As Countries progress economically, Healthcare costs increase, so does the ability of people to pay for them. These increased costs are attributed to the use of pharmaceuticals; increased number of visits to the Emergency Department; Longer Hospital stays over the life span of any individual due to longevity and geriatric problems; multiple surgeries, especially after attaining 60 years of age and increased use of technology to deliver and receive Healthcare.
With the rapid rate of socio-economic growth that is being witnessed all across the world, the volume of Healthcare services required will have a significant impact on the economy, consumers, and Healthcare professionals in any country.
It is our firm belief that most countries in the world shall have to increase their direct spending on delivery of Public Health as well as on Curative Health through Hospitals and other such custodian Healthcare Institutions to at least 10 of their Gross National Income in next 7 – 15 years.
This increased availability of resources for Healthcare shall impact Healthcare Industry in a major way in next two decades. It shall not only integrate the Healthcare delivery across all countries, developing or developed, but will also standardise various Healthcare delivery modules and the outcome of this Healthcare delivery.
It shall definitely improve Life Expectancy at birth, lower the Infant Mortality Rates, Maternal Mortality rates, which together shall lead to increased population burden.
Emerging Trends
(Click on each trend to read more in detail)
The Healthcare Industry requires wide variety of people with various educational backgrounds to function. Most of the occupations in the Healthcare Industry require less than four years of education and training after school; but all occupations that carry out diagnosis and treatment must employ highly educated, trained and adequately skilled persons who require many years of education and training beyond school as well some regulated form of License or Certification to practice. (ILO - ISCO -88, Major Group 2 Professionals, Group 22 Life Science and Health Professional)
Generally, the ratio of these skilled to unskilled occupations in a Healthcare System is 20:80. In Hospitals, the ratio of these skilled to unskilled occupations in a Healthcare System is 40:60.
The Healthcare Industry has emerged as one of the largest industry and Employer in the world in 2008, and provides 1.34 (Afghanistan) to 14.3% (USA) of all jobs and occupations in various countries. Even at 14.3% USA has deficiencies in some types of skilled occupations like Nursing and Technicians.
NOUS predicts that most of the countries will follow USA and will provide many more jobs in Healthcare directly proportional to their investment in Healthcare in next 25 years. The major thrust shall be in African Countries and then in Asian Countries. The growth in employment in Healthcare Industry shall be @ 2 -3% average in most of the countries in the world.
The growing expectations for better Healthcare Services and exorbitant cost of purchasing private Healthcare will force Public Hospitals to scale up their operations to realize the benefits of economy of scale. The better educated citizen in most countries including India, China, Africa and Latin America is already challenging the poor standards of Hygiene, lack of respect and privacy, high morbidity and mortality rates of Public Hospitals.
The Rich and Famous of any country can source Healthcare from anywhere in the world; the Rich but not so Famous purchase private Healthcare; but average enlightened middle class citizen will change the Public Healthcare Provider and make it not only accountable but also more efficient.
NOUS predicts that the structure of Hospitals in near future will change and they shall become providers of Intensive care and Acute care Level Healthcare. The present trend of providing 10 – 30% of total beds as Intensive Care beds will change to 50 – 60%. The present trend of providing 20 – 40% of total beds as Acute Care beds will change to 30% or more. There will be fewer, less than 20%, beds for Intermediate Care in Hospitals. These shall be for Paediatrics and Obstetrics.
Some Hospitals like Military Hospitals will have more Intermediate Care Beds (upto 50%) for long convalescence. All other Hospitals will gradually become Acute Care Hospitals.
The presently available Intermediate Care Beds for convalescence will move to Nurse managed Nursing Homes or Patient’s Homes.
The increasing demand for Intensive care coupled with non-availability of critical care physicians and nursing staff has given birth to Virtual ICUs where using technology based solutions, Intensive Care Units of different types are being staffed with regular staff but virtually monitored by Critical Care Trained Intensivist. This not only enlarges overall reach for Intensive care but also reduces the cost at which the care is delivered.
The span of patient numbers that an Intensivist can treat increases from 16 to 96, the severity adjusted ICU mortality rates reduce by 10% even when the staff employed in ICUs is not fully trained for critical care and average length of stay in ICU also decreases by 20% (It reduces from 2.5 – 3 days to 2 – 2.5 days).
NOUS predicts that in very near future all large Hospitals will have owned Virtual ICUs where as small Hospitals will have third party managed Virtual ICUs. At present, the high cost of technology to be employed for creating Virtual ICUs is the only factor that is restricting growth of Virtual ICU beds.
The rapid advances in Tissue Engineering and Regenerative Medicine has provided the following Human Organs and Tissues which are available or will be shortly available for clinical use. The manufactured organ would be engineered for its recipient with cells from their own body, ensuring that the organ would not be rejected.
- Blood
- Blood Vessels
- Liver
- Lungs
- Teeth
- Trachea
- Urinary Bladder
The process requires controlled and supervised activities to culture and grow stem cells and then altering their Genetic Code. This shall require provisioning of fully controlled tissue engineering laboratories either as on site facility or remote University Based facility.
NOUS predicts that in future, all hospitals will have this new department of Tissue Engineering and Regenerative Medicine which shall provide Tissue Engineering Laboratories, Bioreactors and Robotics to carry out these precise processes on their patients. This will also influence Hospital design as more clean rooms will be required to carry out this work.
The rapid advances in Nanotechnology have developed a large number of Nanoparticles for delivering drugs, heat, light or other substances into Human Body so as to reach specific types of cells (such as cancer cells) and cell components. The Nanoparticles are engineered so that they are attracted to diseased cells, which allow direct treatment of those cells. This technique reduces damage to healthy cells in the body and allows for earlier detection of disease. Nanoparticles, particularly ones made of precious metals, provide or enhance signals in imaging approaches beyond fluorescence microscopy.
Magnetic Resonance Imaging, Photo Acoustic Imaging and Raman Spectroscopy approaches all draw on this branch of materials science.
Compared with existing fluorescent proteins and small-molecule dyes, nanotech probes can offer signals that are several fold brighter and hundreds of times more stable. The newer Nano diamonds do not blink like older Quantum dots or bleach like Proteins. They are useful for long-term tracking molecular activities, monitor cell processes at the nanometre scale, inside cells. Using these diagnostics, Physicians shall be able to tailor individual therapies to the very molecules that shall be treated. Thus one shall be able to distinguish a patient's cancer from other cancer types.
Molecular imaging is gradually being established as a definitive branch of science and Medical schools in USA offer fellowship after postgraduate training in radiology. As of now, Nanotechnology is impacting diagnostics and treatment schedules in Cancer.
All Nanotechnology work areas are treated as Clean rooms, 25% or so confirm to Class 10 Clean Rooms and rest are Class 100 to Class 1000.
NOUS predicts that in future, Hospitals will be required to integrate Nano particles based Diagnostic Tools and Therapeutic Modalities in Healthcare Delivery, especially in treatment of cancer and geriatric disorders.
Today, every patient has to have a number of Healthcare Providers starting with General Practitioner to a number of specialists and super specialists. The patient files are becoming bulkier and un-organised. Advent of Electronic Patient Files and web based repositories will provide seamless integration between various providers at various locations and at various time of patient’s life cycle. This shall help in proper reviews at all stages, control costs and improve patient management by basing it on problem solving rather than symptom management.
There are a number of third party Medical Record Management Companies doing this work in USA. Sooner than later, this will become available to all hospitals as it brings better patient management at reduced cost of Medical Record keeping. There are certain issues related to privacy, provision of access and ethics which are being resolved.
NOUS predicts that once these issues are fully addressed, it shall become universal to have Electronic Patient File with some service provider and patient will provide access to this file when he consults or takes treatment.
Bio-degradable, scaffold integrated bandages are now commercially available where patients own cells (taken by skin biopsy procedure) are allowed to grow into natural skin closure. This provides scar less wound healing. This not only helps in desired healing solutions but also reduces ALSO, graft related problems and increases success rates for Skin Grafts.
Soon, bio degradable scaffold shall be available for growing one’s teeth. There are in fact about 28 lines of stem cell based tissues being worked upon.
NOUS predicts that in near future, Patients will have choice of scaffold based healing solutions which shall not only provide almost natural healing but also reduce Average Length of Stay in IPD.
Photoacoustic Imaging, a biomedical imaging modality has been developed based on the Photoacoustic Effect. Non-ionizing laser pulses are delivered into biological tissues. Some of the delivered energy is absorbed and converted into heat, leading to transient thermoelastic expansion and wideband (e.g. MHz) ultrasonic emission. The generated ultrasonic waves are then detected by ultrasonic transducers to form images.
When radio frequency pulses are used in place of lasers, the technology is referred to as Thermoacoustic imaging.
The optical absorption in biological tissues can be due to endogenous molecules such as haemoglobin or melanin, or exogenously delivered contrast agents. Since blood has higher concentration of endogenous molecules compared to surrounding tissues, Photoacoustic imaging can visualize blood & blood vessels and is a useful tool for studying Haemodynamics. It is also used in vivo for tumour angiogenesis monitoring, blood oxygenation mapping, functional brain imaging, and skin melanoma detection, etc.
Two types of Photoacoustic imaging systems, Photoacoustic Computed Tomography (PAT) or Thermoacoustic Computed Tomography (TAT) with Photoacoustic Microscopy (PAM) have been developed. A typical PAT or TAT system uses an unfocused ultrasound detector to acquire the Photoacoustic signals whereas a PAM system, on the other hand, uses a spherically focused ultrasound detector with 2D point-by-point scanning.
PAT & TAT shall be used in Brain Lesion Detection, Haemodynamic mapping of organs and Diagnosis of Breast Cancer. PAM shall be used for in vitro blood oxygenation mapping of tissues.
NOUS predicts that in future clinicians are going to make wide spread use of this Diagnostic Modality - Photoacoustic Computed Tomography (PAT) or Thermoacoustic Computed Tomography - for diagnostic studies at sub-cellular level.
The trading practices in providing Capital Equipment and Hospital Supplies will change as Group Purchasing Alliance shall establish and operate thereby regulating the whole business of Healthcare provisioning. The market is now operating on profit margins which provide for non-ethical issues, cartelisation, poor performance of warranties, up gradation, etc. There is another factor of slippage of scheduled payments. The time has come when all players involved in Healthcare provisioning have to mature to make the system more effective and responsive.
Group Purchasing Alliance will catalyse this process.
NOUS predicts that in near future, Group Purchasing Alliances of Healthcare Providers in Developing Countries will take over Healthcare Provisioning.