ESG (environment, social and corporate governance) climate change and health equity: Unequivocal evidence links physical and mental health with climate change, highlighting the crucial role of all stakeholders in the health ecosystem.27 Evolving regulatory standards and compliance requirements mandate organisations to mitigate ESG risks and demonstrate actionable diversity, equity and inclusion (DEI) policies. This also entails stakeholders taking greater accountability for minimising their adverse environmental and social impacts while enhancing the health and well-being of employees, their families and the communities they operate in. There are also internal pressures from employees and investors, to integrate DEI commitments and climate change mitigation into business strategies and investment decisions and external pressures to promote equitable access and outcomes.28 The swiftness with which health ecosystem stakeholders respond will expedite the journey towards the future of health.
Sustainability of the healthcare workforce: Most European countries face growing shortages of HCPs leading to reduced hands-on care, declining staff morale and lower productivity. Despite the varying scales of the challenge for individual nations, common concerns include the costs and quality implications of maintaining safe staffing levels and recruitment and retention hurdles. In 2020, Europe had an estimated shortfall of 1 million HCPs, a situation worsened by the pandemic and aggravated by a ‘brain drain‘ of medical professionals seeking better working conditions and pay.29 Furthermore, HCP availability varies significantly across countries (a three-fold difference in the number of practising nurses per 1,000 people and a two-fold difference in number of practising doctors per 1,000 people).30 Moreover, 40 per cent of medical doctors are aged over 55 years in 13 of the 44 reporting countries.31 This scenario necessitates bold, innovative long-term strategies in workforce planning, recruitment, skills development and flexible working arrangements.32 Digital transformation and AI adoption will augment HCP skills and improve healthcare delivery productivity.33 Re-envisioning the future of work – identifying automatable tasks, defining roles and determining work locations – will be crucial for advancing towards the future of health.
How individual drivers could affect the pace of transformation
As in figure 4, there are nine drivers that will influence progress toward the future of health. Five of these drivers –consumerisation; interoperable data and data sharing; continued innovation, including AI; and networks and ecosystems – are unstoppable although the pace of transformation may vary from country to country. The other four drivers, however, will need more affirmative action or risk-decelerating progress.
Drivers that accelerate progress towards the future
Consumerisation: Increased awareness among European citizens regarding service quality and access and how this compares to other countries is amplifying the push for more equitable healthcare services. The pandemic also showcased the benefits of data sharing, digitalisation and embracing scientific and technological innovation. This is paving the way for healthcare’s cultural, digital and economic transformation – a trend likely to continue irrespective of policy changes or individual stakeholder actions.
Interoperable data and data sharing: Despite their essential role in the future of health, progress in these actions has been slow due to varying levels of digital literacy, the digital maturity gap among Europe’s health systems and regulations like the General Data Protection Regulation (GDPR).34 However, Deloitte’s 2020 research found that most countries had established digital transformation strategies to address interoperability and health data sharing.35 For example, the EC’s 2030 Digital Compass and the European Health Data Space (EHDS) aim to bridge these gaps by promoting digital transformation and securing health data sharing across Europe. Coupled with national efforts from countries like France, Italy, the Netherlands and the UK. Moreover, interoperability standards like the Fast Healthcare Interoperability Resources (FHIR) are expected to be adopted by 2024, which will speed up the transition towards new care models. The EC also expects every citizen to be able to access their medical records, strengthen their control over their own health data and secure the use of health data for innovation, policymaking and research.36 Eighty per cent of EU citizens aged 16 to 74 are expected to have at least basic digital skills by 2030 and all citizens to have online access to their health records.37
Continued innovation: The speed of scientific and technological innovation, especially during the pandemic, has expedited opportunities to enhance healthcare outcomes, albeit at a high cost. As citizens become more tech-savvy, demand for such innovations will only grow, with consumer health and technology disrupters stepping in to fill unmet needs. The evolution of AI-enabled healthcare technologies holds the potential to transform healthcare delivery across the spectrum – from streamlining back-office operations and medical imaging to expediting drug discovery and clinical trials.38 Advanced AI, particularly, generative AI, aligned with emerging data standards and regulations, is poised to significantly impact all aspects of healthcare by improving operational efficiency and enhancing personalised experiences for patients, resolving data interoperability issues, expediting the realisation of 5P medicine and bolstering digital and data capabilities.39
Existing networks will expand, propelled by collaborative ways of working that intensified during the pandemic , leading to a surge in strong research partnerships and innovation hubs that foster best practice sharing. Multiple types of trusted partnerships between industry, academia and providers, with shared views on value exchange, backed by a creative and reputable financial services sector and government initiatives, will create optimal conditions for the development of new business models, delivering improvements across the health ecosystem.
Potential obstacles to progress
Promoting institutional trust: Institutional trust and a well-understood social compact are pivotal for realising the future of health. Trust significantly shapes healthy behaviours, including encouraging individuals and their families to become vaccinated, have regular check-ups and embrace healthy lifestyles.40 Trust also influences people’s participation in preventive screening and crucial health services. However, trust levels vary markedly, as highlighted by a 2022 European survey, which revealed that trust in their healthcare systems to provide the best available treatments ranged from 91 per cent in Portugal to a mere 10 per cent in Hungary.41 Notably, people who experience discrimination due to factors like age, ethnicity, gender or socioeconomic status tend to have more negative health outcomes and trust their system less. Addressing this requires stakeholders to enhance transparency and adopt responsible policies geared to mitigate social and economic inequities, thereby fostering more trusted relationships with citizens.
Encouraging behavioural change: Altering individuals’ behaviours towards healthier lifestyles is challenging. Despite abundant evidence that investment in prevention is fundamental to a resilient and sustainable health system, spending on prevention through the various country-level financing schemes (whether government schemes, SHI or PHI) remains remarkably low, averaging less than three per cent of total spending by all healthcare players.42 Consequently, a growing socio-economic divide in health behaviours exists across most European countries; individuals in higher socio-economic groups tend to have better health literacy and invest more of their own money in improving their health, while those in lower brackets often have less health literacy, engage in unhealthier lifestyles and have fewer resources for improving their well-being. Addressing this disparity extends beyond isolated measures like sugar taxes and public smoking fines; it requires comprehensive cross-government actions, incentives, taxes and regulations to ‘nudge’ people to make better choices. Moreover, peer groups, local communities, employers and charities are integral to improving public health within local communities.43
Advancing platforms and hyper-competition: Platform-based, technology-enabled interactions between citizens and health stakeholders will accelerate the future of health. Currently, industry stakeholders compete for siloed sections of the care pathway, but disrupters and technology are prompting payers and citizens’ demands for price transparency and wellness-focused end-to-end clinical pathways. Many health technology innovators are developing platform-based business models to meet these expectations, which will eventually draw all stakeholders together to provide a seamless end-to-end care pathway. Such models can enhance and broaden service offerings by leveraging the wider digital network to co-create goods and services, improving choice. As healthcare products diversify, no single organisation can dominate the full spectrum of care, making the platform business model attractive for producing comparable outcomes with lower capital costs.44 These models facilitate information sharing and goods and services exchange among ecosystem players, competing based on consumer experience. The adoption rate of these platforms will significantly influence the pace at which the future of health is realised.
Transforming from sick care to holistic well-being: Europe’s prevailing reactive sick care model has historically overshadowed holistic well-being approaches. Despite numerous policies aimed at improving service integration, transitioning care outside of hospitals and emphasising prevention and primary care, the shift from acute hospital-centred treatments has been slow. Transitioning the model necessitates challenging entrenched attitudes, although research shows it benefits population health and cost-effectiveness. Achieving this transition requires committed leaders to overcome resistance from stakeholders comfortable with the status quo and foster a collaborative environment focused on quality improvement, safety and effective communication strategies and to design services around the needs of individuals. New funding models are imperative to support these changes. History indicates that such transitions are challenging, time-consuming and require a change management approach. Crucial investments in primary care, public health-led integrated systems, a healthcare workforce proficient in AI, digital and genomics skills, and the advancement of digitally mature, interoperable data systems are essential for success.