A disturbing diagnosis of our current healthcare system
3 eye-opening examples of what’s wrong with our current Belgian healthcare system, and why change is inevitable.
Healthcare providers diagnose hundreds of patients on a daily basis, examining a set of symptoms in order to identify the nature of their patients’ issues. By mastering the skill of problem solving, they help patients understand their individual situation, find the appropriate solution and guide them on their way to recovery.
What if they would use these skills to diagnose our healthcare system as a whole?
You’re right, we’re not really in a position to complain. The Belgian healthcare system is a great healthcare system, ranked among the best in Europe. Great accessibility, fast care and a generous (mandatory) insurance structure with reimbursements of up to 75% of all costs, are some of the biggest strengths Belgian healthcare has to offer. But there is another side to the story. The cost-effectiveness side. And the real issues may just lie in our system’s subtleties.
This month, I’ve put myself in the shoes of a healthcare provider to examine 3 of our industry’s somewhat disturbing symptoms, based on interesting conversations I’ve had with the individuals who witness it every day.
The frightening reality of the fee-for-service model
The current fee-for-service structure, where care providers are paid based on the amount of services they provide, allows some pretty upsetting things to happen. Here’s a very real example:
Neonates in the hospital are monitored continuously, resulting in huge amounts of data captured every second. But only a small fraction of that data is being put to use. I met a neonatologist who’s building a platform, enabled by an AI-supported algorithm, that can predict whether a certain treatment, such as a respiratory intervention, is necessary. This would allow neonatologists to extract value from all the data that’s currently draining away, and funnel it into their decision making process to enable better treatment outcomes for their neonatal patients.
Amazing, right? Well, here’s the catch: research shows that neonatal health outcomes are better when respiratory interventions are kept to a minimum.
Even though this technology could literally save lifes, with the current fee-for-service payment structure, it’s not hard to understand why very few neonatologist are keen on using it. It’s very likely to cause a steep decline in interventions needed, followed by an equally steep decline in their salary.
Fee-for-service offers no way to reward the industry’s best providers. Instead, it creates adverse incentives to add volume, and rewards care providers accordingly. No time to waste in welcoming an outcome-based payment structure, if you ask me.
Throwing pills into a national health insurance loophole
In Belgium, citizens are offered a financial protection measure that allows full reimbursment of medical costs after an individual’s or family’s medical costs exceed a certain yearly maximum. This is great for those who need it, and I’m in favor of covering the (majority of the) costs of patients who suffer from rare or chronic diseases. But if only this measure was waterproof.
A pharmacist told me about a patient who recently brought back medication worth €7000, destined to go straigth into the trash can. The patient didn’t really care, because the entire amount was reimbursed by our national health insurance.
Wait what? Well, this happened (and it happens all too frequently): the yearly maximum is often reached around the end of November, resulting in a December shopping spree at the local pharmacy where everything is virtually for free. You wouldn’t believe the pile of prescriptions patients put on their pharmacist’s counter. Doctors can prescribe medication that far exceed the expiry date, prompting patients to either return to their local pharmacy with a stack of expired medication, or prompting them to take in expired medication. Neither of those options is any good.
I find it very difficult to understand how it’s even possible for doctors to prescribe medication so much in advance that it’s due to expire before it’s consumed. It’s cringeworthy when that much money is thrown away. Money that could be used to make our healthcare system more cost-effective.
I’m confident that digital transformation can, and will, take care of this problem, but the accountability of both the healthcare professional and the patient cannot be ignored. In a healthcare system where such a firm reimbursment model is in place, technology could play a crucial role in tracking and verifying such transactions, increasing transparancy and connecting fragmented systems to offer healthcare professionals and patients insights into the (monetary) value of care.
Low incentives for private health insurance funds to go digital
Health insurance funds employ many people to manually sort through all of their customers’ expense submissions. It doesn’t seem too difficult to use technology for this process, right? But considering the fact that these funds earn money on the back of their customers’ aptness to forget submitting their expenses, it’s not hard to imagine why these funds won’t go digital.
Going truly digital would decrease the margins of error — e.g. wrongfully filling out documents and forgetting to submit expenses — , pretty much all the way to zero. And yes, that eats away their bottom line.
“You can submit your expenses digitally now!” Those were the words I heard from my insurance fund after I broke my ankle a little while ago. Whereas I previously had to put all of my documents in an envelope and send it off with the post, I can now simply upload a scan or picture onto their online portal. A great step forward. Except for the fact that I have to do the exact same work, only now through a different channel. This also means that the system is still prone to the same errors. Oh, and you would expect the waiting time to decrease too..
It’s true, most insurance funds now allow you to track the progress of your dossier via their online portal. But it takes more than just digitizing the current system to truly add value. In fact, digitizing your channels is simply moving the problem. Be careful not to prioritize on bettering the front-end of your solution instead of an integrated and efficient behind-the-scenes longer-term strategy.
Insurers could play a pivotal role in the digital transformation of our healthcare system, as they’re able to become the nucleus of an interconnected ecosystem of healthcare stakeholders such as hospitals, healthcare providers, medical device companies, big pharma players, and most importantly patients. They could act as both payer and processor of the digital health experience, allowing them to empower the system as a whole. But to do so, they should enable a power shift from claims management to customer benefits, leveraging technology to optimize for a foundational infrastructure that enables efficient and reliable data exchange, advanced analytics for claims processing and fraud detection, machine learning for care management and distributed ledger technologies to control treatment costs.
Only if they put their central position to good use, the rest of the system will be able to innovate with them. Simply digitizing their channels won’t cut it.
This is far from an isolated diagnosis of our healthcare system, as these are just 3 examples of reasons why it’s hard for the industry to innovate. All healthcare stakeholders are connected on a very deep level with the wrong incentives for it to become a sustainable system. Fortunately, start-ups pop up in every healthcare subsector, trying to find ways to flip the model. But they can’t do it alone. A massive cultural shift needs to happen on every level, starting with the frontline itself.
Let’s meet at the 5th Conference on Digital Health on September 5th in Antwerp if you want to get inspired about how we can create a more sustainable healthcare model for the future, enabled by technology and digital.
Read my previous blog post on the right breeding ground for healthcare innovation here, or let’s connect if you’re interested in a chat.
