In this series of short papers recommendations for policy goals in digital health are outlined. These recommendations have been derived through the exchange of thoughts with scientists, experts on healthcare policy making, and strategy specialists. Recommendation in part I address both the role of the individual and the role of reparatory medicine.
Recommendation I: We should INSOURCE HEALTH to a greater extent
Looking at the burden of disease from an economic perspective, the main cause is us, that is our way of living. This observation is not just for the individual who suffers from a disease. It describes only the economic view. However, there is a way to join the individual and the economic view in a fair way: If we manage to better insource health from healthcare to the individual, then most individuals will experience better health, the resources of healthcare can be better focused (this is the realistic version of “the healthcare system becomes cheaper”), and the negative economic side effects of disease can be significantly reduced.
What this does not mean and what it does mean
Insourcing health means that individuals take more responsibility for their own health, not less and not more. It does not mean that patients cure themselves (otherwise I would have recommended to insource healthcare instead of health, which I don’t do, except for obvious minor diseases). It does not necessarily mean that individuals necessarily live more healthily (risking your life with extreme sports is a decision which should be respected by others). It does not imply that unhealthy lifestyles should be punished through higher health insurance rates (because this would lead to more bureaucracy, which is unlikely to improve self-responsibility of citizens). It does not exclude social attempts to reduce the burdens of disease. It does not relate to e-banking, where administrative tasks are outsourced from banks to customers as it insourcing health is first and foremost a health issue, not an administrative e-health issue. But what it does mean is to fight the moloch of reparatory medicine, or rather to try to escape it.
Self-responsibility for your health goes hand-in-hand with a better self-awareness and a more conscious decision making in health issues. That is, insourcing health means knowing more and deciding more consciously. Therefore, by its very nature, insourcing has a strong focus on monitoring and prevention, but it also contributes to a better communication between patients and medical doctors or/and other healthcare professionals in diagnosis and therapy. The effect will be more healthy years for the individuals, less economic burden of disease, and a healthcare system which simply becomes better as it benefits from more informed and more informing patients.
How to implement
The implementation of a better or more advanced insourcing of health requires both technology and communication. Technology at its best is more than an enabler. At its best technology nudges common sense behavior. Equally, at its worst it redirects attention from the essential to the irrelevant. The rise of measurement gadgets and apps related to biodata and behavior provides examples of both. What we need are individual health portals, where individuals can combine the data collected about them, share them with doctors and offer them for research. These individual portals should host both data from gadgets and apps, self-created information from own observations, and data from professional diagnosis and therapy. But again, insourcing health only means exploiting the available data by extracting meaningful information, that is information that is meaningful for common individuals without special disciplinary knowledge. It does not mean that everyone has to measure his life 24/7 and in all aspects. Furthermore, when I advocate the insourcing of health, I do not have in mind to question the principal right of patients not to be informed.
The key function of the portal should be to provide the relevant information to the individual and to hide the irrelevant. Transparency always also implies the hiding of information, because every information highlighted creates a shadow for other information, and all information highlighted creates a shadow for all information. The goal of presenting the relevant information to the individual about her health is to enable her a.) to understand her health situation and to manage her own health resources, and b.) to understand which data she shares with others and what this means to her privacy. Such a transparency will nudge a considerate individual processing of health data, since it makes understanding their relevance much easier.
Of course, building such individual health portals is not good enough. They will have to be advertised through emotionally impressing stories. I personally prefer the Nestroy type of stories, that is stories which eventually end well, but before that came very close to total disaster. If it is possible to show how a positive outcome would have been much more sure if patients had had such an individual health data portal, then people will start to understand why they should invest time in a partial insourcing of their health.