Services in many aspects of life are becoming virtual; shops, utility bills and even the faithful paperback book have now become digitised, with an increasing number of us adopting these new formats due to the convenience and cost savings they offer.
In the last decade, healthcare spending in the OECD has increased from an average of 7.8% to 9.7% of the region’s GDP.1
Meanwhile, healthcare providers are ill-suited for the present needs. In developed countries, hospitals focus largely on acute care even though chronic disease is abundant, and an ageing population intensifies the challenge. In emerging markets, inadequate health infrastructure limits the rural and the urban poor to the most basic care. Consequently, the healthcare industry is shifting their view towards virtualisation opportunities in order to meet the high costs of delivering care, limited budgets, and increased needs of an ageing population.
A global research study1 conducted by the Economist Intelligence Unit (EIU) and commissioned by PricewaterhouseCoopers highlights the current opportunities and challenges of mHealth from the perspective of patients, healthcare providers, and payers. The study comprised of two surveys in ten countries: Brazil, China, Denmark, Germany, India, South Africa, Spain, Turkey, the UK, and the US. In the first survey, 1,027 patients were queried on various aspects of mHealth. The patient demographics included a wide range of ages, health states, education levels, and economic statuses. In the second survey, 433 healthcare professionals and 345 executives from public and private payer organisations were questioned. Healthcare professionals were from the public sector (46%), private sector (49%), or were independent physicians (5%); more urban (67%) than suburban (24%) or rural (10%); practicing either in primary (45%), secondary (45%), or tertiary (10%) healthcare centres. The executives from public and private payer organisations were approximately equal, with 55% top senior executives. Additionally, the study also included extensive desk research and 20 in-depth interviews of senior executives and leading experts from various organisations such as healthcare providers, payers, technology and telecommunication companies, academic organisations, think-tank, and non-governmental organisations. Some of the key findings of the study are shown below (the data presented is for the ten countries overall, and not reported for any specific country).
Expectations are huge that mHealth will help to enhance access to care in emerging markets and convert developed countries’ costly healthcare into less expensive, prevention- and patient-centred care. Half of the patients surveyed think that mHealth will improve the cost, the quality, and the convenience of healthcare in the coming years. More than half of doctors and payers say that the widespread adoption of mHealth is anticipated in the near future.
Individual interests of stakeholders, patients, doctors, and payers make healthcare delivery more complex. Patients believe that mHealth provides them with easier access to care, lowers their out-of-pocket expenses, and increases control of their own health. But that requires a substantial, disruptive change from doctor-directed care to patient-centred care. Patients with poorly managed chronic disease and those who spend more than 30% of their household income on healthcare are most likely to use mHealth services.
Doctors, on the other hand, are reluctant to disrupt their traditional roles; 42% of doctors surveyed worry that mHealth will make their patient independent. Only 27% of the doctors encourage their patients to use mHealth products and services to manage their health, while 13% actively discourage patients.1 Nevertheless, doctors are using some aspects of mHealth to monitor patients’ conditions and treatment compliance, access their medical records, and to connect with them. For doctors, improvement in the quality of care is the top driver for adopting mHealth services, rather than convenience.1
Payers, which include private insurance companies and government bodies, are likely to shift towards the patient side and support the disruption of the traditional healthcare system since most of the economic consequences will be borne by them if the healthcare systems fail to reform. Many are redefining their roles and laying a greater emphasis on wellness and prevention areas of health rather than treatment. By providing patients with mHealth services, private insurance companies can ensure a place for themselves in the competitive marketplace. Around 40% of the payers surveyed encourage patients to allow doctors to monitor them through mHealth services.1 Moreover, payers are much more likely to pay for mHealth-related services than doctors.1 Though resistance by doctors may defer some aspects of mHealth, still doctors will not be able to oppose the influence of the internet on patients—and as payers, will support patients in bringing change.
Resistance to change
Innovation in healthcare can involve disruptive reorganisation, making adoption of new technology difficult and slow. Around 27% of doctors and 26% of payers report an inherently conservative tradition and culture of the healthcare system as the major barrier to mHealth adoption.1 The size and complexity of healthcare systems that vary markedly between countries can hinder innovation. The healthcare system regulations can also hinder innovation; regulators face the challenge of balancing patient safety with the potential benefits of using mHealth services. Around 45% of payers and doctors believe that the application of inappropriate regulations is deferring greater use of mHealth.1 Furthermore, an mHealth product or service will only be used if a stakeholder finds some incentive either cost-, time- or care-related linked to it, which is not always easy to demonstrate.
Technology as a barrier
Both doctors and payers believe privacy and security issues are the major barriers to greater use of mHealth; only half of doctors report that the internet connection at their workplace is secure.1 Additionally, poor technical integration of mHealth services impedes uptake; only 53% of doctors report that the mHealth services they use at work are integrated with their main IT systems.1 Additionally, the shortfalls in existing public-sector facilities continue to be a major issue; around 33% of the government doctors do not have access to mobile internet at their work place, compared with only 14% in the private sector.1 Last but not least, the rapid change in mobile consumer technology and adoption behaviours presents another major challenge for mHealth uptake.
Emerging markets as a seedbed for mHealth
As per the first survey, patients in emerging markets are more aware and are more likely to use mHealth services than those in developed countries; around 59% of patients in the emerging markets are using at least one mHealth service, compared with 35% in developed countries, and amongst those patients who do not use mHealth, interest is high in the emerging-market patients.1 Both doctors and payers in emerging markets are much more likely to recommend patients to use mHealth.1 More mHealth services are paid for by payers in emerging markets than in developed countries.1
Widespread adoption of mHealth in emerging markets reflects the relative need. Doctors usually tend to concentrate in urban areas. In developing countries like China, India, and South Africa where the number of doctors per 1,000 population is less than 1.51 and the majority of the population lives in rural areas, the medical care provided, if any, is often by those with the most basic of training. Though barriers to change exist in the emerging markets, the vast need combined with drivers of innovation explains the more rapid adoption of mHealth there.
Need for solutions worth paying for
Worldwide there is a need to find solutions that function in the current environment and are cost-effective. Around 64% of doctors and payers report that although mHealth has exciting opportunities, there are too few proven solutions.1 Despite the market being flooded with personal health phone apps, patients are unwilling to buy these expensive services because they are highly price sensitive; around 49% of the patients report cost as the major barrier to greater use of mHealth services.1
A solution-based rather than technology-based approach focusing on clinical outcomes, value, and patient satisfaction should be adopted. Companies should aim to develop solutions which are not only cost-effective but benefit the payers and/or the providers directly so that they are motivated to pay for these services. mHealth solutions should be created in close association with healthcare providers to avoid behavioural problems of mHealth adoption later. mHealth should be integrated into existing healthcare systems rather than standing apart.
Disruption of the traditional healthcare system is not an easy process. Still, mHealth is being adopted in the emerging markets where the need is vast and barriers are few, amongst patients with poorly managed chronic disease states, who bear a large proportion of their healthcare cost out-of-pocket, and who are not getting good care from existing healthcare infrastructure.
Companies active in mHealth should focus on developing solutions that provide tangible value to all stakeholders and develop associations with prospective partners to create a wider impact globally.
Emerging mHealth: paths for growth. PwC Jan 2014. Available at: www.pwc.com/mHealth.