HEALTHCARE CHALLENGES AND TRENDS
The patient at the
heart of care

3
Quality healthcare is one of the most important
factors in how individuals perceive their quality of
life. In most countries, alongside the economy, it is
the major political issue. In some countries, such
as the UK with the National Health Service (NHS),
the healthcare delivery organisation is a part of
their national identity.
We believe it is time for a new enlightenment in every aspect of the healthcare ecosystem, where
every player, from governments to enterprises to individuals, is involved in improving healthcare. We
want to bring you the best of our thinking, and the best of our partner’s thinking. That’s why we are
writing a series of whitepapers. While we concentrate on the challenges of healthcare in the first
paper, later into the series, we’ll look deeper at its correlation to the pharma industry, and the need
for collaboration between the two and also at the innovative solutions we offer for better healthcare.
Globally, all health economies are facing similar challenges. In addition, the advent of new consumer
technologies is introducing more challenges (or bringing older ones to the fore). These disruptive
technologies promote greater patient power.
The most agile and forward thinking health economies have the opportunity to revolutionise the way
care is delivered, and in doing so to transform their societies. This whitepaper, the first in a series
from Logica, outlines the challenges we see our clients struggling with, and some of the trends we
think will impact healthcare for the better.

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GLOBAL CHALLENGES
There are global challenges that will impact healthcare in the near future. These include:
Rising costs
Spending on healthcare almost invariably grows faster than GDP; the rate of growth of healthcare
spend has exceeded that of GDP since records began. Moreover, spending and economic recession
are closely linked. We can expect to see the rate of growth of healthcare spend in Europe outstrip
GDP growth significantly during the current economically difficult times.
Macroeconomic factors like aging populations or insufficient public funding are challenging both
receivers and providers of healthcare. Adoption and penetration rates of clinical information
systems vary greatly. In fact, the number (and size) of buyers varies from country to country, and is
not necessarily dependent on the size of the country but rather on the structure of the healthcare
system. Additionally, purchasing behaviour is shifting towards more coordinated, joint purchasing.
Canada Japan United Kingdom United States OECD
%
18.0
16.0
14.0
12.0
10.0
8.0
6.0
4.0
2.0
0.0
1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 2010
Figure 1: Health expenditure as a share of GDP, 1960-2009, selected OECD countries, Source: OECD Health Data
2011.

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Changing demographics
Service is in demand
There is increasing demand on the healthcare delivery organisations. And this is happening in
every country. Thanks to advances in our understanding of the causes of diseases, and consequent
improvements in diagnostic techniques and treatments, people live longer. The average life
expectancy in OECD countries has now reached 80 years and continues to lengthen. However, not
only are people living longer, but increasingly people are living longer with chronic disease.
Life expectancy at birth, 2009 Years gained, 1960-2009
83.0 Japan 15.2
82.3 Switzerland 10.9
81.8 Italy 12.0
81.8 Spain 12.0
81.6 Australia 10.7
81.6 Israel 9.9
81.5 Iceland 8.6
81.4 Sweden 8.3
81.0 France 10.7
81.0 Norway 7.2
80.8 New Zealand 9.7
80.7 Canada 9.4
80.7 Luxembourg 11.3
80.6 Netherlands 7.1
80.4 Austria 11.7
80.4 United Kingdom 9.6
80.3 Germany 11.2
80.3 Greece 10.4
80.3 Korea 27.9
80.0 Belgium 10.2
80.0 Finland 11.0
80.0 Ireland 10.0
79.5 Portugal 15.6
79.5 OECD 11.2
79.0 Denmark 6.6
79.0 Slovenia 10.5
78.4 Chile 21.4
78.2 United States 8.3
77.3 Czech Republic 6.7
75.8 Poland 8.0
75.3 Mexico 17.8
75.0 Estonia 6.5
75.0 Slovak Republic 4.4
74.0 Hungary 6.0
73.8 Turkey 25.5
73.3 China 26.7
72.6 Brazil 18.1
71.2 Indonesia 30.0
68.7 Russian Fed. 0.0
64.1 India 21.7
51.7 South Africa 2.6
90 80 70 60 50 40 0 5 10 15 20 25 30
Years Years
Figure 2: Life expectancy at birth, 2009 (or nearest year), and years gained since 1960. Source: OECD Health
Data 2011; World Bank and national sources for non-OECD countries.

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Filling the resource gap
Even as demand increases, there is a global shortage of clinicians. Countries with the highest
number of clinicians per population will need to address graduate intake in to medical schools, which
is falling in real terms in many countries. The challenge isn’t limited to doctors either, as enrolment in
nursing colleges has also fallen in some countries.
Ireland 52.8
Austria 51.4
Chile 47.4
Korea 45.5
Denmark 42.9
Turkey 42.9
Finland 37.8
Australia 37.3
Netherlands 36.4
Czech Republic 35.3
United Kingdom 34.5
Germany 34.3
Poland 33.7
Slovak Republic 33.0
Slovenia 33.0
OECD 32.5
Iceland 31.7
New Zealand 30.3
Hungary 29.8
Canada 29.7
Portugal 28.3
Sweden 27.5
Estonia 27.4
Italy 27.1
Japan 27.0
Belgium 26.9
United States 26.7
Norway 26.6
Greece 25.7
Switzerland 24.1
Spain 23.9
France 18.2
Israel 11.6
0 10 20 30 40 50 60
Per 1,000 physicians
Figure 3: Medical graduates per 1,000 physicians, 2009 (or nearest year). Source: OECD Health Data 2011.
Arguably, a storm is brewing in France, where the number of doctors over 55 is amongst the highest
in the OECD. Combined with an overall reduction in the number of graduates emerging from
medical school, France may well see the number of doctors leaving the profession exceeding those
entering. It is generally the case that a skills shortage increases costs (or reduces service quality)
so a well run health system makes sure staff are properly equipped and doing the right tasks for
their skills and training. This presents an ethical challenge, as European states seek to fill the gap by
recruiting doctors and nurses from other countries, thus depriving those societies of their healthcare
professionals.

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Easy access
The graph shows the distribution of hospital sizes. As demand and spending increase, health
economies will increasingly need to balance ease of access to their services against the cost of
operating smaller hospitals. For many countries, the rationalisation of the healthcare system means
the closure of small regional hospitals, which becomes a politically-charged issue. This rationalisation
also has to take into account the increasing specialisation of tertiary hospitals, which we address later.
100%
90%
80%
70%
60%
50%
40%
1-100 beds
30%
101-250 beds
20%
251-750 beds
10%
0% >750 beds
Denmark
Finland
France
Portugal
Sweden
Netherlands
United Kingdom
Czech Republic
Estonia
Germany
Norway
Poland
Slovakia
Spain
Switzerland
Total no.
2452
3713
128
123
298
366
156
920
919
hospitals
51
56
26
50
21
na
Figure 4: Share of hospitals by number of beds. Source: Nordic Healthcare Group
Focus on quality
What patients expect is changing
The quality of care is increasingly important – as patients begin to exercise their right to choose how
and with whom they engage for their healthcare. They demand transparency of data and processes.
As a consequence, healthcare organisations will need to focus on how quality outcomes can be
published in a meaningful way for patients. Patient safety is the major focus of patient advocacy
groups and healthcare leaders. They will enforce deeper investigations of medication errors, hospital
acquired infections, wrong site surgery or pressure sores, like never before.
Becoming customer-driven
Where the patient needs to be - at the heart of care
To address the needs of the expert patient, and to start the transition of healthcare to a demand
driven model, some of the world’s leading hospitals are placing the patient firmly at the centre of
everything they do. For example, the Cleveland Clinic in Ohio has a clear mission to improve the
patient experience, and has a board-level Chief Experience Officer leading the Office of the Patient
Experience. According to their website, the mission is to ‘ensure care is consistently patient-centred
by partnering with caregivers to exceed the expectations of patients and their families’. Cleveland
Clinic, along with a handful of other pioneering hospitals, has always been a bellwether in patient
care, and it will be interesting to see how many European hospitals make similar arrangements.

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Global healthcare trends
Move from being supply driven towards a demand driven consumer model
As a society, we are changing rapidly, and this is apparent in the relationship between care providers
and the citizen. Patients are increasingly becoming stakeholders in their own care journeys; they
demand transparency in access and information about their care and importantly, about the quality
of service provided. Universal access is the basis of virtually all socialised healthcare economies. But
citizens are now demanding access on their terms. They want to schedule appointments when and
where it suits them, not the provider. They want the latest drugs or clinical trials; and of course, an
end to surgical waiting lists. Or they want to be given the option to ‘go private’ without incurring a
personal cost.
The internet is changing citizen behaviour. This means the way governments interact with their
citizens has to change too. Municipalities are providing more services to the citizen using technology.
We will see healthcare providers do the same - adopt technological solutions to streamline processes
such as setting up virtual appointments with doctors or looking up lab results online.
Healthcare is the last of the major supply driven industries. It will not be so for long. It will be the
citizen that demands the transition to an industry that answers their needs, fears and aspirations.
Informed patients and the rise of social media
Patients are becoming more and more involved in their healthcare, with a higher stake in the journey
than before.
Patients are simply better informed than ever before. Information about medical conditions and
treatments are now easily available on the Internet. This has to some extent, shifted the focus of
the patient-provider relationship towards the patient. The advent of social media is also driving
healthcare interactions in new ways. Patients are exploiting these resources to discuss treatments,
procedures and even individual practitioners. Alongside, healthcare practitioners, agencies and
charities too will need to use social media to communicate with their citizens; in times of crisis this
will become a critical mechanism.
What this means is that healthcare agencies need to have a clear strategy to take full advantage of
social media.
Patients exercising choice
Healthcare systems are under close scrutiny by society. With patients having a bigger say in what
they choose and demand for, government policy is impacted and in turn, healthcare providers.
Healthcare needs to become demand-driven to satisfy the needs of citizens and governments.
Patients increasingly want to decide how and when to engage with their healthcare environment.
Governments, health authorities and the medical profession will be challenged to provide
patients with the information and services that will allow citizens to make informed choices about
their healthcare. This will mean publishing data on indicators of quality (such as outcome data,
readmission rates, so on) and also introducing ways for patients to book appointments at hospitals
at times that suit the patient, not the provider.

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Patient-centred medical home
Episodic, disease-oriented care in hospitals is not the most effective or efficient way to deliver care.
The advent of the patient-centred medical home (PCMH) acknowledges this reality. It promotes
care relationships across a spectrum of providers and in a variety of locations, of which the one
that is most attractive to the patient is their home. This approach encourages patients to become
stakeholders in their care. The care delivery system will be designed so that it fully exploits
information technology, helps coordinate care across the community and monitor the patient’s
conditions, and supports patient awareness.
It is the advances in IT to support real-time monitoring that will make PCMH the norm, the standard
clinical practice. Hospitals will be able to discharge patients earlier, because they know that the
patient’s condition can be continuously assessed, and interventions can take place to ensure acuity
is addressed outside of the hospital environment.
Hospitals as networks
Building hospitals without walls; care for patients without borders
Increasingly, hospitals are part of their communities, and all communities are facing the demographic
and disease challenge, as described earlier. Hospitals may have to implement complex, multi-
organisational processes to address these challenges in an efficient and effective manner. A shift in
paradigm is called for that will mean large, tertiary hospitals building networks of smaller hospitals
and primary care clinics. Care can then be divested to these networks, made available closer to the
patient’s home and therefore more convenient. This model will require coordination of all providers in
the network and flow of information to continually manage the care of a patient through time.
Personalised medicine
The practice of medicine has always been based on evidence uncovered through observation.
And today, clinicians are at an advantage. There’s a host of diagnostic techniques available that
allows them to make faster and more accurate diagnoses. Radiology allows clinicians to investigate
structures deep within the body, whilst histopathology allows clinicians to investigate tissue samples
using microscopes to identify tumours, viruses and so on.
Translational research and the advent of personalised medicine
Increasingly however, core science is providing new insights for the clinical community, particularly
in the field of genetics. Translational research is about how fundamental scientific research benefits
patient outcomes, either through the development of new diagnostic techniques, new drugs, or the
modification of clinical practice, the latter often referred to as the Bench to Bedside cycle. To stress
the importance of this field, the National Institutes of Health in the United States has established the
National Centre for Advancing Translational Sciences (NCATS). According to their website, the action
was made possible by Congress’ approval of a fiscal year 2012 spending bill and the president’s
signing of the bill, which includes the establishment of NCATS with a budget of US$575 million.
Similar initiatives are underway throughout Europe and Asia Pacific.
Genetic sequencing offers immense potential for improvements in healthcare. Understanding the
molecular composition of each citizen allows clinicians to profile patients for active but undiagnosed
diseases. Clinicians will also be in a good position to assess a citizen’s disposition to disease in the
future, and to devise care plans to ensure the patient’s wellbeing is addressed in the most direct
manner. This concept of personalised medicine will allow society to move away from treating
disease in a ‘one size fits all’ manner. And move to targeted and accurate strategies that will reduce
unpleasant side effects and improve health outcomes.

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Logica can help
Governments and healthcare organisations need partners who can help them understand how
our healthcare landscape is changing, and how to make the most of the emerging trends and
technologies. Logica knows European healthcare like no one else. We bring our experience and
expertise, and those of our partners, to help our clients.
Here are some of our innovative IT solutions for healthcare in Europe:
• e-CareLogic: approach to information aggregation and portals, supporting clinical
processes and patient management across multiple locations by releasing and re-using
existing information both for patient care and for organisational management.
• eHealthbox: supports patient care through a combination of electronic patient records,
telemonitoring and a joint care process between the patient and the clinician.
• Defence Medical Information Capability Programme (DMICP): a global health technology
project linking 450 fixed and mobile clinic locations with a real-time centralised electronic
patient record for 300,000 military and government employees and their families.
• Logica I Can Help: a smartphone application where health professionals register skills and
availability to a register that can be accessed by emergency services seeking specialist or
geographic availability.
• Logica’s Machine2Machine (M2M) platform is the realisation of ‘The Internet of Things’,
where any ‘thing’ being a machine, device, even a plant or a person who will communicate
to another ‘thing’ regarding its current status over any available connection. The available
connection can be wired, wireless, mobile or any combination. A SIM card or mobile data
connection is, therefore, not a prerequisite for transporting status information. Logica
runs two of the three world’s biggest M2M platforms, and we believe this could be
transformational for healthcare.

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