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2021 global health care outlook Accelerating industry changeOverview and outlook 2 Global healthcare sector issues in 2021 5 Consumers and the human experience 5 Care model innovation 7 Digital transformation and interoperable data 10 Socioeconomic shifts 18 Collaboration 22 Future of work and talent 25 Questions/actions health care leaders should consider for 2021 27 Endnotes 32 Contents2 T HE COVID-19 PANDEMIC is placing enormous strain on the global health care sectors workforce, infrastructure, and supply chain, and exposing social inequities in health and care. COVID-19 is also accelerating change across the ecosystem and forcing public and private health systems to adapt and innovate in a short period. A number of foundational shifts are arising from and being exacerbated by COVID-19s spread. Examples include consumers increasing involvement in health care decision-making; the rapid adoption of virtual health and other digital innovations; the push for interoperable data and data analytics use; and unprecedented public- private collaborations in vaccine and therapeutics development. Amid these dynamics, governments, health care providers, payers, and other stakeholders around the globe are being challenged to quickly pivot, adapt, and innovate. We expect industry leaders to use the momentum ignited by organizational and ecosystem responses to COVID-19 to address six pressing sector issues in 2021 (figure 1). How health care stakeholders analyze, understand, and respond to these issues will shape their ability to navigate from recovering to thriving in the postpandemic “new normal” and advance their journey along the path to the Future of Health. Overview and outlook 2021 global health care outlook3 urcelote al Deloitte Insights | 1 Global health care sector issues in Digital transformation and interoperable data Transitioning from standardized clinical protocols to personalized medicine Leveraging AI to provide realime care, interventions, and nudges to change consumer behavior and patterns ork and talent Introduction of new business models, exponential technology, and agile ways of working Capacity and demand analysis to match the pandemic needs Utilization of remote sta (clinical and nonclinical) Socioeconomic shifts Programs to support a person holistic welleing cognition of the need to focus on underserved populations and work with governments to modify policies and programs Consumers and the human experience Consumersincreased ownership of their health and data Provision of clear and concise information on treatment care and cost lance between virtual visits and a trusted physician relationship Care model innovation Changing focus from acute care to prevention and welleing Transitioning from standardized clinical protocols to personalized medicine olving payment modelsvalueased/ outcomeocuseduniversal coverage Making nancial operation and performance improvements Collaborations osystems that enable realime data and analytics and serve as centers for education, prevention, and treatment osystems that connect consumers to virtual, home, inerson, and auxiliary care providers Accelerating industry change4 GLOBAL HEALTH CARE BY THE NUMBERS Combined public and private health care spending is expected to fall globally by 2.6% in 2020, due in large measure to the detrimental effects of COVID-19related lockdowns and social distancing measures on the provision of nonemergent care and care restrictions. In most countries, nonessential surgeries and screenings were postponed for months, although outpatient care was far more affected than inpatient care or pharmaceuticals. 1 Fallout from the pandemics associated global economic recession also appears to have muted health care spending in 2020. Patients reduced visits to physician offices, clinics, and emergency departments; delayed refilling drug prescriptions; and cut back on discretionary health care purchases. In some countries, job losses ate into contribution levels for employment-based health insurance, despite extensive government support. 2 COVID-19s global grip is likely to extend well into 2021; however, health care spending should begin to recover as governments invest heavily both to control the pandemic and to roll out COVID-19 vaccines and treatments. A recommencement of deferred surgical and diagnostic procedures and an improving economy should also boost spending. 3 Between 2020 and 2024, global health spending is expected to rise at a 3.9% compound annual growth rate (CAGR), considerably faster than the 2.8% recorded in 20152019. 4 The fastest growth will be in Asia and Australasia (5.3%) and the transition economies of Central and Eastern Europe (5.2%), and the slowest in Latin America (0.7%). 5 Global health care spending as a share of gross domestic product (GDP) is projected to rise to 10.4% in 2020, up from 10.2% the previous three years. The sectors GDP share should average 10.3% in 2021 and 2022. 6 Drivers for continued health care spending growth include population aging, increasing demand for care, countries gradual economic recovery, clinical and technology advances, and the expansion of public health care systems. In addition, the growing international competition for health care workers may push up labor costs. 7 On a per-capita basis, spending will likely continue to be unevenly spread, ranging from US$12,703 in the United States to just US$37 in Pakistan in 2024. Efforts to close this gap will be hampered by higher population growth in many developing economies. 8 Population growth and agings impacts on public health care systems will likely vary by region. The global population of 7.8 billion (as of November 2020) is expected to increase an average of 81 million per year, to 8 billion by 2023. 9 Asia and Africa are the fastest-growing regions. Meanwhile, life expectancy at birth continues to rise, reaching an estimated 74.1 years in 2020 and a projected 74.9 by 2024. Nigeria and Pakistan are among the countries expected to see both larger and younger populations (41% and 35%, respectively, of their populations will be 14 years or younger in 2024). Meanwhile, the populations of Japan, Venezuela, and much of Europe will be shrinking and aging. 10 As the pandemic has proven, communicable diseases continue to pose a threat, especially in emerging economies. Also notable is the steady increase in noncommunicable diseases (NCDs) such as heart disease, cancer, and diabetes. NCDs account for 41 million deaths a year, or 71% of the global totaland this share rises to more than 80% in the most developed markets. 11 Increasing life expectancy and lifestyle-related factors (rapid urbanization, lack of exercise, changing diets, and rising obesity levels) are primarily responsible for NCDs increasing morbidity rates. 12 2021 global health care outlook5 Consumers and the human experience Consumers are drivingand acceleratingthe pace of change in health care. Their needs and goals are driving innovation in health-related products, services, and tools. Their preferences are driving the development of digitally enabled, on-demand, and seamlessly connected clinician-patient interactions. Their demands are driving the transition to patient-centric care delivery across geographies and socioeconomic groups. And their expectations are driving industry stakeholders to elevate a transactional patient/customer health care encounter into a holistic human health experience. COVID-19 has challenged consumers sense of well-being and accelerated their desire and determination to become more active, engaged, and empowered in managing their health. Consumers are learning about their health risks, communicating with their doctors in new and different ways, and changing their attitudes about data privacy. They want convenience, access, and transparency around treatment care and cost. Each of these factors has a significant influence on how consumers are feeling and interacting with their health system, 13 as seen in findings from Deloittes recent global and US health care surveys and a consumer survey during the peak of the COVID-19 crisis: 14 Many consumers show greater activity and engagement. Consumers are increasingly willing to tell their doctors when they disagree with them, are using tools to get information on costs and health issues, are tracking their health conditions and using that data to make care- related decisions, and are accessing and using their medical record data. Consumers are using virtual visits more than ever before and plan to continue using them. Since the onset of the pandemic, consumers using virtual visits rose from 15% to 19% from 2019 to early 2020; this jumped to 28% in April 2020. Even before COVID-19, consumer adoption of virtual visits has been increasing since 2018. On average, 80% are likely to have another virtual visit, even post COVID-19. More consumers are using technology for health monitoring. Growing numbers of consumers are using technology to monitor their health, measure fitness, and order prescription drug refills. More than three- quarters of those who track their health say it changes their behavior at least moderately. A trusted clinician relationship remains paramount. The top factors for “an ideal health care experience” include doctors who listen to/ care about them, who dont rush, and provide clear communication. As health systems, technology companies, and others roll out virtual Global health care sector issues in 2021 Accelerating industry change6 services, it is imperative to provide the same personal experience as during an in-person visit. This is particularly true for organizations that are developing tools or services for those with chronic conditions, as they are most likely to value a sustained relationship. Health care organizations need to consider another trust-related issue: Although more consumers are sharing data because of COVID-19, as the public health crisis calms down, its unknown if they will be willing to continue to do so. Organizations will need strategies to build trust to make consumers feel comfortable sharing their personal health data. One strategy is to make clear that consumers own their data. It was found that a large majority of consumers (65%) think that they should own their own health data versus those (30%) who think their doctor should own it, and even fewer who think that the government should own it. 16 In a recent Deloitte survey on human experience, consumers ranked empathy and reliability as the top two factors when seeking out a health care experience. 17 Every persons health journey is different. Organizations along the entire health care value chain should recommit themselves to understanding consumers and creating a multifaceted strategy that speaks to where consumers are and what they need right now. Focus is shifting from health care to health and well-being. More resources (time, money, and attention) are being allocated from the end of the health care value chain (treatment and aftercare) to the beginning. There will be a greater focus on promoting healthy lifestyles, vitality, and wellness; on primary and secondary prevention; and on early diagnosis. 15 2021 global health care outlook7 Care model innovation Health delivery organizations (HDOs) around the world are struggling to solve long-present challenges of health care affordability, access, quality, and efficiency. However, existing care models can impede their efforts to adapt and evolve for the future, even as COVID-19 accelerates the imperative to transform (see sidebar, “COVID-19s impact on care delivery model transformation”). Health care delivery models today are oriented around the provider, primarily focused on physical health, and prioritize location and payment model over consumer needs. Experiences are fragmented, transactional, and analog, with redundancies, misalignment, and disconnected interactions common among functions and stakeholders. These characteristics can intensify existing operational and organizational headwinds pushing against efficient and effective health care delivery. COVID-19S IMPACT ON CARE DELIVERY MODEL TRANSFORMATION 18 The health care delivery landscape and the behaviors of consumers it serves have pivoted dramatically amid COVID-19driven public health and social needs. New preferences and practices are likely to remain in place postpandemic, accelerating the imperative for HDOs to transform care models to remain relevant: Site of service and care transformation. Consumers expect providers to meet them where they are and deliver care on their terms to ensure the utmost safety, security, and seamless engagement experience. Ubiquitous adoption of virtual care. Increased adoption of provider-to-patient and provider-to- provider interactions in virtual settings is making it more convenient and cost-efficient to monitor, sense, diagnose, intervene, and treat acute and chronic conditions. Workforce reimagined. Workplace dynamics and practices are changing to address capacity and demand challenges; examples include remote working and virtual delivery, multidisciplinary teaming, and increased automation to reduce administrative burdens. New partnerships and markets. Competitors are creating nontraditional and public-private partnerships to better serve the community; struggling small or boutique health organizations are merging with/being acquired by larger ones that have withstood the pandemics economic impacts. Emerging disruptors. Giants from other industries are aggressively making moves to enter or expand in the health care space (e.g., targeting rural areas and pharmacy delivery, pursuing market dominance in remote monitoring). Health equity. Public and private health systems are addressing the remediable disparities in health between race and socioeconomic status by offering more affordable, accessible, and equitable health services. Accelerating industry change
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