The road to 2030

Where are we headed in healthcare?

Where will you be in 10 years? Watching your family grow, forging a career, enjoying retirement or slowing down with advancing older age?

Just as our requirements as individuals change over time, so do our healthcare needs alter with our changing life circumstances.

We need more care when younger (for baby health and immunisation) and older (for arthritis, heart disease or aged care), and for special circumstances (breaking a leg, having a baby, getting the flu). But what we often don’t think about is that the health system itself is evolving to support us. Drawing on research I’ve been conducting with colleagues in Australia and internationally, we can point to four key trends and one conclusion that will pave the healthcare road to 2030.

More people will live longer with more illness

Worldwide, people are living longer. In Australia a man who is 65 years old today can expect to live another 20 years, and a woman a couple of years longer. Already more than half a million Australians are aged over 85 years and this is on the rise. In addition, one in every two Australians is now living with the long-term burden of at least one chronic disease such as diabetes, heart disease, kidney disease, asthma or cancer.

Obesity is also concerning across all age brackets. It’s a slow-ticking problem, as being obese is associated with other illnesses such as diabetes, stroke, heart disease, some forms of cancer, breathing problems, gout and poorer mental health outcomes.

The challenge for the future health system will be to provide high quality, safe healthcare for growing numbers of people who are not only living longer but coping with more than one longterm illness. More people in the emergency room, the GP clinic, and in acute care puts more pressure on the system.

More changes will occur, rapidly

New medicines, technologies and ways of delivering services are emerging constantly. Whether or not they make it into the health system to benefit the community, however, depends on many factors. The availability of financial and other resources, the ability of clinicians and clinical teams to take them up, and the dynamics between policymakers, politicians and the expectations of the public, all play a part.

Right now, we are seeing the rapid advancement of artificial intelligence (AI), bringing with it considerable opportunities and risks. While AI can greatly improve some diagnostic services, particularly in radiology, there are many questions that remain unresolved around ethics (Should a machine’s algorithm decide on my care?) and the privacy of data (Who gets access to all the computer information AI generates?).

The health system of the future must be engineered to safely, ethically and effectively assess and manage rapid advances in technology, medicine and services. Otherwise, there will be diminished trust in the very system we need for our future wellbeing.

More care will be more personalised

Imagine having an instruction manual that predicts all the ways you will personally react to treatment for your diseases and illnesses. While in the future we will know so much more, already that instruction manual is being written, based on astonishing advances in genome sequencing.

It’s healthcare re-invented, custom-designed for the specific individual.

Scientists are learning how a change to a single cell could be the difference between inheriting a disease or not. They are also investigating what genomic factors determine how cancerous cells grow and replicate and what causes of an individual patient’s disease at the molecular level leads to, say, diabetes and cardiovascular disease. Clinicians will be able to prioritise your care based on this information. Understanding your biology and the prognosis of the diseases you might develop, and your likely responses to a specific treatment, means much better tailored care for you.

So, the good news is that clinicians will be able to use this ‘instruction manual’ to accurately map treatments to your individual needs. They and you will have so much more deeply insightful and accurate information available to make informed decisions—not only about what care might be best for you, but what recommendations you will choose to accept, reject or modify.

The health system will need to build supports around this powerful new paradigm. The new information systems, diagnostic capacity, genomic tests and clinical training will not be cheap. But many people think that price will be worth paying so that healthcare professionals know how best to apply the new knowledge, privacy issues are resolved, and patients are counselled and guided in their decision-making.

Fewer people will be admitted to hospital

In a time when we seem to be building large numbers of new hospitals and beds in every State and Territory, this fourth point might sound strange. But in the future, less people will be cared for in acute settings. Advances in technology and new models of care will mean that services will be available in the community that otherwise would have required a hospital visit. There will also be more emphasis on preventative measures that will keep people healthier longer and less in need of the type of acute care offered by specialists in hospital.

The federal government this year committed more than $11 million to research projects investigating how to keep people out of hospital and focusing on better management of heart disease, kidney disease, diabetes and mental health. That’s only a down payment on what’s needed.

Telehealth services, health apps and internetbased symptom-checkers are already emerging as key enablers. These services can be available online 24/7 and are an alternative to visiting the GP or emergency department for nonlife-threatening illness. There are simply more resources available to people seeking health information than ever before.

High quality, safe community-based services will also develop in tandem. It’s all designed to enable everyone, but especially older Australians, to stay at home longer and delay or avoid entry to hospital or residential aged care.

Our health system will evolve

Looking ahead, and with the benefit of rigorous and insightful research from both here and overseas, we can say with confidence that our health system will evolve, and it will be shaped to a considerable degree by the four trends I have outlined. It will be guided by people working in the system who care deeply about each other, their patients, the service they provide and the broader community. Most importantly, the leaders of this new caring system of the future will love new knowledge, and continuous improvement. It’s the only way for it all to work out well in the end.