Digital innovation – what does it really mean?

Digital economy ministerialMinisters, the business community, civil society, labour and the Internet technical community will gather in Cancún, Mexico on 21-23 June for an OECD Ministerial Meeting on the Digital Economy: Innovation, Growth and Social Prosperity. Today’s post is by Paul Chaffey, State Secretary in the Norwegian Ministry of Local Government and Modernisation.

Some weeks ago the last video rental store in Oslo closed down. In 1990 there were 3500 such stores in Norway. Today there are only a few left. How could that happen?

Digital distribution has taken over many value chains in the last ten years. As we know, the marginal cost of such distribution is near zero. Thus, music, films, news stories, maps, encyclopaedias, books, charts, etc. may be made available for millions of people at almost no cost at all.

Digitalisation of goods and services destroys established business models and disrupts existing value chains. New value chains emerge. This is often called disruptive innovation. Digital technology influences the way we organise various economic sectors in a very profound way already. And this is only the beginning. More and more business models and value chains will be disrupted. Examples are plenty – the Nordic music streaming service Spotify pushed down CD sales almost overnight; Netflix is on the way to pushing out linear television from our homes; Facebook is in the process of taking over the media business; and Uber poses a serious challenge to the taxi business in many countries.

The music industry story is a case in point that illustrates that the denial of the looming technology development is not a very good strategy to adopt in a long term. Even if we know that employment in the CD-producing and distributing industry will decrease, we must realise the enormous possibilities new digital technologies afford us to develop whole new industries and to create new employment opportunities. That’s why all CEOs and public sector managers should acquire strategic ICT-knowledge – to be able to monitor and follow up on this development. Digital technology is a great driver for change and it creates the opportunities for new and improved business processes, new products and new services all the time. If you do not follow, you will be eliminated.

Understand value creation potential

It is crucially important to understand the drivers for this development and the paradigm shift that has happened the last few years when it comes to availability of new digital service platforms. The potential for value creation that springs from this development is twofold:

  • Ability to solve great societal challenges by harnessing digital innovation.
  • The added value that smart digital applications represent in a commercial. environmental and social context, including new employment opportunities.

The potential for value creation lies at the crossroads of new technology, new business models and the knowledge and competences of the workforce. It is up to our political will to make it happen.

A good starting point

Norway has a good starting point to succeed with value creation based on digital innovation:

  • We have a highly educated population with high participation in the labour market.
  • We have a highly productive and adaptable work force with employees thriving in their workplace, taking responsibility and accepting responsibility.
  • We adapt to using new technologies very quickly, both as private persons and businesses.
  • We have a digital infrastructure of high quality and high penetration – both mobile and fixed.

Let me mention some examples of Norwegian digital innovation agility. The municipal commuting company in Oslo – Ruter – has developed an app to buy all kinds of tickets for local transport. No cards or card machines are needed any more – you can buy your ticket (with all kinds of duration) anytime, anywhere.

Our tax authority has totally digitised tax returns – as a citizen, you actually do not need to do anything to hand in your tax return. It will be posted on the government website Altinn where you may view it, and you may change it – but if you do not have any remarks, you just do nothing. Most of Norwegian population are now “digital taxpayers”.

The last example concerns a new app for state employees to hand in their travel expense reimbursement claims. This may be done entirely on your smartphone – you just snap a picture of all paper receipts and upload it to the government website. This was made possible by changing the government regulations to drop the requirement for physical paper receipts to be enclosed to your reimbursement claim.

ICT and digitalisation, a crucial factor for innovation and productivity growth

Innovative use of digital technologies increases the competitiveness of our businesses and contributes to society’s total productivity. It is the foundation of our future welfare as a nation. Thus we as a government must create favourable conditions for digital innovation to thrive. We need to adapt our regulations, remove obstacles to digitalisation and secure a first class digital infrastructure offering communication services of high quality. We also need to ensure that the availability of digital competences and skills meets the demand in both the private and public sector.

Digitalising the public sector to reap benefits – care technologies

Digitalising the public sector is a high priority for the Norwegian government. State agencies and municipalities offer more and more digital services and the use of these has significantly increased over the last few years. Within our health and care sector, we are aiming for a country-wide rollout of digital care services in our municipalities. Care technologies represent a relatively new business segment with great potential for saving costs for care services and affording home-tailored, safe solutions for elderly and chronically ill citizens at the same time.

Taking a wider view, this technology may have a revolutionary impact on the whole health and care sector, by preventing quality decline that would inevitably come when the demographics kick in.

Today, a large portion of care workers’ time goes to looking for information from various sources, travelling from place to another place, collating and handing over information to others, instead of doing their actual job. Efficient use of digital care technologies could provide real time support for various tasks and enable seamless communication between various entities involved in patient and elderly care.

We have conducted a series of highly successful pilots about care technology use in various municipalities in Norway. These projects demonstrated a great potential for cost savings and better quality of care. What we learned from them is summarized below.

  • Successful implementation of assistive technologies and remote care largely depends on the involvement of the users – citizens – at an early stage, and careful consideration of their capability of and interest in benefitting from the technology.
  • Close cooperation between the health and care services and the technology providers is essential to optimize the functionality of devices and services to meet the needs of both care workers and the citizens.
  • Benefits of care technology rollout will materialize over time. However, the introduction of new technology requires implementation of change management in the public sector. Service design may be an important methodology to lean on here.
  • National coordinated approaches are needed to scale the use of care technologies to the whole of the public sector and create conditions for a thriving care technology market.

This is digital innovation in practice – and we need to make it happen to be able to care for an increasingly old population. This is also a unique opportunity for our ICT-businesses to develop solutions for a global market.

I am looking forward to discussing digital innovation at the forthcoming Cancun Ministerial on digital economy.

Useful links

Effekter av teknologiske endringer på norsk nærings- og arbeidsliv

Kronikk: Når digitaliseringen kommer og tar oss

Årskonferansen 2016: Remix – det nye arbeidslivet

OECD work on Innovation in science, technology and industry

OECD Digital Economy Outlook 2015

The doctor will see you now (if you turn on the video) Mark Pearson on OECD Insights


Stepping Up to Tackle Mental Ill-Health

mental healthStefano Scarpetta, Director, OECD Directorate for Employment, Labour and Social Affairs, and Francesca Colombo, Head of the OECD Health Division

“Mental health issues exact a high price on individuals, their families, employers and the economy,” said OECD Secretary-General Angel Gurría, “Policymakers have been too slow to act. Strong political leadership is needed to drive reform and tackle this issue.”

Winston Churchill, Virginia Woolf and millions of others have suffered in the past or still live with mental illness. As many as half of all people in OECD countries can be expected to suffer from mild to moderate mental ill-health at some point during their lives. And yet despite the scale of the problem, mental illness is still too often a second thought for health systems, and a forgotten issue for policy makers. For too long the widespread worldwide burden of mental illness has done little to galvanise a policy response: those suffering from mental ill-health often experience prejudice and fear, struggle to get the treatment they need, and are more likely to experience unemployment, inactivity and physical ill-health than the rest of the population.

The OECD has long been shedding light on the unacceptably high personal, societal and economic burden of mental ill-health. For several years, we have recommended policies countries need to introduce to tackle mental illness, to give those affected the care and services they deserve. In OECD’s Making Mental Health Count we show that there are unacceptable treatment gaps for mental illness, even in the most advanced countries. Too many people go without treatment or wait too long for treatment and are unable to access the most appropriate treatment. Evidence-based treatment for mild and moderate mental illness is often unavailable, patients have to wait a long time, or face high costs. For severe illnesses, comprehensive treatment plans tailored to patients’ needs are few and far between. The outcomes tend to be, as one could expect, poor. OECD data show that in Denmark, New Zealand, Norway, Sweden and Korea, individuals with bipolar disorder or schizophrenia have a mortality rate some 4 to 6 times higher than the general population.

Mental illness does not just reduce the wellbeing of affected people and their entourage. The economic costs of mental-ill health are high, too, as they can exceed 4% of GDP. The OECD report Fit Mind, Fit Job suggests that people with poor mental health are much less likely to be in work, and, when employed are more likely to be absent from work. Depending on the severity of the mental illness, the employment gap can be 15 to 30 percentage points relative to the rest of the population. Not surprisingly, people suffering from mental ill-heath face a risk of poverty that is 30% to double that of the total population.

There are better ways to tackle mental ill-health. Evidence-based services – like psychological therapies, early intervention approaches, or pharmacological therapies – should be made more easily and quickly accessible. We need front-line public servants – GPs, nurses, teachers, social workers – to understand how to spot the signs of mental illness, and to know where to direct people to get help. Employment and health care services ought to act fast – and work together – when mental health problems are recognised or diagnosed. We need better policies to allow those affected by mental ill-health to find jobs, to be fully productive at work and avoid protracted periods on sick leave when they would do better on the job.. Public policy, while essential, is not enough: we need to involve employers and social partners in the required actions to make the labour market inclusive for people with mental ill-health. And we need to act early because the onset of mental health problems is typically during youth and adolescence. Young people seek help even less than others but their education success suffers significantly thereby further impacting on their labour market chances later in life.

It is encouraging to see that policy makers are finally grappling with these challenges. Besides its analyses and striking statistics, the OECD Recommendation of the Council on Integrated Mental Health, Skills and Work Policy provides a set of policy principles that help countries address, through an integrated approach, the impact of mental health problems on health, education, employment and social outcomes. This Recommendation, to which all OECD members countries have adhered, sends a very clear message: that mental health must be at the heart of health, employment, education and social policy making, giving countries the impetus to make this commitment a reality. Mental health is finally moving to the top of the global agenda, too. Political leaders, international leaders, thought leaders, and policy makers worldwide are slowly waking up to decades-old cries of campaigners, patients, families, and sufferers, and looking for ways to bring mental health care out of the shadows.

The status quo on mental health is no longer acceptable. The message is clear: we must all step up, together, to tackle mental ill-health. Now, it is the time to do it.

Useful links

Mental health systems in OECD countries

Mental health and work

The doctor will see you now (if you turn on the video)

health workforceMark Pearson, Deputy Director, OECD Directorate for Employment, Labour and Social Affairs. Also published by Europe’s World

An elderly man with cardiovascular disease tests his own blood pressure, and sends the results to an online application that his doctor can access. Another patient with depression living in a rural area far from health services tells a psychiatrist how he is feeling via a video connection. All of this occurs without the patients leaving their homes.

These scenarios may sound like something scripted by writers of science fiction, but such ‘telehealth’ has the potential to bring high-quality and specialised care to previously underserved populations. Studies indicate patients respond positively to using the technology, and it increases access to health services. Health professionals report that it reduces the need for patient visits, and assists with clinical decision-making. There is also evidence suggesting that telehealth can improve patients’ ability to manage their own health, not to mention lower the cost of healthcare through fewer hospitalisations.

Despite this clear advantage, health systems have yet to abandon their hospital-centric approach to care. If telehealth is such a good idea, why is not being given wide support? One of the most intractable problems holding the service back is a much-needed rethink of the types of workers we will need in future health systems.

Up until now, much of the discussion on the healthcare workforce has centred on the shortage of doctors or nurses. It’s true that many doctors in particular are approaching retirement and will soon need to be replaced. An OECD report released this month shows that countries have substantially increased their training of doctors and nurses, and the numbers are growing. But this is an expensive approach. A recent report by the UK’s National Audit Office has indicated it takes three years and costs about £79,000 to train a nurse, ten years and £485,000 to train a general practitioner, and 14 years and £727,000 to train a specialist. These huge investments deliver healthcare professionals with astonishing skills, but regrettably we do not always take advantage of these skills wisely.

There is evidence of a considerable skills mismatch in the health sector, with a large proportion of health workers over-qualified for the work they do. The 2011-12 OECD Programme for the International Assessment of Adult Competencies survey showed that between 70-80% of doctors and nurses report being over-qualified for some aspects of their work. This suggests an inefficient use of their time and a waste of human capital. To be blunt, is it really worth ten years of training someone to spend much of their day looking into children’s ears to confirm that they are a little bit red and might require some basic antibiotics? Is there not a way their skills could better serve the population’s health?

At the same time, after all that training, about 50% of doctors and 40% of nurses report being under-qualified for some of the tasks they have to do. Education and training programmes need to transform so as to make health workers ‘fit for practice’. The outlook at present is discouraging, as many health programmes teach little about the skills we know to be needed in future systems such as ICT and people management.

Perhaps the biggest challenge will be to rethink ‘who does what’ – or ‘scopes of practice’ in the health jargon. This means letting appropriately-trained clinicians perform tasks they were previously not permitted to. The most common example of this is the nurse practitioner. In some countries, these more advanced nurses, who usually have a Master’s qualification, can prescribe limited medication and order diagnostic tests under controlled conditions. An OECD review in 2010 showed that advanced-practice nurses are able to deliver the same quality of care as doctors for a range of patients. Most evaluations find high patient satisfaction, mainly because nurses tend to spend more time with patients as well as provide more information and counselling.

Is it so difficult to imagine that diabetes workers, when backed with strong ICT support and clear protocols about what to do when symptoms are not within a prescribed range, can be trained to ensure that treatments are followed correctly, leaving those with more expertise to focus their attention on problematic cases? The barriers to realising this vision remain considerable. There are strong lobbies against change, particularly by professional associations. Policymakers need to engage these groups boldly, so they too can begin to see change as the tremendous opportunity to gain new skills and focus on what they do best, rather than succumbing to the impulse to feel threatened.

Traditional roles and responsibilities need to transform, and alongside them so do the antiquated ways of thinking. The evidence base for change is growing, but it needs to be matched by a growing political will. The question is, are governments bold enough to meet the challenge?

Useful links

OECD health statistics

OECD health workforce project

Health workers with right skills in right places needed

Health policies and data from the OECD

Where do OECD countries stand in the “war against cancer”?

SA10519_WCD_Logo_(offene Version)

Gaétan Lafortune, Senior Economist and Principal Administrator, OECD Health Division

In his State of the Union address in 1971, President Richard Nixon declared a “war on cancer”. World Cancer Day provides a timely opportunity to reflect on how much progress has been achieved over the past 45 years in the United States and other OECD countries in winning this war.

The good news is that after a poor initial start in the 1970s and 1980s, the mortality rates from cancer (age-standardised to remove the effect of population ageing) have come down in most OECD countries since the mid-1990s, thanks to a reduction in important risk factors such as smoking and improvements in survival related to earlier diagnoses and better treatments. But still, all countries could do better in their fight against cancer to reduce the number of new cases through public health and prevention efforts, and by detecting cancer earlier and treating it adequately.

Large reduction in cancer mortality rates on average across OECD countries since early 1990s

fig 1

Source: OECD Health Statistics 2015, (extracted from WHO).

There were nearly 5.8 million new cancer cases in OECD countries in 2012 (up from 4.6 million a decade earlier) and 2.6 million deaths (up from 2.3 million a decade earlier), according to GLOBOCAN. Cancer incidence is higher in men than in women in all OECD countries, with average age-standardised incidence rates of 310 and 242 per 100,000, respectively.

Data recently reported in Health at a Glance 2015 show that cancer accounted for 25% of all deaths in 2013, up from 15% in 1960, mainly because there has been a much sharper reduction in deaths from cardiovascular diseases over the past 50 years. In several OECD countries, mortality rates from cancer among men are at least two times greater than among women, because of greater prevalence of risk factors (e.g., smoking and harmful alcohol consumption) and later detection.

Cancer Mortality, 2013 (or latest year)

fig 2

Source: OECD Health Statistics 2015, (extracted from WHO).

Information on data for Israel:

Lung cancer continues to be by far the main cause of cancer mortality among men, accounting for 26% of all male cancer-related deaths on average in OECD countries in 2013, but it is also the main cause of cancer mortality among women, accounting for 17% of all deaths. Breast cancer is the second most common cause of cancer mortality among women in OECD countries (15% on average).

Main causes of cancer deaths among men and women in OECD countries, 2013

fig 3

Source: OECD Health Statistics 2015, (extracted from WHO).                

The cost of cancer goes far beyond health care

Beyond the costs in terms of human lives, the economic costs of cancer are also considerable. Cancer consumes around 5% of all health care costs, and growth in spending on cancer is outstripping growth in total health expenditure. But the cost of cancer is not only borne by health systems. There are also opportunity costs related to the loss of productivity and working days.

In a population-based cost analysis in the Lancet, the economic burden of cancer across the European Union was estimated at €126 billion in 2009. Health care costs accounted for €51 billion, equivalent to €102 per citizen. Productivity losses because of early death cost €43 billion and lost working days €9 billion. Informal care costs – the cost of work and leisure time carers forgo to provide unpaid care for relatives or friends with cancer – amounted to €23 billion. Lung cancer had the highest economic cost of €18.8 billion.

Much more can be done to improve cancer care, but at what cost?

OECD research indicates that countries can do more to reduce the social and economic costs of cancer, and save lives. Survival after diagnosis of various types of cancer, such as breast cancer, cervical cancer and colorectal cancer, have generally increased over the past decade, thanks to earlier diagnosis and better treatments.

fig 4

Further progress is possible. It has been estimated that about one-third of cases could be cured if they are detected on time and adequately treated. Systematic screening of at-risk populations should be implemented where it is proven to reduce mortality, where cost-effectiveness is acceptable, where high quality is assured and the public is educated about the benefits and potential harms of screening.

Making cancer care rapidly accessible and of high quality, continuously improving services with strong governance such as a national cancer control plan, and monitoring and benchmarking performance through better data are also important in improving patients’ outcomes.

But the progress in cancer survival has come with a cost. New types of surgery, radiation therapy and chemotherapy (including the introduction of new high-cost drugs which in some cases prolong the lives of patients by only a few weeks) have contributed to increased survival, but at increasing cost. And it is likely that these costs will continue to grow, with population ageing and improved sensitivity of diagnostic tools leading to the detection of more cases. This will all add up to higher costs.

An important challenge in cancer care that many OECD countries have already started to face is balancing what may be doable given the growing range of possible treatment options and what may be sensible to pay for publicly. Economists can provide some guidance in making difficult decisions about resource allocation through cost-effectiveness analysis. But at the end of the day, it will require hard policy decisions to manage these fiscal challenges responsibly and sensitively.

Useful links

OECD Health Statistics 2015 The OECD Health Database offers the most comprehensive source of comparable statistics on health and health systems across OECD countries. It is an essential tool to carry out comparative analyses and draw lessons from international comparisons of diverse health systems.

Time for your check-up

How much do you know about health? Take the OECD Health at a Glance 2015 quiz and find out. The data visualisation below will help.

Today visionary, tomorrow down to business: Health and the Sustainable Development Goals

Eduardo Pisani, Director General of IFPMA – the International Federation of Pharmaceutical Manufacturers and Associations.

As our heads of state prepare to meet later this month in New York at the United Nations General Assembly (UNGA) to adopt the Sustainable Development Goals (SDGs), including the vision of Universal Health Coverage, I will allow myself a moment to appreciate the magnitude of the promise we are making to future generations.

The adoption of the SDGs gives governments and those of us involved in the health community a chance to embrace a vision as fundamental as the Declaration of Human Rights when it was adopted by the UNGA in 1948. It is one of the few occasions where we are not over-dramatizing the point – the next generation will judge us on whether we measured up to the challenge.

I am sure many of us will feel the magnitude of this moment. However, I am also in no doubt that after the meeting we will have to roll up our sleeves and get down to work. From the innovative pharmaceutical industry’s perspective, we are in a good shape to lead the way in some areas; in others we will need to get stuck-in and work through the difficult questions in partnership with others.

Valuable lessons from the legacy of the MDGs

Since the launch of the Millennium Development Goals (MDGs) in 2000, those of us working in global health have learned a lot.

We have learned it is possible for the world to come together in the pursuit of shared goals for a common good. Our sector has a considerable track record in this area but though we can measure up with the best of them (Ref UN Global Compact), we won’t be able to rest on our laurels.

We have learned that just in fifteen years we can halve the global deaths attributed to some of the world’s biggest killers such as TB or malaria. However, with chronic diseases increasingly threatening low- and middle-income countries, these advances may be short-lived. We need new strategies in face of the influx of these chronic, and to a large extent preventable, diseases. And so, in addition to discovering and researching new treatments, innovative pharmaceutical companies are looking to creative ways of leveraging the knowledge and expertise of local governments, industry and civil society, using new technologies to reach the greatest amount of people possible.

A great example is Be [email protected], Be Mobile, a multi-sectoral partnership we’re contributing to that uses mobile phones to tackle chronic diseases, spearheaded by the International Telecommunications Union and WHO, and supported by NGOs, the private sector and the African and Asian development banks.

Lastly, with the Ebola outbreak, we have very recently learned what it means to be unprepared, to come up short in the face of a crisis and see health systems collapse under pressure, and how quickly the repercussions can be felt around the world. While our pipelines are yielding new treatments and vaccines to contain this disease, we are reminded once again of the importance of resilient health systems in face of future epidemics. This is where the powerful concept of Universal Health Coverage comes in.

Universal Health Coverage at the heart of sustainable development

Universal Health Coverage (UHC) is at the core of the SDG for health, promising all the right to basic health care without financial hardship. UHC means a parent living in a rural India can reliably provide insulin for their child living with diabetes, it means a woman in Colombia will be screened for breast cancer so she can begin treatment before it is too late, it means a health center in Guinea that receives a patient infected with Ebola virus has the capacity to prevent further transmission in the community and to its health care workers. It means more than access to medicines alone.

With 400 million people lacking access to basic health care and many millions more lacking regular access to essential medicines, no one would say guaranteeing health as a right for all is an easy feat. To promote a mission as grand as UHC, we will likely find ourselves in partnerships that move beyond the vision of the SDG for health and the global health community, also tackling challenges around water and sanitation, urban living, education and climate change through convening fora such as the United Nations Global Compact.

As such, it is no accident that the 17th goal of the SDGs is one dedicated entirely to the promotion of partnerships. Whereas partnerships in the health sector are by no means a new phenomenon, partnerships looking forward will be characterized not only by their ability to sustainably serve the needs of populations, but also by an increased linking up of diverse sectors. As stated by the OECD in its 2015 Development Co-operation Report, “with the growing diversity of partners involved in development co-operation, it is more important than ever to avoid duplication of effort and fragmentation.”

Excellent examples of multi-sectoral partnerships already underway include GAVI, a global vaccine alliance between public, private and civil society sectors which has delivered 500million vaccines to children over 15 years; 4 Healthy Habits, an initiative between the pharmaceutical industry and the International Federation of Red Cross and Red Crescent Societies (IFRC) to promote healthy behaviours at community-level and fight chronic diseases; and the Global Health Innovative Technology (GHIT) Fund, a partnership between the government of Japan, the Bill and Melinda Gates Foundation and the Japanese pharmaceutical industry to research and develop new medicines to combat infectious tropical diseases. As the common thread throughout, the pharmaceutical industry supports efforts towards UHC. In 2014, we identified a set of guiding principles in the areas we believe our industry can contribute, and with the adoption of the SDGs we are galvanized. The SDGs will require pooling resources, expertise and working together across sectors as well as with governments and civil society like never before; luckily, we are not starting from scratch.

Click to view full size

There is increasing recognition that providing quality health coverage is a key contributor to the wealth and economic productivity of countries. As I look ahead to this next generation of targets, I am confident that though challenges remain, we are well placed to rise to the occasion. Achieving these new goals and closing the gaps in health coverage will take commitment and creative thinking, as well as cross-sectoral partnerships, and this is enthusiastically welcomed by myself and my colleagues in this industry.

Useful links

OECD work on health

Health systems are still not prepared for an ageing population

The number of over-80s has doubled
The number of over 80s has doubled

Today’s post is by Francesca Colombo, Head of the OECD Health Division

That population is ageing across the world is well known. As fertility rates drop and life expectancy improves, a bigger share of the population is greying. At least one in four people will be aged over 65 by 2050 in about two-thirds of OECD countries. The share of those aged over 80 years will more than double, from 4% in 2010 to 10% in 2050. In Japan, Spain and Germany, this trend will be even more pronounced, with the proportion of the over-80s expected to triple, rising from 5% to 15% in Spain and Germany, and from 6% to 16% in Japan. The speed of ageing will be even more dramatic in some emerging economies. China, for example has taken only 40 years to increase life expectancy from 40 to 70 years, something that took Germany 80 years.

Such a demographic shift has an impact on societies and economies. The size of the workforce will shrink, putting pressure on governments to reform labour markets, pension entitlements and retirement age thresholds, so that older people can remain productive and employed longer. We’re already seen employment rates of older people improving over the past decade in many G20 countries. Rising education levels and skills will help more people work for longer periods of time, although differences in opportunities throughout individual life-course trajectories will affect their ability to remain fit for work as they grow older. The experience individuals gain through education and work will help to raise productivity and keep economies growing as populations age.

In the face of the speed of population ageing, though, our health systems are still too slow at reforming and remain ill-prepared for the consequences of greying societies.

The health care delivery model prevailing today has not kept pace with the changing epidemiology and health needs of the population. The focus often remains on building new hospitals, buying expensive new equipment and upgrading acute service delivery structures. The management of care processes remains to a large extent focussed around episodic care needs. However, population ageing requires a different approach, involving a shift from acute, episodic and hospital centric care to the management of chronic conditions, the delivery of continuity of care across different care settings and providers, and a strong role for primary care professionals such as general practitioners.

A main challenge will be the management of complex combinations on chronic conditions. In many OECD countries, more than half of individuals aged over 65 have more than one chronic condition, and from age 75, many people will have three or more. Health and social care systems are still grappling with how to manage the diversity and uniqueness of this complex combination of diseases and care needs in an effective way, in relation to how to organise care teams, how to identify the right measurement metrics, or how to equip health professionals with the skills they need to address changing population structures and epidemiological profiles.

A compelling example of how health systems struggle to respond adequately to the rising complexity of population ageing is dementia. Dementia affects a growing number of people worldwide – currently estimated at 47 million but expected to rise to 76 million by 2030. In the OECD, France, Italy, Switzerland, Spain, Sweden and Norway have the highest prevalence rate, with 6.3% to 6.5% of the population aged 60 years and over now estimated to live with dementia. For a person affected by dementia, the outlook is pretty grim. For a start, there is no cure as yet nor disease-modifying treatment. Several clinical trials have failed miserably in the past. There is hope that international processes – started with the G7 Summit in London in December 2013, continued with G7 Legacy Events during 2014 and ending with an international Health Ministerial Conference hosted by the WHO with the support of the UK government and the OECD in Geneva in March 2015, will bear some fruit.

But beyond changing incentives for public investment in research and encouraging private investment to finding a cure, the lives of people living with dementia remains poor in most countries. This must change through training doctors and caregivers, and equipping them with better tools to assess the needs of people with dementia; facilitating improved care co-ordination, particularly across health and social care services; and encouraging a better focus on measuring outcomes for people with dementia (such as quality of life, safety of services and medical products, effectiveness and responsiveness), as well as for the many families and friends who look after people with dementia. OECD work has shown 10 basic features that would make a differences, ranging from minimising the risk developing dementia to unleashing the potential of technology to support people with dementia, and helping people die with dignity.

Underpinning some of the difficulties of health systems in addressing population ageing is a failure to understand and monitor adequately the care processes through the data we have today. In an era of ‘big data’, health systems remain poor at using the massive amount of administrative, clinical, population-based, and biological data that are routinely generated from the millions of contacts individuals have with different parts of the health system. Most often, such contacts remain unrecorded; or records are paper -based, not standardised, nor shared across the care pathway. To improve care for old patients with complex care need, we need these data to be stored and linked so as to display a more granular picture of the quality of the care delivered to patients, especially those affected by chronic or multiple chronic conditions. Addressing weaknesses in the governance of this data infrastructure, including through generating better outcome measures to monitor care delivery and through enabling a privacy respectful use of personal health data, will be key priorities for the future.

Useful links

OECD work on health policies and data