TUE Peter de With

Peter de With is a professor of video content analysis at Eindhoven University of Technology.

22 December 2021

Many innovations not only improve healthcare, but they also increase already exploding healthcare costs. We should carefully think about which innovations we should focus on.

After the first waves of the Covid-19 pandemic, the Dutch healthcare system could finally relax a little during summer. But after the government relaxed the rules and behavioral guidelines, the pandemic came back with a vengeance. And now, we’re stuck with the newest update: the omikron virus.

During this entire period, I was increasingly participating in drafting a proposal for a national healthcare improvement program in the coming decade. That proposal has been submitted by now, and those involved are now reflecting on the contents and thinking about possible improvements.

Like in many other countries, the costs of running the Dutch healthcare system are rapidly rising. The Ministry of Health, Welfare and Sport has the largest budget, in the order of 100 billion euros, and it’s growing due to the costs associated with vaccination and Covid treatments.

Yet, our system also has some uniquely Dutch characteristics. Health insurance companies exert cost control and, together with the government, have tuned the system in such a way that there’s no redundancy left for all standardized practices and treatments. The result is that our system has much fewer intensive care units than anywhere else in the developed countries.

Additionally, we have a highly diversified healthcare network of intermediate-layer working medical professionals, everyone tuned to the lowest cost while still offering good quality. This has created a system that’s so diversified and specialized that it lacks flexibility for large operations like pandemic healthcare. Right now, we need simple uniform rules and statements and swift responses, but our healthcare system is unable to do this. Still, we keep ending up in the top-performing lists, due to our dedicated professionals and the flexibility on the working floor. Hats off to these great people!

This leaves us with several fundamental questions. Where do we go from here? Is the current healthcare system suited for the upcoming wave of elderly people? Can technology help here or should we stay away from expensive innovations? Doctors and medical experts always point out to me that technology has only made healthcare more expensive. Technology can help, certainly, but we should use it cleverly. Let us deploy technology where it will give clear gains.

I’ve been in hospital regularly over the past two years because a relative was being treated. This enabled me to make a few observations. Intensive treatment requires multiple appointments and careful planning. Appointment-making requires a relatively large overhead, while treatment actions can be quite simple. If departments would consider the whole process, they could organize it differently.

The same holds for collaboration between the basic pillars of the healthcare system: the general practitioners, the regional care centers and the academic hospitals. The borders between those pillars are substantial and good information exchange is scarce because ICT systems are largely incompatible. The healthcare system should try to learn from how other large organizations improve their efficiency: a more uniform approach of interaction and data exchange.

Standardization of information exchange and protocols should become more uniform and satisfy national – if not European – standardization agreements. Finland has standardized healthcare data exchange at a national level and uniformized ICT, saving about 15 percent annually on ICT costs.

Another aspect is that our government asked us to make a profit out of the national project and boost our GDP through export. One wonders whether this is an ethical question. This demand probably boosts innovation because the project needs to come up with unique new solutions, but at the same time, it will very likely make our healthcare system more expensive, too. Given our demographics, it might make more sense to make choices about what treatments to offer to the elderly.

Can’t we do both at the same time? I remain optimistic and suggest that we can when we look back in the history of healthcare and think over a longer time. If initial investments are being made, it has always been the case that enthusiastic entrepreneurs and spinoff companies have been able to develop better solutions that were less complex and better applicable to humans. A recent example is ultrasound imaging, which in many cases can replace more complex imaging that relies on radiation. Similarly, it should be possible in the longer term to establish more of such innovations, provided that we have the correct focus for the work.

Secondly, we need to further strengthen the ecosystem for such healthcare innovations. Otherwise, we lose development speed, causing the valuable contributions to our economy and healthcare systems to be lost. This implies that we need more tech companies in healthcare in the Netherlands.