6. Healthcare

6.6 Result

That concludes our work on designing a new healthcare system.
Its essential features are:

•  regular, bundled preventive health checkups

•  one doctor and two nurses per 100 citizens

•  completely state-organized healthcare system

•  health data managed by the state, extensively analyzed

•  a health app for information, evaluation, and appointment scheduling

•  doctors paid based on satisfaction, competence, and efficiency

•  polyclinics with specialist doctors in pairs to achieve greater efficiency

•  elimination of the least efficient treatments when the system's utilization is too high

•  simulation of the entire system in the computer (utilization)

•  hospitals under the responsibility of the counties

 

It is a much more complex system than those presented in the last chapter. It still costs a lot of money, but in return it provides citizens with a level of healthcare that is appropriate to the importance of our health.

Each of us only has one body. Once its health is gone, everything else suddenly becomes unimportant. Good healthcare is not just an ethical issue. Economically, it is much better for a state to keep its population healthy, so that workers can actually work well.

A prerequisite for this futurity to actually be desirable is that we are willing to entrust the state with all of our health data. The state must therefore be trustworthy and robust enough that we do not regret this decision. We will work on a draft for a novel state system in the 10. Chapter “State”.

Let's return to our example, the stressed, overweight smoker from the beginning of the chapter. How would he have fared in our new healthcare system?

It is determined at his first annual preventive checkup that he is in poor physical condition. The doctor gives him advice on how to change his lifestyle and what risks he otherwise runs (for example, that of a heart attack). The doctor also explains to him how to recognize a heart attack and how to behave in that situation. This reduces the risk of a silent (i.e., undetected) heart attack, and such an explanation can also be frightening enough that the patient actually changes their behavior. If the patient already has high blood pressure, they will receive medication for it. Finally, the patient will receive any vaccinations they are due for. He's already here anyway, so it's easier to follow the doctor's advice on that.

A year later, at the next checkup, the doctor has significantly more options. Firstly, he can compare how the patient's health has changed over the year. Has he gained more weight? What does the CT scan of the lungs look like now, compared to last year? Has the blood pressure increased?
Furthermore, the patient's data from last year, like that of all citizens, has been analyzed many times throughout the year by algorithms. As a result, the doctor can now tell the patient much more precisely the risks they are taking with their lifestyle: the percentage risk per year of having a heart attack, of developing diabetes, increased risk of death, and so on. Also data on how much the patient can improve their outlook by losing weight, exercising, quitting smoking. With this material, the doctor has a better chance of convincing the patient of the need to change their lifestyle.

Of course, it's the patient's decision how they live their life. But this healthcare system gives them early warnings if something goes wrong. If it is something where subsequent damage can be prevented through medical intervention (for example, with medication for high blood pressure or diabetes), then this intervention will take place early. If it's a decision the patient can make on that day (like a vaccination), he's much more likely to follow the doctor's advice than if a separate appointment were necessary. Because the right decision is the easier one for him (this principle is called “nudging”). If it is something that only the patient can change themselves (like exercising), they receive the warning early, and the information they need to make an informed decision.

And if the patient does end up in the hospital, at least it has no financial incentive to perform every possible operation on them. Instead, the hospital only wants to achieve the best possible patient satisfaction and a good competence rating.

Review of Requirements

Requirement	Features of this Futurity
low demands on people’s character	•  payment of doctors based on competence and patient satisfaction •  review based on citizens' health data
no world government	unproblematic
costs considered	•  cost estimate done •  focus on cost reduction (e.g. polyclinic)
automatic adaptation to a changing world	•  automatic adjustment of the list of paid treatments and medications •  extensive autonomy for doctors (working hours, division of labor, equipment)
help citizens keep up with change	•  health app for organization and overview •  annual consultation with family doctor •  bundled preventive checkups
promote technological development	•  competition between doctors through reserve capacity (80% utilization target)
resilience to withstand adversity	•  reserve capacity (80% utilization target)