We've been hearing about the rising costs of healthcare for as long as we can remember, and it usually comes with stories of the sufferings of individuals who cannot afford the high costs of much needed treatments. The WHO reported a 15.1% increase in world health expenditure as percentage of GDP from 8.6% in the year 2000 to 9.9% in 2015, and a 146% jump in health expenditure per capita from US$587 to US$1,300 over the same period. These figures are alarming. There are no signs of improvement if we continue with the current trajectory. Certain things need to change.
Increase in healthcare demand, supply and price
Healthcare costs are increasing in both the demand and supply sides. Nowadays people live longer, and the elderly demand more attention and support than younger people. Illnesses among the elderly are more complex due to the long-term impact of chronic diseases, the nature of diseases prevalent in elders such as cancer, Alzheimer's and others. The effect of acute illnesses on vulnerable senior citizens is more troublesome to treat. Drugs and medical equipment are becoming more expensive. Well-known drugs, especially those that have outlived their patent protection, have become extremely cheap with the emergence of generic unbranded versions of the drugs. However, newly discovered drugs, designed to be more effective or with the ability to treat more complex diseases, command a much higher price tag today than the new drugs of the last half decade. Also, mark-up on pharmaceuticals is a major contributor to hospital revenue in countries with non-prescription practice, adding significantly to the cost of treatment. A recent survey by the Thailand Ministry of Commerce, which received data from 295 private hospitals, reported mark-ups of pharmaceuticals from 30% to 300% on cost. On top of all that is healthcare consumerism, where patients receive more autonomy in healthcare decisions, resulting in more engagement and continuity in care. Since knowledge about, and beliefs in, healthcare vary between patients, some make treatment choices without medical knowledge or guidance leading to ineffective, and sometimes, wasteful treatment.
Value in healthcare
We normally seek value in everything we purchase. We seek to get the most out of money spent, and healthcare should be no different. However, due to the complexity of healthcare, it currently is quite different. Healthcare is very personalised. People tend to make irrational decisions when it comes to personal issues. It would be easy to finalise a purchase of a Japanese mid-level sedan over a European make with similar specifications that cost 4 times more. But deciding on a pacemaker would be much different. The notion that health is invaluable, and one should receive nothing but the best treatment, can be seen in most cultures. But no one talks about how to finance it. To think seriously about value in healthcare, especially in public health, we must understand and remember two rules: get it early and get it right.
It is cheapest and most effective to treat any illness early in its course. This is common knowledge. In public health, prevention is key, through education and vaccination, if possible. Early detection with screening tests and health check-ups can help eradicate the problem before it becomes an issue of urgency.
Apart from getting it early, the treatment option chosen must be effective. Otherwise that early treatment opportunity will go to waste. The illness will progress. Costs will increase. Effective treatment does not always mean new and expensive drugs. The WHO defined Rational Drug Use (RDU) in 1985 to promote the use of evidence-based, cost-effective drugs. New drugs are also being gauged in relation to cost-effectiveness by comparing the significance of additional benefits in comparison to increase in cost. Public health services can be made sustainable if health economics is taken seriously. So can healthcare consumerism.
Yet we still have one more issue. We will never have enough healthcare experts; either they are too far away, or they don't exist.
Creating value in healthcare with artificial intelligence
Artificial Intelligence is the product of knowledge and experience. Because it is a machine, it doesn't get tired and is always available. The first rule of Value in Healthcare: get it early, can be fulfilled with AI technology. Health screening is great, but it is expensive. You must screen the entire population. Some governments can only afford to target screening high risk groups, leaving the rest at risk of late sickness detection. A significant portion of the cost of health screening is the expert personnel costs that are needed to manually review the test results. Each and every single test must be checked. Even if the prevalence of that illness is known to be very low, testing is still necessary. With the use of AIs in screening for abnormalities in test results, however, experts can spend less time on potentially normal results and concentrate on acute cases. Today's computer vision technology has already made medical image screening a possibility: PAP smears to screen cervical cancer, chest x-rays to screen tuberculosis, mammograms to screen breast cancer, and much more. By combining digital and telecommunications technology, test results from anywhere in the world can be sent in and receive automated screening within seconds.
AI technology can also help in choosing the right treatment. Medicines and medical devices are mostly developed in overseas countries with evidence of efficacy in different populations, in terms of ethnicity, culture and lifestyle. We can only try to extrapolate from what evidence we have available, how efficacious the drug may be in our population. With data collected from years of practice together with AI technology, we can now know and predict the response to the drugs in our population and make right choices. Applying subsequent costs to each treatment option and public health policy making with regards to nationwide population coverage will be much easier and accurate. Again, getting it right, and more immediately, is the result.
Quality of care first, then cost
Arguably, quality is the main concern, if not the only concern, in healthcare. There are stories of misdiagnoses by AIs, or AIs dispensing the wrong medication. These are cautionary tales and can happen just as in real practice, if the technology is implemented without the right set of controls. However, what is more unnerving is that these issues are already occurring to some extent from human experts but rarely do we see any documented or reported evidence. It is unfair to healthcare patients and consumers if healthcare providers communicate only about the price of services without stating the quality of care, including outcomes that patients will receive. In order to confidently harness the power of AI technology, we need to know and set these current human performances as the benchmark. We can thereby objectively decide, based on benefits and potential risks of deploying an AI technology. If we start with performance monitoring of healthcare practices together with the will to improve it, Artificial Intelligence or not, we are already going somewhere forward in our dedication to excellence.
Author: Dr. Veerachat Petpisit, CEO, Healthcare Ventures, BridgeAsia, Email: veerachat_p@bridgeasiagroup.com
Series Editor: Christopher F. Bruton, Executive Director, Dataconsult Ltd, chris@dataconsult.co.th. Dataconsult's Thailand Regional Forum provides seminars and extensive documentation to update business on future trends in Thailand and in the Mekong Region.