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THE NET IMPACT ON HEALTH DIVIDE
Demos and Vision - Third Global Forum on e-government - Tuesday 13 March 2001 - Naples

THE STORY LINE
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The evidence and case studies collected so far suggest five major conclusions:

1.     Healthcare systems (like all over-developed institutional systems) are suffering a crisis of efficiency.
A number of evidence support – in Demos and Vision study – the argument of an ever increasing inefficiency.
For instance, think tanks have reconstructed – upon WHO and World Bank data – historical series of life expectancy (to be more precise of Dale - Disease Adjusted Life Expectancy) and healthcare expenditure. Therefore, they measured how many years did OECD countries gained for each decade since 1940 and how much did they spend in healthcare (as a percentage of GDP) to get such results. Results say that whereas immediately after the war OECD countries were able to add in one decade more than 5 years to life expectancy spending 4,1 % of their income on healthcare, they are now progressing of a mere 1.9 years spending twice as much.
We, as a society, seem increasingly unable to obtain sufficient value for the money that we actually spend
[1].

2.     This crisis is primarily due (like for all over-complex institutional systems) to lack of information (which is of poor quality and insufficient vis a vis the ever increasing number of available options) and of limited choice.
Inefficiency is about low productivity, inability to allocate resources to more productive uses. For instance, success rates of equally available treatments can be dramatically different. However, Vision and Demos case studies show that the consumer knowledge regarding information about such differences is close to nil, as is the possibility to choose. Such a system does not allow for continuous reallocation of resources from less to most useful means.

3.     The Internet offers the prospect of significant change.
As we all know, with the Internet information becomes much less costly and range of choice is no longer constrained by physical location.

The US based Global Health Network makes it possible for a number of LDCs to share resources and disseminate them very quickly under emergency situations  (as in the case of epidemic, natural disasters, famine). The smart card healthcare information system – which is currently being tested in Lombardy – has  the potential of reducing  cost  and personalizing  and improving service.

Internet can then not only improve things but – as case studies show – bring the system to a radically different scale in terms of efficiency and quality.

4.     Technology alone can do very little.
In fact, changes that Internet could bring about will require just what we mentioned before: a huge reallocation of power and resources but also the disappearance of the old web of protections and the emergence of a brand new system of rights and regulations.
We will then have to overcome powerful resistance. The British
National Health System, for instance, is now discovering how its on-line product - NHS direct – is putting its entire distribution channel under pressure.
And we will have to address entirely new concerns. The project case studies demonstrate that every internet success is succeeded by an internet problem: smart card centred systems have not even started to deal with new issues of reliability, confidentiality, ownership of health information.
More information and more choice will not only  bring about  much higher performance but also highlight the need for radical changes at the very core of Healthcare Systems Organisations and legislation.

5.     Developing countries have a potential competitive advantage.
Notwithstanding the large gap developing counties still have in terms of infrastructure and hardware, some of them show a relative advantage in terms of skills[2] and of - what Tom Bentley from Demos and Francesco Grillo from Vision - call Network propensity. Moreover resistance to the above systematic changes is much lower as  these countries do not have, for instance, heavily institutionalised national healthcare systems and regulations to be radically restructured and redesigned.

This last result may appear counterintuitive: digital divide between developed and developing societies does not appear to be as great as older, more established inequalities, for example, life expectancy, income and income sustainability. Western healthcare systems, on the contrary, seem to be increasingly unable to deliver what people expect.

[1] Efficiency is also very different between countries: curiously, the U.S. seems to be less efficient than countries like Greece.  The Americans do enjoy a DALE of 70 years, spending USD 4,186  per year on health, whereas Greeks can expect a disease-free life of over 72 years, spending less than  USD 1,000. This data demonstrates something more: when it comes to evaluate and make policy recommendations on health care, we should never forget that health systems are not only made up of doctors and drugs but also of many more variables including diet and lifestyle.

[2] IT literacy but also English proficiency in India, for instance, is – within the 20 to 35 years age bracket – higher than in much more “advanced” nations like Italy or Germany