megatrends

Health Care Foresight

Identifying megatrends
Futures insights by Deloitte in collaboration with Professor
Sohail Inayatullah and Dr Luke van der Laan
 Health Care Foresight

Introduction
Health care futures are typified by a convergence of
drivers or megatrends that are rapidly shaping health
care futures. Megatrends are defined as the great
forces in human and technology development that
affect the future in all areas of human activity, in a
horizon of ten to fifteen years1. We should also
recognise that none of these drivers and megatrends
in and of themselves will shape a foreseeable future.
Rather, it is suggested that a convergence of drivers,
needs and wants both in and outside of health care
will result in health care futures that are
discontinuous with current trajectories. There is a
significant increase in the scope of possibilities for
health care futures – health care provision is no
longer linear and continuous, predictable or immune
from disruptive change.

1. Naisbitt, J. and Aburdene, P., 1991. Megatrends 2000—Ten Directions for the 1990s. Megatrends
2000: Ten Directions for the 1990s.

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Health Care Foresight

Discontinuity
Predictions were based on
continuity from the past. With
incoming disruptions, discontinuity
will be the new normal.

Politics Demographic Shifts

Traditional policy and regulation making Key Climate change, urbanisation, increased
chronic care, changing substance use &

Megatrends
will no longer work as we move into
value-based care. Policy makers must global paramedics such as viral illness &
drive accountability from all parties, mental health decline are key shifts in
providers, public and private. today’s world.

Universal or Non-Universal Digitalised Futures:

Provision of Health care Technology & Health care
Universal health care as a system is Innovation
financially unsustainable. The trend is to Soft changes such as the move towards
move into more privatised systems, a inner technologies are increasing. “Open
commodification of health care. Health” or peer-to-peer health enables
sharing of knowledge with innovation as
critical shift.

Globalised Industries
+ Commodification
A new era has emerged where
democratisation of health, education,
science and arts is disrupting
dominant models of private
enterprise and government.

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 Health Care Foresight

Continuity / Discontinuity
For a desirable future to be achieved in The business or evidence-based cases
health and well-being, possible futures demanded by decision makers cannot
need to be imagined. Probabilities are be projected as no previous pattern
easy to identify as they are largely the (or evidence) of the change exists.
product of the extension of the present Health care change is not immune.
and patterns of the past – past data. Indeed it is highly likely that a
They are a continuation of current convergence of trends will create
phenomena whereas discontinuous discontinuous and abrupt changes in
phenomena have no pattern in the past health care systems, no matter how
and are much harder to imagine. If flux advanced or rudimentary. The response,
and rapid change suggest that due to the paradox, is likely to be
discontinuous change is likely, then the reactive and costly.
future is currently not in the realm of
probability and needs to be created. The continuity and discontinuity of
Miller2 echoes this logic and illustrates phenomena in health care play a
that discontinuity differs in nature. Some significant role in determining futures.
hold great opportunity, some are This is achieved through human sensing
incremental, some pose great threats and imagination or said differently the
and some are unknowable. human capability to anticipate what
does not exist yet. Unfortunately, recent
It is the lack of knowing or having research illustrates that the systems and
evidence that is the source of inaction in processes within which such sensing
policy and decision-making. Information should take place, empirically suppress
overload and the dependence on the ideation of new solutions5. Financial
continuity paralyse efforts toward taking austerity also kills innovation and the
proactive action3. Almost without ability to anticipate risk6. To a large
exception, the lack of an evidence-based extent, health care futures are highly
case in modern decision-making dependent on government policies and
inevitably leads to a instant dismissal of regulations. Unfortunately the
proposed change and action. Therein government processes and systems that
lies the paradox of the future as outlined develop policies are typified by financial
by Deloitte, where decision makers austerity and being in systems that avoid
support investments and policies based political risk. The likelihood of
on continuous, linear patterns of change re-imagined health and well-being policy
while recognising that change is likely to and futures is not optimistic.
be discontinuous. Successful companies
often fail to develop new disruptive 2. Miller, R (2015) Learning, the Future, and Complexity. An Essay on the Emergence of Futures
technologies due to the dilemma of Literacy European Journal of Education, Vol. 50, No. 4,
meeting the current needs of its
3. Gelatt, H.B., 1993. Future sense: Creating the future. The Futurist, 27(5), p.9.
consumers and their future demands4.
4. Thrasyvoulou, X. (n.d.). Understanding the Innovator’s Dilemma. Retrieved from http://ww-
w.wired.com/insights/2014/12/understanding-the-innovators-dilemma/

5. Van der Laan, L. and Yap, J., 2015. Foresight & Strategy in the Asia Pacific Region: Practice and
Theory to Build Enterprises of the Future. Springer.; König, Michael, Sedlatschek, Elisabeth, Wallner,
Natalie. 2014. Strategic Foresight. Oder: Hic sunt dracones!. CFO aktuell – Zeitschrift für Finance &
Controlling (4): 139-141

6. Johnson, M. W., Christensen, C. M., & Kagermann, H. (2008). Reinventing your business model.
Harvard business review, 86(12), 57-68.

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Health Care Foresight

Policy
Policies that shape health care are including parts of the systems this realisation, we still have health care
typically conservative especially in terms traditionally located outside of the systems and governments paralysed by
of traditional models of funding, primary system is crucial in understanding old ways of thinking and are seemingly
health care provision and clinical futures. Bearing in mind that unable to renew themselves. To create
practice. Generally, national policies collaborative co-creation of value is the such a systemic shift, four levels of
related to health care follow the same currency of the 21st century where change are required (e.g. required, as
patterns and principles globally and systems co-create new frameworks and shown below.)
according to the relative wealth of value, the traditional ‘closed system’ of
nations. They look much alike. Indeed health is perilously close to becoming These four layers represent different
health care has been described as less relevant to the needs of society. The types of reality. Many attempts at
predominantly reactive and provider future of health care depends on a change only focus on systemic shifts
oriented7. Providers, governments, large different way of thinking to chart the without transforming the worldview,
corporations, insurance companies, future than the thinking that has caused culture and core narratives that sustain
hospitals and the clinical caregivers the problem, to coin Einstein’s famous the system, and thus, the problems
themselves all seem constrained by the outlook on wicked problems. Yet despite paradoxically strengthen. Stories are, in
dogma originating from attitudes and effect, bottom-up.
practices from the last century. Yet, the
nature of health care is shifting
dramatically away from these patterns of A shift from measuring
the past and there is considerable illness to measuring
pressure from societies worldwide for prevention and wellness
providers, public and private, to become
more accountable, relevant and
responsive while providing greater and
more equitable access to health care
and well-being.
A systemic organisation
shift in terms of nature of
The response to this pressure varies but
health care, e.g. shift from
is generally subjected to neoliberal
hospital to home care
measures of costing, large corporate
interests, traditional clinical practice
models and the linear development of A shift in the deep culture
national policy. Measures of health care of the worldview of the
performance include an index health system
measuring access to health care, health
care integration and adoption of new
technologies and innovations8. It is
argued that while these measures are
helpful, they still reflect a linear A shift in the deep metaphor or
incremental approach to health care. story of health care, e.g. from
What is missing from policy ‘doctors know best’ to ‘I am the
development is a bottom-up systemic expert of my body’ 9
re-design. A systematic approach

7. http://www.iftf.org/fileadmin/user_upload/downloads/hh/Report_U.S.Analysis_of_FutureHealthIndex.pdf
8. http://www.iftf.org/fileadmin/user_upload/downloads/hh/Health_Horizons_Research_Agenda_2016_Global_Health_Economy.pdf
9. http://www.altfutures.org/projects/primary-care-2025/. Accessed 2 July 2016.

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 Health Care Foresight

For example, when asked about the Universal or non-universal provision the barriers to coordination of health
futures for hospitals, a workshop with of primary health care care systems (bureaucracy, insurance
Aboriginal peoples in Australia Universal health coverage (UHC) is still companies, cost, government regulation)
suggested that current hospital hours the most prominent health care all in some way corroborate a conclusion
are focused on the Western model. That aspiration across nations despite its that moving away from a universal
is, they are based on the individual. variable quality of service when health care system by governments
Space is not designed for communities implemented. Universal health coverage points to an irreversible mistake,
and thus, only a few visitors are allowed. is described by the World Health spiralling health costs and inequality.
This may make sense for those with Organisation (WHO) as a system Given that health equity is positively
small Western networks of friends but providing health care to citizens without correlated with higher productivity12,
for Aboriginal communities with far incurring financial hardship. Often the this is not just an ethical issue but an
broader network ties, hospital visiting type of services are defined as those of economic one.
requires space for many to visit. This Primary Health Care (PHC). The funding
requires hospital redesign with certain models vary from taxation-based high More so than economic considerations,
flexibility. Given the correlation between government involvement to privately the principal enabler of effective and
health, well-being and strong funded compulsory insurance health efficient health care delivery is good
friendships10, rethinking the hospital is services. Even though the models vary, governance. The notion that only
crucial. they are all impacted by governmental commodified goods and services can be
policies and regulations aimed at delivered efficiently and effectively is an
However, the strength of future increasing access to health care at economics myth. Sound governance in
approaches is exploring alternative minimum standards. Increasingly, these the public sector is possible. Matters of
solutions by questioning assumptions, heavily-regulated systems are being health, education and other universal
for example, with new technologies labelled by governments as rights, privatisation and the arguments
such as apps, wearables, and smart unsustainable. that promote it are misplaced. That said,
floors that enable one to heal from hybrid models of joint public / private
hospital homes and health hub. The Despite the higher cost per capita of service delivery have been found to
necessity of hospitalisation can then be non-universal health care systems as provide meaningful solutions in the
questioned. Pragmatically, it is evidenced by the OECD, governments provision of primary health services.
recognised that only when these new are suggesting moving toward more
models are accepted in the mainstream privatised systems. In developing nations
and enabled by policy, will necessary where universal health coverage is
transformations take place. However, it deemed unaffordable, the push by
is more likely that policy will not lead private interests is most apparent. That
practice, but rather that innovations will said, the example of the United States
disrupt current systems. which also illustrated higher growth
rates in health spending evidences that
non-universal health care systems lead
to a) higher costs per capita, b) high
growth of costs, c) only marginally less
government spending as a percentage
of GDP, and most disconcertingly d)
lower access and equity to health care
provision11. In addition to this evidence,

10. http://www.health.harvard.edu/newsletter_article/the-health-benefits-of-strong-relationships. Accessed 1 July 2016.

11. OECD Health Statistics 2015
12. http://www.health-inequalities.eu/HEALTHEQUITY/EN/about_hi/marmot_reviews/. Accessed 1 July 2016.

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Health Care Foresight

The ethics Not only is it an imperative that

governments need to ‘get it right’ they
Globalised industries &
Commodification

underpinning the have to ‘do the right thing’. An

increasingly seductive neoliberal
Global industries have traditionally
illustrated the highest rate of investment

provision of a assumption is that the provision of basic

health services can only be delivered
in research and development (R&D) as a
business imperative. The impact of
universal effectively and efficiently if commodified
and privatised. This increasing trend
globalisation in this regard has had a
significant impact on how health care
health care system toward the commodification of
health care across all aspects of
has developed in the last fifty years.
Their growth and development into
is compelling and provision, innovation, education and highly competitive, influential and
technological enablement is of concern sophisticated conglomerates are clearly
many argue, as it suggests that the universal evidenced. In many respect, large
provision of health care is threatened by pharmaceutical, technological, private
futures-smart. proprietary interests and would result in health care and insurance industries
declining access and equity. have had unprecedented influence over
the sovereign powers of national
The link between economic inequality governments, often influencing their
and health has already been evidenced models of PHC and UHC. The effects
by the US Bureau of Economic have largely been both good for
Research13 and further underpins the consumers and the profitability of the
ethical argument that moving away from enterprise. However, the influence of
universal health care would result in global corporates in funding lobbying
further inequality and discrimination - a groups and even being associated with
world where the wealthy are healthy. unethical practices in the development
Further inequality is simply untenable in of policy has not been isolated. The
the long term. It would have a effects on health care systems therefore
destabilising effect globally and have been proprietary and based on the
numerous local second order impacts commodification of health.
which would disrupt the income and
social security of wealth creation. Thus, it However, for some insurers, moving to
is in the long run interest of the wealthy the prevention paradigm is not only
to support or even subsidise global good for society, it can be good for the
health equity. bottom-line. For example, in one future
scenario, the global health insurer
moves its strategy from a reactive view -
pay for illness - to a proactive view - help
the citizen imagine how their life could
be better if they were healthier. This
meant changing their narrative about
consumers from "we cover your health
insurance," to "we create the healthier
you."

13. Deaton, A (2003) Health, Income, and Inequality, NBER http://www.nber.org/reporter/spring03/health.html

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 Health Care Foresight

While some initial costs are higher - for channels. In order to harness the Digitalised futures: technology and
example providing free dieticians in new potential of this increased productivity in health care innovation
campaigns and lobbying government to the sciences and technology, the efforts There has been an exponential increase
change legislation favouring citizens to of governments and commerce must in health care innovations. This is
take charge of their health - over the combine to achieve what has been generally good news for society as the
long run, their costs will drop as the evidenced as an increase in majority of innovations are designed to
insurance costs associated with illness investment14. enhance quality of life, fight disease and
are reduced. Thus, it is to the benefit of promote well-being. The more
all - the insurer, the consumer, the There are reasons why the Global concerning view is that most health care
government - to "place a fence at the Financial Crisis (GFC) and many more innovations emerge out of privately
top of the hill" rather than the examples of disruption have been funded research and development and
"ambulance at the bottom." discontinuous and where economists as such, are subjected to expected
have failed to identify the risks, they financial returns. In most cases, the
However, while there are examples of were able to identify and develop intellectual property (IP) is safeguarded
individual corporate foresight individual risk assessments but not risk by legislations prescribing IP rights for
challenging traditional views, overall to the overall system. Of course, at a limited periods. Until these periods are
health care commodification is part of deeper level, the same economic exhausted, the health care innovations
the long-term process of economic rationale no longer applies. This is an are usually expensive and not included
rationalisation that had its greatest important consideration in the in primary health care treatments. Yet,
impetus in the late 19th and most of the remodelling. Along with “breaking patents” in the name of
20th century. As numerous commodification15, the GFC resulted providing access to new drugs affordably
commentators have suggested, a new from other macro waves of change - the negates the effort and investment in
era has emerged where the shift in the world economy to East Asia, R&D.
democratisation of health, education, with greater rates of saving;
science, arts and even politics is disintermediation leading to the decline The UNESCO Global Science report16
relentlessly disrupting these dominant of the middle man; and a focus on confirms that there is a strong trend
models of private enterprise and increasing debt instead of looking for toward increased global capacity in
government. As such, to incrementally systemic solutions to inequity. Similar to scientific research and several
build on the logic of the last century the current health care industry, the middle-income economies have seen
would make current wicked problems in disruptions of health care are largely significant increases in scientific
health even more wicked. resulted from macro changes such as capabilities and innovation in health. As
the shift to the health care wellness, the an example, Brazil, China, India, Iran and
Knowledge creation in health cannot be emergence of Asean Economic Malaysia are increasingly recognised as
contained. It is driven by need and the Community (AEC), and the shift of power hubs for nanotechnology. In addition to
efforts of an increasingly resourceful in the health care stakeholders. the localisation of expertise, these are
science and technology global talent. often typified by open international
Despite the exponentially increased level knowledge sharing and collaboration
of scientific production and cross-border through open educational channels. The
collaboration, patenting remains expanding global co-creation of value,
dominated by a minority of countries. innovation and new technologies
This is unlikely to continue as health increasingly know no borders and
research and innovation continue to challenge traditional IP parameters.
expand beyond traditional proprietary

14. UNESCO Science report: toward 2030 http://en.unesco.org/unesco_science_report

15. p.450 in Bakker, K., 2007. The “commons” versus the “commodity”: Alter‐globalization, anti‐privatization and the human right to water in the global south.
Antipode, 39(3), pp.430-455.
16. Neupane, B. (2015). A more developmental approach to science. UNESCO science report: towards 2030, 6.

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Health Care Foresight

Trends in technological innovations, the But, it has the potential to transform the
internet of things, blockchain futures, model of health care provision and
hardware innovations, neurotechnologies, strongly influence future health care
nanotechnology, nanomaterials, food systems while relieving governments of
printing, synthetic biology, additive some financial pressures or allowing
manufacturing and a host of other them to re-allocate funding to emerging
technology-related developments are technologies.
increasingly capturing most observers’
attention17. There is a rapidly growing
number of health care innovations on the
horizon that both excite and concern
r egu la r
policy-makers. Chief amongst these are
genome editing and transhuman
enhancements and the ethical
MEDITATORS
exper ien ce
perspectives adopted in proceeding with
research and
development. 87% decrease in heart disease

As important as hard technological

innovations and health care 2.0 are, soft 55.4% decrease in tumours
changes such as the move toward inner
technologies which enhance well-being
and increase resource efficiency are 50.2% decrease in hospitalisation
exponentially increasing. Yoga and
meditation are the most prominent of
these (as shown in the infographic on the 43% decrease in hospital resources used
right)18-20.

Open health, much like the surge of open

education, open science, crowdfunding
30.6% decrease in mental disorders
and open innovation, is of significant
social value. Promoting models that
encourage open health systems,
30.4% decrease in infectious diseases
peer-to-peer health, community-based
health and the sharing of knowledge and
innovation for the public good is a critical
shift in relieving the pressure on health
care provision. It cannot exist in isolation;
much like open education cannot exist
outside the formal educational structures
of society.

17. OECD Horizon scan of megatrends and technology

http://ufm.dk/en/publications/2016/files/an-oecd-horizon-scan-of-megatrends-and-technology-trends-in-the-context-of-future-research-policy.pdf
18. Lazar, S.W. (2005Meditation experience is associated with increased cortical thickness, Neuroreport 16 (17),1897.
19. http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0140212. Accessed 1 July 2016.
20. http://www.huffingtonpost.com/entry/yoga-meditation-health-care-costs-study_us_562fa500e4b06317990f8754?ncid=fcbklnkushpmg00000063.
Accessed 1 July 2016.

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 Health Care Foresight

Demographic shifts likely increase in demands for accessible

Unprecedented demographic shifts services and what consumers are
related to health and well-being are prepared to pay for. If government and
taking place globally. These include the city authorities fail to provide accessible
much researched and increasingly health services, it is likely that the
understood notion and impact of majority of citizens will experience
population ageing. Less understood, and repeated health pandemics in addition
even sometimes overlooked, are the to increased untreated chronic health
demographic shifts due to climate issues. It is likely that this will not only
change, urbanisation, human mobility, impact negatively on the economy, but
migration, increased chronic care, also lead to civil unrest.
changing substance use and global
pandemics such as viral illnesses and
mental health decline.

Health futures are largely influenced by Cities can lead in health as well. For example, it has been argued following
population demands and as such the case below21:
demographics are influential
determinants of model redesign. If a With increasing scientific evidence that city design directly impacts our life
rethinking of health care and well-being changes and our long term health, city planners are redesigning for health. City
is required ‘from the bottom-up’, it design improvements include creating greener and more bio-diverse spaces to
would suggest closely monitoring, enhance psychological health – for instance, bringing in light rail to reduce
authentically engaging and collaborating congestion (time spent in traffic directly relates to heart disease), changing zoning
with stakeholders in each demographic to reduce pollution (in polluted areas fetus size drops) and rethinking population
group. Alternatives to traditional care density zoning. Enhancing green spaces can also reduce drought as there is
models are required, such as chronic considerable evidence that the suburban/strip mall model of development blocks
disease management through billions of gallons of rainwater from seeping through the soil to replenish ground
community-based collaborative care water. Rethinking city design can greatly reduce costs over the long term. Building
models. Genome technology will also design is part of this revolution, creating cradle to cradle buildings with zero
strongly influence population-based emissions where there is no-away to throw things. Energy self-reliant buildings
approaches to care delivery. are on the cards. Green buildings, while costing more initially, enhance
productivity. Productivity gains are estimated at 16% and USD160 billion.
It is estimated that 66% of the world’s
population will live in cities by 2025.
These cities will range on the spectrum
of economic wealth from being
prosperous to being very poor. This
presents a range of different health
issues and provision models.
Irrespective of economic status, these
highly urbanised, information-rich
residents will illustrate a growth of high
consumer expectations. There will be a

21. Inayatullah, S. (2009). Creating the prevention prama society. The Health Advocate. Issue 2, December, 24–27

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Health Care Foresight

In contrast to these potentially positive Global inequality in health continues to

trends, the convergence of demographic broaden. While significant progress has
shifts may not be as closely anticipated been made to economically improve
and therefore does not form part of the middle income populations in many
future model design yet. As urbanisation developing countries, the majority of
introduces greater stress and urban those at the lowest income levels
isolation, there are grave concerns seemingly remain in poverty. This
regarding the exponential increase in inequality is not only economic, but
mental health issues. The World Health extends to the poorest being
Organisation estimates that by the year increasingly vulnerable to disease. The
202022, if current trends for increase of pandemics that have not
demographic and epidemiological been anticipated and are
transition continue, the burden of under-researched is likely to have far
depression will increase to 5.7% of the greater impacts on the health of the
total burden of disease, becoming the poor but also on society generally.
second leading cause of
disability-adjusted life year (DALYs) lost. Communicable diseases, neurological
Worldwide, it will be second only to diseases and antibacterial resistance all
ischaemic heart disease for DALYs lost pose a risk to the poor but increasingly
for both sexes. In the developed regions, affect the whole global community.
depression will then be the highest Mental health and neurological diseases
ranking cause of burden of disease. This have largely been treated outside of the
has physiological impacts and when mostly physical pathologies of primary
converged with substance abuse and health care. Yet with dramatically
urbanisation, a whole new future increased technological enablement of
context is triggered. human productivity, faster pace of life,
information ubiquity and increased
Compounding these examples are the levels of stress, the incidence of mental
megatrends of growing inequality in health issues has increased into what
developed and developing nations. In may be, a much larger pandemic than
the OECD, poverty rates increased up anticipated. This may be ascribed in part
until 2010. Increased inequality will be by a much slower physiological
experienced by the populations in 86% adaptation than the pace at which
of developing nations. Many of these people have been enabled to function.
developing nations are regarded as While much is being researched and
‘fragile states’ and the threat of done about the shift toward chronic
geopolitical instability and security risks illnesses, mental health epidemics and
in countries spreading outside countries associated social and economic
is high23. consequences remain underestimated.

22. http://www.who.int/whr/2001/chapter2/en/index4.html. Accessed 1 July 2016.

23. OECD Horizon scan of megatrends and technology
http://ufm.dk/en/publications/2016/files/an-oecd-horizon-scan-of-megatrends-and-technology-trends-in-the-context-of-future-research-policy.pdf

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 Health Care Foresight

Health Care Foresight: What Works?

Are there possibilities of change, a shift to alternative futures?

“Prevention as a new health worldview stems Firstly, what is needed is a move toward
a prevention worldview. This not only
partly from a sage advice of the past – an apple a frees up capital for health equity policies
day keeps the doctor away, wash your hands, but enhances well-being.
and look both ways before crossing the street –
Secondly, it is not just prevention but
and from public health pressures that empowerment. This is manifested
understand that reckless individual behavior generally at the systemic level through
leads to overall cost increases for all.” 24 peer-to-peer health and the new
wearables that allow direct personalised
health information - the quantitative self.
This is moving from a narrative of the
"doctor will see you now" to "take charge

17000
In Australia of your health." There are certainly risks
Premature deaths
prevented with anti -smoking as with cyberchondria, but the notion is
public education and legislation that with flattening of expertise, the user

USD176m
can access different types of information
(expert, medical; peer-to-peer
Invested in tobacco
control delivered USD8.6 crowdsourced with a trip advisor of
billion in economic evaluation; personal and community
returns
anecdotal) with the medical system

27%
In India being the centre helping patients
Increase in deaths discover alternatives.
from chronic
disease from 40% in 1990 to
67% in 2020. In Australia, an example of a national

13%
policy of empowerment is the new
National Disability Insurance Scheme. In
Growth in cardiac-
related spending this new model, the person with
expected annually disability is at the centre of the scheme.

44m
He or she decides what care is funded.
In USA
This may consolidate the market for
People expected to have carers, putting small providers at risk. If
diabetes by 2034 if current
trends continue the metaphor was a food court, it could

USD336b
lead to larger restaurants taking over
In annual
and forcing smaller providers out of
, cost for health care business. However, a more apt analogy
triple the current
annual cost of USD113b is "room service" where new app based -
artificial intelligence (AI) - technologies
allow the person with disability to order
what he or she wants when he or she
wants it. This is an example of a bold

24. Inayatullah, S. (2009). Creating the prevention prama society. The Health Advocate. Issue 2, December, 24–27

11
Healthc Care Foresight

health policy initiative. Both sides of autonomy and the likelihood to connect
politics have approved it for different with others. In the final scenario,
reasons. Conservatives prefer this "Multi-door Health Centres" emerge,
market based model in that as where the general practitioners are the
efficiencies in the health care industry gatekeepers. He or she would offer
are likely to result. Progressives prefer different pathways - genomics or other
this model as it empowers the person. It advanced treatments or the door of
will also encourage innovation as meditation and diet change; or the door
providers will have to find more effective of moving to cities that were less
- person and cost-centred - ways to polluted. The doctor in this future
meet the needs of the client. becomes the trusted coach and advisor.

Thirdly, foresight work is not just about

empowering patients but other actors in
the health system, asking them their
alternative futures. In workshops with
general practitioners, for example, four
futures emerged. The first is "the Star
Trek Health" model where new
technologies allowed easy and early
diagnosis. Many general practitioners
would disappear as AI applications
would take over. The second was the
"Return to Values" scenario. In this
future, doctors would focus on
compassion and connection, using
placebo to create better health
outcomes. Patients come to them not
for informational purposes but for
communicative purposes. In the third
scenario, "Corporates Take Over," the
complexity of health changes are too
much for general practitioners. Running
their own "corner" health practice is too
cumbersome so they sell and work for
large health providers. This relieves
administrative pressure but reduces

12
 Health Care Foresight

Future Scenarios in Less-Developed

Countries
Foresight is not just for wealthy areas but can be used successfully in less-developed areas as well - what has been called ‘pro-poor
foresight’. In Bangladesh, Inayatullah's work with the Ministry of e-Health led to the four futures25. Participants in a three day workshop
included public health professionals, hospital directors, surgeons, local health application developers and others. We reproduced these
scenarios to illustrate how futures will work in poorer nations (refer to Table 1). Indeed, studies have emphasized the innate nature of
foresight, its accessibility to all and relatively minimal cost to develop or institutionalise26 foresight in organisations, government
departments and non-governmental institutions.

Leap-Frog 2025 Create new

decentralised
This scenario depicts an e-health e-health system
infrastructure developed from the Smart use of
technology
bottom up with the Ministry of

-UP
through low
Health and smart technology, Ministry of Health cost devices

TOM
Facilitator to ensure eg: medical
thereby leapfrogging the traditional integration & “apps”, bio
sensors

BOT
(modern-western) health system. interoperability

Industrial technologies

INSTITUTIONAL
E-Health Car/Bus Scenario ACTORS

This scenario focuses on the

relationships between the stakeholders
and the implementation of health care. OWNER
GOVERNMENT
The owner is the government, the
navigator is the health care system and Focuses on relationship
the driver is the Ministry. HEALTH CARE between institutional actors and
SYSTEM national health care system HEALTH CARE
SYSTEM
MINISTRY
NAVIGATOR DRIVER

Institutional actors include the director of

IMPLEMENTATION OF health services, the government, and the
HEALTH STRATEGY national health care system with its
numerous nodes

Rural & urban

patients

25. Sheraz, U., Inayatullah, S., Shah, A. (2013). Ehealth futures in Bangladesh. Foresight. Vol. 15, No. 3, 177-189.
26. Van der Laan, L. and Yap, J., 2015. Foresight & Strategy in the Asia Pacific Region: Practice and Theory to Build Enterprises of the Future. Springer.

13
Health Care Foresight

Employers

E-Health Party
This scenario highlights the
dynamics for ensuring the success
of the e-health system. Citizens in
this future are empowered with
financial sustainability and Employers give Public & private
information, promoting prevention wellness program partnership
Focuses on
as a worldview. political, and
social dynamics
of E-Health
system

Health care
consumers

Individuals incentives
+
Major actors/roles: donors,
insurance agencies,
- Less discrimination Enhance understanding of personal health goverments, health
professionals
- Able to monitor
our health
- Prevention as
dominant worldview

Health Cloud Scenario

This scenario envisions the guiding
metaphor to be a 'cloud', referring Health life cycles
can be tracked
to public health information and monitored
available to all. It also connects
citizens in a health cloud network

Cloud
that monitors their life stages.

Computing
Cloud ‘network’
Health organised through
by tracking birth
sub-districts /upazilas
of every child

14
 Health Care Foresight

Table 1: E-Health Scenario 2025 Summary

E-Health Leap frog E-health car Health cloud E-health political

Scenarios 2025 party

Litany or Smart use of technology Cost-effective digitalisation All births and life Paying people to stay
headline of health sector for cycles are registered healthy through public
Usage of low-cost
enhanced health service and tracked disbursements of health
diagnostic devices
customisation expense funds

System Integrated and E-health records Shared public utility Data collection and
interoperable universal system interoperable cloud data management for
e-health system everywhere achieving public disbursement
total data capture

Main Public health sector, Government, line Government, Government, insurance

stakeholders ministry, health care information, agencies, donors,
donors, community citizen system and concerned communication, patients and health
technology (ICT)
associations, rural and citizenry professionals
companies, digital
urban citizens natives, public health
NGOs, international
agencies and donors

Dominant Decentralised systemic Individual, decentralised Universal right to health Welfare-based model
worldview/deep governance promoting and personalised health and information of public funds transfer
structure participation and collective care for inducing health
ownership consciousness in
people

Metaphor Fly-over E-health car/bus, driving Connectivity cloud Raise the price of vice,
to the new future lower the cost of virtue

These scenarios have a number of patient at the centre. However, the and 20% toward creating horizon three,
purposes. First, they create new challenge is horizon two – how to the long-term vision. For example, new
conversations about what is possible in reconcile current needs with the state-wide key performance indicators
the system. Second, even as they open emergent future. In one foresight focused on prevention and on
up possibilities, they anchor the system workshop held with over fifty health partnership between health sectors.
so that it is not overwhelmed and clear directors, when asked as to their
trajectories are possible. They also help preferred future, most imagined a far This is the core tension: the current
the ministries make financial decisions more preventive model with the hospital health model is in transition. Without the
as to what and where to invest. Finally, moving to the home (or the doctor in the act of foresight - envisioning and
they help transform the system, moving body via genomics and nano-health creating alternative futures - strategies
from the health politics of what is known bots), essentially where the main focus will remain focused on what is known.
to what can be created. was ensuring patients stayed well and Once alternative possibilities enter the
when they were ill they remained in current paradigm, then interventions are
Finally, in health settings the challenge is charge of their own health. The health required to create pathways to the
between horizons. For example, horizon system would be a coach, focusing on emergent futures. If these are not done,
one is the current system which is being the patient. However, in an open-space then patients will most likely lose out. As
challenged in the immediate term by session when asked to develop projects in times of stress, systems can easily
cost containment and ageing which is that they could work on over the next revert back to the past, instead of a
leading to debates about the most year, they selected projects in areas they jump to the novel.
effective societal model to deliver health were already comfortable with, they
outcomes, given that the current system focused on the present. When they
is under stress. Horizon three is the reflected on this tension between the
emergent peer-to-peer, use of new world they want and the world they
wearables, the well-being revolution, need to live in, they articulated a budget
with the patient at the centre. In short: strategy wherein 80% of the budget
the preventive worldview with the would go toward horizon one projects

15
Contacts
Dr Janson Yap Ng Zhi Hui
Regional Managing Partner Senior Consultant
Risk Advisory, Southeast Asia Risk Advisory, Singapore
+65 6216 3119 +65 6800 2884
[email protected] [email protected]

In collaboration with
Professor Sohail Inayatullah Dr Luke van der Laan
Prof Sohail Inayatullah is the UNESCO Chair for Future Dr Luke van der Laan is the Director of Professional
Studies. Prof Inayatullah has addressed or conducted Studies at the University of Southern Queensland,
foresight workshops for various government and Australia. He holds an Honorary Professorship at the Far
institutions including Joint Research Centre, European Eastern Institute for International Relations. Dr Luke van
Commission; Government of Thailand; and der Laan holds a PhD in Leadership, Foresight and
Government of Canada. He has written and co-edited Strategic Thinking. He has published across the areas of
twenty-two books including What Works: Case Studies leadership, foresight, strategic thinking, innovation,
in the Practice of Foresight (2015); CLA 2.0: technology futures and sustainability, among others. His
Transformative Research in Theory and Practice (2015). most recent book is Foresight and Strategy in the Asia
Pacific Region (2015).

About The Deloitte Future Health Care Centre of Excellence

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