Bogi Eliason, futurist and associated partner at Copenhagen Institute for Future Studies

Moving Denmark’s Healthcare Sector towards a Welfare State 2.0

During the next 20 years, Denmark will experience a radical change in its population demographic. By 2040, the number of citizens over the age of 80 is expected to double. This will present new demands and strains on the healthcare sector. Not only do we need to shift our paradigm from treatment to ­preventative healthcare, we must also decide how to effectively use our data to improve care delivery, streamline operations, and optimise patient outcomes.

In Denmark, we have an outdated and harmful perception that our healthcare system is effective and sustainable, despite the fact that it is over 150 years old. According to futurist and associate partner at Copenhagen Institute for Future Studies, Bogi Eliasen:

“Back then, there was a need for hospitals where people were treated for their symptoms and diseases. We still think of our hospital and healthcare today as institutions that can take care of patients who become acutely ill. But in the future, we will have to do more than treat the sick and the weak. For this, we need to have a much greater focus on prevention.”

The time has passed where we could remain anonymous citizens. We need to develop a system and framework where people and the system can use data for mutual gain
Bogi Eliasen

As a society we need to take action now so that the healthcare system does not eventually break down from a lack of capacity and financial instability.

By 2040, the number of citizens over the age of 80 is expected to double (Source: The Danish Committee for Health Education). Dramatic shifts in demographics will pose a two-sided challenge to the healthcare system: a rising demand for healthcare combined with an aging workforce. Increased life expectancy and end of life care will be difficult to finance when the workforce – correspondingly – declines in proportion to the number of citizens over age 65.

The aging population will put an increased strain on the healthcare system, as costs will continue to rise if we run the system the same way we do today. According to Eliasen:

“Determining the resources required to anticipate and respond to this demand is contingent on a number of factors, including technological advances in diagnostics, treatment, and the expectations of the elderly for the healthcare system and aging generally. Today, we treat patients for illness and disease when they have obvious symptoms. These symptoms already manifest late in the disease process (e.g., dementia) and are probably a whole lot more expensive than if we were to find a more effective way to identify and treat disease earlier.”

On average, the last 30 years Danes have gained 10 years longer life expetency of which 5 years are with increased diesese burden.

Changing philosophical approaches to improve outcomes

Instead of viewing the elderly population as a burden, we ought to focus on how we can deal with the challenge proactively – today and into the future – through preventative measures and health promotion. For many Danes, chronic diseases are a daily struggle and the number of diagnoses has increased in recent years, partly because of better living conditions and opportunities for treating diseases that were previously life-threatening.

As Eliasen explains:

“One third of the population lives with one or more chronic diseases. Since this affects a large number of Danes, we must focus on how we are investing in healthcare funds. Currently, almost every penny goes towards treatment and there is very little earmarked for prevention. Healthcare professionals, policymakers, and the general public have to start thinking about prevention and healthcare funding in a different way to improve outcomes for everyone, particularly quality of life and well-being. The healthcare budget should be seen as investment, not cost.”

A sustainable welfare state

Since 1968, the Danish government has registered its citizens every time they interact with the public sector. Fortunately, this has given us a large amount of data that can provide us with an accurate picture of our overall health and disease progression. The volume and depth of that information has increased significantly over the past two decades and will continue to grow in the years ahead.

“We have enough data to see that ‘one size does not fit all’ and average treatments and disease courses are not the right way to think about welfare. We must recognize that it is no longer sufficient to regard health services as a public service you are entitled to when you are ill. As a citizen you have to take more responsibility and have more insight into your own data and what it means,” Eliasen says.

Source: KORA

For a number of years, both the citizen portal (borger.dk) and health platform (sundhed.dk) have been sources of personal information. These platforms create an opportunity for the Danish healthcare sector to offer targeted apps that can help citizens to identify solutions to prevent chronic diseases, especially life style diseases. Paraphrasing Eliasen, everything that can be done outside the hospital should be done outside the hospital.

This also means that municipalities will play an even bigger role in the future in educating children and adults on the importance of leisure activities, fostering good public spaces, and maintaining the environment that can enable individuals and communities to keep the healthy healthy.

Should the Danish state release citizens’ healthcare data?

“There are a number of reasons why data is not being released. The biggest challenge is that we are overly focused on producing data rather than using the available data. There is too much focus on innovation instead of implementing what we know will work. Today, the public sector owns controls your data and they can provide it to you when you need it. While your hospital record can reveal a lot, it is ultimately your behavior and overall health that will be crucial in the future.”says Eliasen.

We need to be more open and transparent

Danes need to be honest with each other and recognise that if we want to continue developing as a society, we need to harness and leverage our data. For Eliasen, the Danish welfare state is not as digitised as it needs to be and we need to engage in ideological and political discussions on the matter. Quite simply, if we want a welfare model in the future, then the public has to step up and take responsibility to create the framework for data use.

Eliasen claims that: “the time has passed where we could remain anonymous citizens. We need to develop a system and framework where people and the system can use data for mutual gain. It requires citizens to know who uses their data as well as when they use their data. In addition, the public sector should offer some form of dynamic consent, where citizens can decide for themselves which institutions have access to which data, where that is possible.”

With this approach to data, we will also gain more insight into our genetics and biological evolution. We will see ourselves from a different perspective and know more about our anatomy. Of course, biological insight comes with a host of ethical issues. Ultimately, Eliasen suggests “it is crucial to our health and to the welfare state of the future that we become more open to knowing about our body, genes, and health. Combining this knowledge with the behavioral and public data, that is where Denmark and the Nordic countries can both secure the Nordic Welfare Model 2.0 and be global leaders of the new health paradigm.”

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