Market Research was referenced for the following metric: Artificial intelligence in healthcare market by application – preliminary diagnosis, (USD Millions).

8 The 2016 Healthcare Artificial Intelligence Market Report by Global Market Insights was referenced for the following metric: Healthcare artificial intelligence market by application/segment – therapy planning, (USD Millions).

9 The 2016 Remote Patient Monitoring Devices Report by Grand View Research was referenced for the following metrics: Global remote patient monitoring devices market, by end-use – hospital based patients (USD Millions); Global remote patient monitoring devices market, by end-use – home healthcare (USD Millions); and Global remote patient monitoring devices market, by end-use – ambulatory patients (USD Millions).

10 The 2016 Telemedicine Market Report by Grand View Research was referenced for the following metric: Telemedicine market estimate by country (USD Millions).

11 Statista was referenced in 2014 for the following metric: Number of users of pay-to-use apps for connected medical devices for use at home and form telemedical services relating to remote patient monitoring.

12 The 2017 Global Surgical Robotics Market Report by Allied Market Research was referenced for the following metric: Global Surgical Robotic Procedures Market Revenue – Overall (USD Millions).

13 The 2016 Image Guided Therapy Systems Report by Grand View Research was referenced for the following metric: Image Guided Therapy Systems Market (USD Millions).

14 The 2016 Medical Imaging Market Report by Grand View Research was referenced for the following metrics: X-ray market, by technology – digital (USD Millions); CT market, by type – advanced (USD Millions); MRI market, by field strength high (USD Millions); SPECT market, by product – digital (USD Millions); and PET market, by product – digital (USD Millions).

15 For Australia (Metric = Accreditation for wearables).

16 For Australia (Metrics = Regulation/legislation around data sharing and regulation/legislation around data protection/security).

17 For U.S. (Metrics = Regulation/legislation around data sharing and regulation/legislation around data protection/security).

18 For France, Germany and India (Metric = Regulation/legislation around which EHR platforms to use);
For Australia, China, India and Singapore (Metric = National vs regional policy on EHR (yes/no));
For Australia, China and India (Metric = Policy on data protection).

19 For Brazil (Metrics = Regulation/legislation around which EHR platforms to use; National vs regional policy on EHR (yes/no); and Policy on data protection).

20 For India, Brazil, China, Russia, Singapore, Saudi Arabia and South Africa (Metric = Accreditation for wearables).

21 For France, Germany, Italy, Netherlands, Spain, Sweden and U.K. (Metric = Regulation/legislation around data sharing).

22 For Italy, Netherlands, Spain, Sweden, U.K., Germany and France (Metric = National vs regional policy on EHR (yes/no))

23 For France, Germany and Spain (Metric = Policy on data protection).

24 For U.S. (Metric = Accreditation for wearables).

25 For India (Metric = Policy on data protection).

26 For China, India and Germany (Metric = Regulation/legislation around data protection/security).

27 For Sweden (Metric = Regulation/legislation around data protection/security).

28 For Saudi Arabia (Metrics = Policy on data protection; Regulation/legislation around data sharing; and regulation/legislation around data protection/security).

29 For U.S., Saudi Arabia, South Africa and Russia. (Metric = National vs regional policy on EHR (yes/no)).

30 For France, Germany, Netherlands, Spain, Sweden, Italy and U.K. (Metric = Accreditation for wearables).

31 For Brazil and South Africa (Metric = Regulation/legislation around data sharing);
For Brazil and France (Metric = Regulation/legislation around data protection/security).

32 For Australia, China, Italy, Netherlands, Russia, Singapore, South Africa, Sweden, U.K., U.S. and Spain. (Metric = Regulation/legislation around which EHR platforms to use);
For Italy, Netherlands, Russia, South Africa, Sweden, U.K. and U.S. (Metric = Policy on data protection);
For U.K., Italy, Netherlands, Russia, Singapore, South Africa and Spain (Metric = Regulation/legislation around data protection/security).

33 The Global State of Mobile Networks Report by Open Signal is referenced for the following metrics: Availability of 3G or Better (4G) and Overall Mobile Speed(MPS).

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