Severe weather is one of the many natural disasters common to both Europe and East Asia. Typhoon, Monsoons, and earthquakes hit many East Asian countries with noteworthy frequency. Harsh winters, overheated summers, excessive rains and floods, and in some parts, even earthquakes, are frequent occurrences in Europe. These events interruptions in water and power supplies, disruptions in communications, and in many cases large-scale evacuations of individuals to safer areas, including refugee camps, with families truncated, health services disrupted, yet a variety of health problems emerge due to unsanitary living conditions, among others. Disaster preparedness and response are therefore, major issues common to both Europe and East Asia. There disasters are not all natural, though, nor are they all due to severe weather if even so. We have seen in recent times the emergence of new microbes, viruses, causing epidemics, and potentially, even pandemics. We have seen novel bacteria, and the resistance of even known ones to treatment. There is also the threat of terrorism, local and imported, also common to both Europe and East Asia, with potentially devastating immediate, short-and long-term implications for health and health service provision. Both regions thus on the one hand, have many health and related issues in common yet have those that are contextual. They could therefore no doubt benefit from each other in many ways regarding addressing their healthcare delivery issues, including those concerning disaster preparedness and response. Many of these issues are uncomplicated and require measures that individual countries in each region could handle without outside help, but there are also many that require the involvement of international technical and other assistance. In general, the principles of disaster preparedness apply to all countries starting with a consideration of the needs of the family unit1, 2, in particular those of children3, who are even more vulnerable at these times. In the U.S, the Joint Commission Joint Commission on the Accreditation of Healthcare Organizations have stricter standards for hospitals’ backup communications4, hence many communities now have hospital-to-hospital radio communications using amateur or Ham radio operators via a local Metropolitan Medical Response System (MMRS)5,6,7. It is clear even from the above that healthcare ICT plays a major role in communication between relief personnel prior to and during disasters, and in several other aspects of disaster management such as surveillance and tracking activities, and indeed, in public health education. It is also important to recognize the overlap in many areas between preparedness and response, hence the need for efforts in both directions to be in tandem. Each country also needs to have a National Disaster Response Plan, all involved in its implementation trained well in advance in all its aspects, and there are valuable courses and manuals to help with such training8, 9. In short, countries in both regions need to invest in healthcare ICT to prepare for and respond to these disasters efficiently and effectively, both of which could save many lives. Countries in the more advanced countries already have sophisticated communications infrastructure, yet many have had to depend on Amateur Radio Disaster Services (ARDS), when disasters essentially wiped out existing telecommunications avenues. This underscores the need for investments in these technologies, even in developed countries, in electronic health records and data management technologies that ensure data and information safety and accessibility, which would not only guarantee communications between emergency relief personnel, but also enable the sharing, in real time, of crucial patient information between healthcare professionals. The UK's National Health Service (NHS) has programs such as Connecting for Health in England. It also has the Informing Healthcare in Wales, and the National eHealth / IM&T Strategy in Scotland. Other European countries would also need to have such programs but in fact also a National Healthcare ICT Policy. Indeed, these technologies could help countries in both regions and elsewhere in the world achieve the dual healthcare delivery objectives of providing their peoples with qualitative health services while simultaneously reducing health spending. The decision on July 12, 2006 by German Chancellor Angela Merkel’s cabinet to approve controversial reform plans aimed at shore up the country’s beleaguered health system and reduce corporate tax rates, underscores some of the themes of our discussion on the importance of healthcare ICT in healthcare delivery10. Thus, it not only underscores the finiteness of resources allocable to health services in any country, and the need to reduce health spending while simultaneously delivering qualitative healthcare, but also the connection of health to the economy. The German health service costs an annual 144 billion euros (US$183 billion,) and health spending is increasing, population aging, and recent high unemployment, expected to rack up a shortfall in 2007 or roughly 7 billion euros. It is little wonder that Merkel’s government plans to increase healthcare charges by 0.5% from 2007 to help finance the pecuniary-challenged health service, a move unpopular among voters and that threaten the grand coalition government. The Government also plans to reduce, in its company tax reforms, corporate tax rates from a nominal 38.65% to 29.16% with effect from January 2008, both the health and tax reforms going to parliament later in 2006. The country’s Finance Minister Peer Steinbrueck noted detailing the tax plan, that it would make Germany more attractive to invest in, and bolster its comparative advantage. Although the tax changes will cost the government more than 5 billion euros annually in the medium term, it seems overall that the benefits accruable from the plans, which include the introduction of a flat capital gains tax from January 2008, capital gains currently subject to personal income tax rates, particularly in preventing capital flight outweigh the costs. Indeed, Government plans to go ahead with the plans, despite protestations by Germany’s eight industry associations, which cautiously welcomed the plan but released a joint statement recently indicating that tax burden would escalate with the plans in the investment phase. Government plans to use the extra tax revenues to help buoy service's financing, including healthcare delivery, in particular children’s health. Government had earlier introduced a 3-percentage-point rise in the country’s consumption tax to 19%, to which parliament concurred in June 2006, many of course piqued by this VAT increase, which they claimed would slow if not stagnate the country’s economic recovery. The financial crunch facing Germany’s health services is not peculiar to the country and neither are the prospects of healthcare ICT diffusion and the implementation and use of the appropriate health information technologies to address its issues resulting in the achievement of the dual healthcare delivery objectives mentioned earlier. The Bush administration in the U.S., for example, on July 11, 2006 projected that the elderly will confront another double-digit increase in their Medicare premiums in 2007, leading to monthly payments of almost $10011. The monthly premiums for supplementary medical insurance will increase from $88.50 to up to $98.40, or more, an 11.2% increase, projections, which if the presupposition underlying it that Congress would cut Medicare payment rates for doctors by about 4.7% in 2007, did not materialize could mean even higher insurance costs for seniors. According to Mark McClellan, administrator for the Centers for Medicare and Medicaid Services, the increased volume of care provided Medicare patients necessitate the higher premiums, as doctors are utilizing services more in providing these services, for examples, imaging, physiotherapy, lab tests, and prescription medications use, on the rise. What is more, a CMS fact-sheet released the same day noted, “Use of these services varies substantially across practices and geographic areas, with no clear impacts on health,” and according to McClellan, “We can’t keep pumping more money into a payment system that is not sustainable.” How true, but what then is the answer? Does this not underline the need to seek ways to achieve the dual healthcare delivery objectives? The premiums help support physician services and outpatient care (Medicare Part B,), which taxpayers also finance. Government programs fund the premiums of roughly 7 million of the poorest beneficiaries, ex-employers help some retirees, but most of the country’s 43 million beneficiaries pay for themselves, and would also the increase in premiums. What are the chances of these increases compromising and perhaps eliminating the access to health services or at least some of them, by these senior citizens? Could we avert such situations by exploring credible ways to achieve the dual healthcare delivery objectives, specifically promoting healthcare ICT diffusion and utilization of these technologies, appropriately, in the execution of healthcare programs at the primary, secondary, and tertiary prevention levels? Do such measures not also apply to other countries including in Europe and East Asia, and indeed, in the rest of the world? As Kirsten Sloan, national coordinator for health issues of the American Association of Retired persons (AARP) noted, we could reduce costs for seniors by reducing costs in the entire health care system via increased utilization of technology. She also noted that legislation aimed at making medical care paperless cut health spending, and indeed, medical errors, improving the quality of healthcare delivery and saving lives all at once. According to Sloan, “We’re going on several years of repeated double-digit increases, and it's also roughly three times the rate of the Social Security (cost-of-living) increase…It puts a real squeeze, particularly on moderate-income seniors.” The observation by McClellan that premiums for the new drug benefit have been lower than projected, the average premium projected a year ago to be roughly $37 a month, which fell to $24 a month as seniors and the disabled sought plans offering lower monthly premiums, attests to this squeeze.
Increasing healthcare costs no doubt put significant strain on the budgets of many countries, and influence their public finances. New Organization for Economic Co-operation and Development (OECD) data in fact confirms this for its member countries, many of which are in both regions under consideration. OECD Health Data 2006, an all-inclusive database of comparable health statistics in major developed countries, showed that health spending continues to increase in OECD countries and, if current trends persist, governments would have to increase taxes, slash spending in other sectors or make people pay more out of their own pockets in order to sustain their current healthcare systems12. The data indicated that health spending has grown more rapidly than GDP in all OECD countries apart from Finland between 1990 and 2004, accounting for 7% of GDP on average, in 1990, and 8.9% in 2004, an 8.8% increase from 2003. With many of these countries obtaining most of their health services funding via taxes, these developments are ominous for their peoples, particular the poor, this is more as projections indicate probable increases in health spending as a percentage of GDP even further because of expensive new medical technologies and population ageing. Again, we see the potential of healthcare ICT to cut costs without compromising care as they could obviate the need for many of these pricey technologies by strengthening aspects of health services delivery that do not require the use of costly technologies. In other words, by facilitating the prevention of diseases in the first place, or their treatment in ambulatory/domiciliary/community settings, rather than in hospitals, thus eliminating the often-substantial costs involved with the latter, yet not compromising care, healthcare ICT could help achieve the dual healthcare delivery objectives mentioned earlier. The public share of health spending is increasing in many countries in these regions, for examples in Korea, from 38% in 1990 to over 50% in 2004, the percentage of direct, out-of-pocket spending 37% in the same year, versus in Greece, 45%. On the average, private insurance contributes only 6% of total health spending in OECD countries. Nonetheless, it is an important health-funding source for some individuals in some European countries such as Germany, the Netherlands, and in France, in which latter, it covers between 10% and 15% of total health spending, and is more prominent in payments for prescription medications rather than for hospital or ambulatory care, in many countries with publicly funded health systems. Money for more than 75% of drugs spending in several European countries in 2004, for examples, France, Germany, Austria, Sweden, and Spain came from public funds12. Regardless of where the funds come from, however, an ever-increasing health spending is unsustainable in any country be it in Europe or in East Asia, or indeed, in any country in the world. Furthermore, the higher a country’s health budget, the more it compromises its ability to provide other important services to its peoples. What is more, that the country spends an increasing proportion of its economic resources on health does not necessarily translate into the provision of better health services. In fact, the reverse is sometimes the case13. Studies have also shown that investments in new medical technologies have led to increased and often unnecessary service utilization, which drives up costs14. The reasons for increased service utilization under these circumstances vary with health system, ranging from the absence at least in theory of adverse selection in publicly funded health systems, to that of Tort law reform in others, where healthcare professionals practice “Defensive Medicine” in order to avoid litigation, among others. Yet, in either instance, healthcare ICT could reverse the trend, in publicly funded systems for example, obviating the need to invest significant amounts of money on medical technologies that would be redundant in some circumstances, or would at least not duplicated in others, in particular, the infrastructure-intensive, diagnostic imaging technologies, or those for treating cardiac and cancer patients. At the most basic levels, we could, via intensive, healthcare ICT-based, primary prevention programs, start to see the need to coalesce secondary prevention services, with reduction in the prevalence of diseases requiring the use of costly technologies such as magnetic resonance imaging (MRI), computed tomography (CT) scanners, cardiac catheterization, and coronary artery bypass graft (CABG), among others. Healthcare-ICT related services such as business process outsourcing and client resource management would make the need to duplicate certain health services unnecessary, thus saving costs, possibly significantly. There thus needs to be system changes in many countries were they to reap the immense benefits of healthcare ICT in achieving the dual healthcare delivery goals mentioned earlier. This would require policy changes in regard healthcare ICT in these countries, many, both in Europe and East Asia, which currently lack a National Healthcare ICT Policy, the essential starting point for such systems reforms. Many countries in Europe have actually embarked on the path of widespread healthcare ICT adoption. In January 2003, the U.K government struck a £168m “broadband” deal with BT, which aimed to enable the NHS improve its infrastructure to connect hospitals and GP surgeries across the country to a fast internet connection. The high-speed network would underline the NHS modernization program. It would enable for example, online appointment scheduling, easier access by healthcare practitioners to patient information at the point of care (POC), and the electronic transfer of prescriptions. The deal gave credence to Prime Minister Tony Blair's declaration in November 2002 to bring broadband to all GP surgeries and schools in the U.K by 2006. It would take much less time for patients to see a specialist as doctors exploit the capabilities of the network to carry out online diagnoses using imaging or video-conferencing, for examples, and patients receive treatments form doctors in their local hospitals with remote expert guidance saving transportation costs, even lives due to prompt and effective treatment. Government also envisaged experts in one region being able to share knowledge with a variety of hospitals and care centers, and the streamlining of health service provision. However, things have hardly turned out the way Government hoped in many ways. Many would insist that the gridlock in the system persists, and that the fundamental problems of the NHS remain unsolved, for example, the management issues arising from the increasing market orientation of health service provision in the country, one of which in fact include the vagaries inherent in the development of pervasive healthcare information and communication technologies. Many have called for example, for an independent investigation into the £6.2bn upgrade of the NHS IT system, querying if the robustness of the plans to meet NHS demands. Nonetheless, Government is adamant that the 10-year IT (NPfIT) program aimed at connecting over 30,000 GPs in England to nearly 300 hospitals by 2012, and has an online booking system, a centralized health records system for 50m patients, e-prescriptions and fast computer network connections between NHS organizations, undergoes periodic evaluation, and is resilient16. There is no doubt that the development process of such massive projects is fraught with hitches, some of which could escalate costs. There is also no doubt that investing in these technologies involves much more than implementing them successfully. For example, what if afterward, the end-use refused to have anything to do with them, or did not utilize fully their potential? What about issues of the safety and confidentiality of patient information, or its security, and what in fact would happen were these technologies, which necessarily have different origins, could not communicate with one another, or did defectively, causing communication delays? Such concerns have led some to propose that the Health Select Committee helps resolve uncertainty about NPfIT by requesting the government to commission an autonomous technical assessment as soon as practicable. Government on the other hand remains sure that the technical architecture of the national program is apposite, would deliver benefits to patients, and ensure value for taxpayers’ money. These issues, policy, technical, management, end-user, and many others are not peculiar to healthcare ICT efforts in the U.K. In fact, they are issues every country would likely confront, as they are inherent in technology implementation, including healthcare ICT. They also illustrate possible market openings and which, for every country of interest to ICT vendors, they need to identify and elucidate. In other words, that any health system attempting to implement new healthcare ICT would likely confront end-user resistance is doubtless, particularly were the implementers oblivious to the importance of end-user buy-in, from the outset of the ICT project. Even if they were not, there would likely be ongoing need for training and for building on the support garnered by prior change management efforts. There would also be need for example, for any country serious about disaster preparedness to examine on an ongoing basis, the biosurveillance challenges it faces. In the U.S for example, a federal advisory group is working on recommendations regarding the data elements required to help healthcare providers and public health agencies communicate and share crucial healthcare data during an array of scenarios including pandemic outbreaks, natural disaster, and biological attacks17. On July 07, 2006, this biosurveillance workgroup from the American Health Information Community met to advance toward its goal of making recommendations that would enable physician offices, hospitals, ER departments, and labs to send within 24 hours, information in a standardized and de-identified format to public health agencies. This workgroup exemplifies the need for the sort of identifying, understanding, and elucidating issues germane to healthcare delivery and the role of healthcare ICT in addressing these issues mentioned above that not only healthcare ICT vendors keen on doing business in any country, but on which the country itself needs to embark, on an ongoing basis.
Eighteen million people in the EU and about 58,000 EU citizens commit suicide annually, tens more attempting it. Do these statistics not point to the urgent need to formulate and implement an action plan for mental health promotion and the prevention of mental illnesses in all EU member states? What role could healthcare ICT play in such programs? Would an appreciation of the ramifications of such statistics not help a healthcare ICT in devising strategic market options? Would it not help an EU country in policymaking, program development, and in healthcare ICT investments decisions? Would addressing these issues vigorously not help reduce the significant health and economic burden of these disorders, and facilitate the achievement of the dual healthcare delivery goals mentioned earlier? There is no doubt that early intervention and preventive initiatives could help save the lives of many persons that have depression, yet on average, EU member states allocate only 3% of their healthcare budgets to disease prevention in general, that of mental illnesses, a small part of this amount, annually. Would this not have to change in light of such grim statistics as mentioned above? A recent EU report noted that 25% of Europeans would likely experience mental health problems in their lifetime, and that more than 27% of European adults have mental ill health annually18. The EU report also noted that depression and anxiety disorders, and stress-related disorders, are the most prevalent mental health problems, and that by 2020, neuropsychiatric disorders, with depression most prevalent, would constitute the commonest cause of illness in the developed world. A key objective of the Program of Community Action in the Field of Public Health (2003-2008), termed “The Program Decision”, which the European Parliament and the Council adopted on September 23, 2002 a key instrument behind the development of its health strategy is harnessing health for economic growth and sustainable development15. Article 152, § 1, of the EU Treaty guarantees a high degree of human health protection, which broadly expressed the intent of the “The Program Decision” to support an integrated and intersectoral health strategy embodies. One of the chief aspects of this intent, which is in keeping with a new European health strategy, launched on 15 July 2004, is to develop connections with relevant Community programs and actions and with national and regional initiatives, to promote synergy and shun overlaps19. The EU also plans to improve the analysis and knowledge of the effect of health policy formulation, and of other EU policies and initiatives, for examples, that of the internal market on health systems, and how these could enhance its goals of health promotion and disease prevention. It also plans to develop criteria and approaches for evaluating policies for their effect on health as well as other links between public health and other policies. Again, these plans underscore the need for understanding and elucidating health issues, both peculiar to countries, both in Europe, East Asia, and indeed, elsewhere in the world in order to determine the best approaches to addressing them. This exercise, or process cycle analysis, essentially involves identifying health issues and those influencing health, decomposing them, to expose more underlying issues and their processes, eschewing historical fallacies. Process cycle analysis would reveal the processes that need addressing and in what manner, that is, whether to expunge, facilitate, or modify them in some way or another, and which health information and communication technologies would best do the job. It is, therefore not surprising that the EU’s plan stressed the need for cooperation between Member States regarding information about health systems. Other priority issues include the effects of patient and healthcare professional mobility on health systems, healthcare quality assurance, and health technology evaluation, cross-border collaboration in health services, and economics and health. The pivotal role in the EU actualizing these priorities is self-evident, an indication of the domains of likely future healthcare ICT investments, the EU’s interests in better understanding if, why and how cross-sector health, has economic benefits, also indicative of the crucial link between healthcare delivery and the economy. It is also indicative, though, of the importance of aiming to achieve the dual healthcare delivery objectives mentioned earlier, which creates the prospects of buoying both health and the economy simultaneously. To underscore the key role that healthcare ICT would play in the healthcare delivery scheme in future, including in financial and economic issues, the EU also wants to develop a Hospital Activity, and Resources Information System to fortify the cross-analyses of health accounts information of hospitals and their impact on health services provision, and on patients’ access to it. The EU would support its members’ efforts to implement the System of Health Accounts it set up under the Community Statistical Program, again, the foregoing an indication of the non-health information systems whose role nonetheless influences healthcare delivery. These accounting and other non-health information and communications technologies would continue to feature prominently in healthcare ICT investments budgets throughout the EU, and elsewhere in Europe in the coming years, creating for example, intense competition between vendors of enterprise software-based and the increasingly popular, web-hosted, customer relations management technologies, for example. This is more so with the increasing emphasis on customer-focused healthcare, and efforts to reduce waiting times, and enhance client satisfaction. With the mobility of patients and healthcare professionals likely to be a major issue in a milieu that is actively promoting labor mobility, these technologies and those that would facilitate cross-border access to patient information, hence improve the quality of healthcare delivery, would gain market ascendancy in Europe. There is no doubt, that East-Asian firms, keen to enter the European healthcare ICT markets would benefit from understanding the tide of health services provision on the continent. The key goal of the first two years of the “The Program Decision”, for example involved establishing the basis for an all-inclusive and coherent approach, via a focus on three key priorities: health information, health threats, and health determinants, initiatives designed to fashion self-sustainable means for member states to synchronize their health-related activities, 130 projects chosen by 2004 for funding20. Collaboration with international organizations for examples the World Health Organization (WHO), the Council of Europe, and the Organization for Economic Co-operation and Development (OECD) are ongoing. For example, the EU would offer financial assistance for WHO-activities, unless otherwise agreed in exceptional circumstances, in keeping with the Financial and Administrative Framework Agreement between the European Community and the United Nations, which became effective on April 29, 2003, areas of cooperation including data and information gathering, health monitoring and disease surveillance. Considering the previously mentioned, these areas would continue to attract significant healthcare ICT funding in the years ahead. The EU also has direct grant agreements with the OECD, which would address public health programs for examples, performance assessment of health care facilities for quality strategies, health economics and cost-effectiveness issues in the different levels of prevention, labor mobility issues, including of healthcare professionals, System of Health Accounts support outside the EU’s Statistical program. In other words, there is also a wide scope for healthcare ICT investments in actualizing programs relating to this agreement. The global budget for the program in 2005 was € 61,460,411, administrative and operational budgets, the indicative global amount for grants, € 48,316,546, the EU co-funding up to 60%, typically, and with projects with strong European benefit, and in new member states or candidate states, sometimes up to 80%. There are compelling reasons that not just EU countries but also indeed, all countries have a stake in health, the most fundamental being the maintenance of the health of their peoples, but there are also economic reasons, which attest to the intimate connections between health and the economy mentioned above. In other words, countries in Europe would increasingly invest in healthcare ICT that would help them achieve the dual healthcare delivery objectives. The contribution of the Commission on Macroeconomics and Health (CMH), whose final report appeared in 2001, to this link between health and economy is undoubted, in developing countries21, as is its value in guiding investments in health, even if its bearing to EU countries, with different health issues seem unclear. The CMH report not only confirms that investing in people’s health in developing countries, a noble objective in its own right, has noteworthy economic paybacks, for the peoples and their countries. Despite its focus on developing countries, which incidentally some of the countries in East Asia, are, some of the empirical evidence gathered referred to industrialized countries, not to mention the intuitiveness of the applications of the concept of the economy/health connection to all countries, whether developed or developing. The report noted a variety of cost-effective investments that could result in the achievement of the dual healthcare delivery goals, which essentially is saving lives and money simultaneously. In short, that healthcare investment in the less financially endowed would not only help lift the poor from the poverty abyss, but the country’s economy overall from it. This further highlights the need for the implementation and use of healthcare ICT in healthcare delivery in these countries in particular, and indeed, in all countries, including those in Europe. With 87,000 recorded protests incidents in 2005 in China, over the effect of the country’s economic policies on the poor, for examples, farmers displaced to make way for industrial growth, and with the country’s population aging, and birth rates falling, due to deliberate government policy, could China for example, afford to ignore this need? Would China for example, not have to invest in technologies that could save it money while it could deliver qualitative health services to its aging population? Should it not continue to seek ways to sustain its economic development in the likely event of a dwindling labor force? What could a healthy seniors’ population offer the country in the years ahead when it might need them to keep its industrial engine rolling? Do these queries not suggest the likely healthcare ICT investment scenario in the country in the near future, for example, the increasing use of ambulatory/community/domiciliary technologies? The characteristic quantitative effect of life expectancy on economic growth is that a 10% increase of life expectancy at birth boosts economic growth at least by 0.3 to 0.4% points of GDP per year21. The CMH report on developing countries and its focus on investing in communicable diseases in the main are instructive, and with the main types prevalent in each country identified, the most appropriate healthcare ICT for addressing them would be more readily determinable. Does this not underscore the point we made earlier about the need for process cycle analysis in every instance by interested parties be they healthcare ICT vendors, non-governmental, or governmental organizations? While East Asian developing countries might be focusing more on communicable diseases, hence healthcare ICT vendors seeking to business there more on the technologies most appropriate for addressing the issues the decomposition/exposition exercises revealed and their processes, the reverse would be true of vendors in East Asian seeking to do business in Europe. That said, that does not mean that Europe does not have communicable diseases, or that East Asia lacks noncommunicable diseases. In fact, the latter at least in the more affluent countries, are starting to see increased prevalence of chronic noncommunicable diseases, and the former, communicable diseases such as HIV/AIDS, Syphilis, and Tuberculosis, in some areas not to mention the avian flu, which is in fact causing global health concerns these days. There is no doubt that we need to determine the priority interventions that would, and perhaps, significantly reduce the burden of disease in the country in question. In Europe for example, the burden of disease in the main due to chronic noncommunicable diseases, the approaches to addressing the issues would likely involve more complexity in terms of the need for multidisciplinary, intersectoral collaboration in devising sophisticated healthcare ICT-enabled programs that would help in achieving the dual healthcare delivery goals. The programs would involve primary prevention, which lends itself to the use of these technologies particularly in a region where the telecommunications infrastructures are available. They would also involve secondary and tertiary levels disease management strategies, for examples for mental health, and cardiovascular disease, and intricate infectious diseases, for examples, nosocomial, and medication-resistant infections. Prevention at these levels would benefit from healthcare ICT, for example, sophisticated mobile technologies that the likes of LG and Samsung Electronics of Korea, could compete with European companies for, successfully in the European healthcare ICT markets. Sales of LG, until recently better known for household air conditioners, and plasma TV, although now ranks high in mobile phone manufacturing, increased an estimated 21%, to $23.6 billion (24,659 billion won) in 2004, although it dipped slightly to 23,774 billion won in 2005. Its sales of handsets increased from 6.9 million in 2000 to 44 million in 2004, 20 million in the U.S alone. The company has supplied American carrier Verizon Wireless, to which it sold 11 million handsets in 2004, 6 million to Cingular/ AT&T the same year. LG Electronics was the first firm to launch a CDMA (Code division multiple access) platform-based digital mobile phone, with avant-garde multimedia and data transmission capabilities, features that are invaluable in delivering a variety of primary, even secondary and tertiary prevention health programs. The company is a major manufacturer of CDMA/GSM handsets, UMTS 3G handsets, Mobile TV Phone (SDMB/ TDMB/ MediaFLO/ DVB-H), its 2005 global sales of 55 Million Units amounting to US$ 9.9 Billion, impressive22. Samsung is the quintessential Korean electronic firm, the 44 million handsets LG sold in 2004 just roughly half of Samsung’s output, and LG’s 3G technologies head start, threatened in both Korea and China. Incidentally, Samsung has reported an 11% fall in quarterly profits, battered by decreasing margins for cellular phones and flat screen TVs. The company reported that it made 1.51 trillion won ($1.59bn; £864m) in the three months prior to June 31, 2006, versus 1.69 trillion won in 2005, although it expects recovery across its businesses in the remaining half of the year. The company also revealed its $1.9bn deal to manufacture LCD display screens for Sony of Japan, under whose terms it will manufacture LCD panels for 50” flat screen TVs subsequent to a “significant” demand rise. With firm having to contend with a global market awash with LCD TVs, and stiff competition from Nokia and Motorola in the “cut-throat” mobile phone market, seeing its second quarter mobile phone profit margin drop to 9.5%, from 12% during the same period in 2005, the major world chipmaker, seems to be struggling. Nonetheless, these issues, and LG and Samsung, exemplify those, including the potential competition foreign firms venturing into the healthcare ICT markets in East Asia would likely face, and possibly in European markets too. On the other hand, European firms need to be looking at healthcare ICT more suited to the management of communicable diseases in developing countries, as these constitute although not exclusively as noted earlier, the major burden of disease in these countries.
The dyadic interactions between Europe and East Asia in terms of business opportunities and market openings in the healthcare ICT sector would, therefore, reflect the dynamics of health and non-health factors, in particular what is happening elsewhere in the economic sectors of the countries in these two regions. However, and as noted above, it would not just be a matter of developed versus developing, as health and economy are extremely complex issues, whose intricacies require in-depth analyses to unravel. The fundamental issues confronting health systems in developing countries differ from that Europe face, which makes extrapolating such findings as of the CMH mentioned above somewhat tricky. Some might also argue that because the health status of the EU countries is already relatively high, achieving additional health system improvement would be harder and more expensive, hence unlikely to accrue significant economic payoffs. Furthermore, there are differences in demographic variables, for example, population aging, and health indicators that could significantly influence the economic burden of disease in these regions. To be sure, the dichotomy of developing and developed countries is not absolute in terms of the individual as there is affluence in the former and poverty in the latter, and there are prospects of transitioning from one group to the other. In fact not only was Portugal and Ireland until recently deemed developing countries, there is poverty in some parts of Europe, and according to the most recent Eurostat figures the working poor, are becoming poorer, the purchasing power of workers on the minimum wage varying between 1 to 7.5 among the EU-28, seven member states not having a minimum wage23. This report also indicated that Luxembourg, with the highest per capita income in the EU, and the highest minimum wage, also has the largest number of workers stuck on that minimum wage, versus others in the same year, 2004, the U.K (1.4%, the same incidentally for the U.S), 15.6% in France, and 3.1% and 4.5% in Ireland, and Poland, respectively. The migration issue further complicates the picture in Europe, with potential significant effects on its health and economy, even if the migrants are more prone to impoverishment in the short term. There are about 20 million migrants in the EU, and the numbers are increasing daily. Defined as third-¬country nationals with temporary or permanent legal residence, migrants, include immigrants, refugees, and asylum¬ seekers, among others, and exclude automatically, EU citizens. Caritas Europa’s recent, third report on poverty in Europe, noted that asylum seekers are among the most susceptible groups of the EU population, lacking not just pecuniary wherewithal, but also social empowerment, the combination of education, housing, employment, and health problems these migrants confront a potential wellspring of future socio-economic problems in their host countries. They face health risks for example, due to deprived living conditions, lack health insurance, and do not have the funds to pay for healthcare. Would these countries not need to major policy reorientation to avert the long term health and economic, not to mention social consequences of these issues, and what role could healthcare ICT play in their efforts in this direction, for example in social inclusion, health promotion, and disease prevention? Do these issues not support the need for the sort of country-specific process analysis mentioned earlier, rather than depending on broad, dichotomy-based assumptions, were efforts to address them to succeed? There is no doubt that there are costs linked to illnesses. Even basic COI (Cost-of-illness) studies, which reckon resource quantity (funds), used in disease treatment vis-à-vis the extent of its negative economic costs (lost productivity) to society, indicate this much, the limitations of such studies, for example, causality direction of the health/economy dyadic, regardless. COI studies attempt to recognize and measure all the costs linked to a specific disease or risk factor, direct, indirect, and intangibles costs. The point here is that in exploring the healthcare ICT markets, there is need for process cycle analysis, which could be at different levels, country, regional health authority, hospital, which, among others would reveal funds guzzling issues and processes that need modifying. Depending on a variety of factors that govern their overall strategic interests, a healthcare ICT firm might want to, as the governments or local authorities ought to do, make this an ongoing exercise in perpetuity, because no health system could ever be perfect, and as long as it confronts constraints, must evolve for the better or risk oblivion. Thus, it is necessary for example to know the drivers of direct costs, that is, those on the health sector concerning disease prevention, diagnosis, and treatment, and might include costs of ambulances, in/outpatient, medications, rehabilitation, and community health/healthcare, among others. It is also important to know those of indirect costs, that is, costs due to lost productivity potential of ill patients, or those that died precipitately. Some have included in this estimation the loss of future earnings (discounted), the so-called human capital approach, and others have adopted the scenario-based, willingness to-pay technique, estimates of indirect costs, often a matter for contention. Intangible costs, which aim to account for the psychological aspects of illnesses to the ill person and to his/her family, are even more difficult to measure, hence more contentious. Nonetheless, an exploration of these different drivers, and their costs, for examples via the disease prevalence, or the more data-intensive incidence costing methods, would reveal perhaps even cryptic issues and processes that underlie them, and which the application of the appropriate healthcare information and communication technologies could help modify and improve, hence reducing the costs, while not compromising healthcare delivery. Cardiovascular diseases for example are some of the commonest noncommunicable diseases among Europeans. The economic burden of coronary heart disease (CHD) in the UK (direct and indirect costs,) was GBP 1.73 billion (EUR 2.5 billion) in 1999, GBP 2.42 billion (EUR 3.5 billion) and GBP 2.91 billion (EUR 4.2 billion) in informal care, and lost productivity (24.1 % due to mortality and 75.9 % to morbidity), respectively24. The overall yearly cost of all CHD-related burdens, GBP 7.06 billion (EUR 10.2 billion), was about 1 % of 1999 GDP and 11 % of total national health spending for 199921. Such estimations could also reveal the costs and their drivers for other diseases, and even enable comparison of costs for diseases and costs within and between countries, facilitating policy formulation and program development. By understanding these issues, healthcare ICT firms would be better able to develop the appropriate product and service mix, and develop the right strategies for the markets either in Europe or in East Asia that interest them. It is not always that these firms have either the resources or willingness to embark on such analyses, in which case, they need to hire someone to do the job. With regard countries, should the U.K for example, knowing that in 1999, CHD had the highest burden their direct, indirect, and total costs respectively, GBP1730, GBP 5325, and GBP 7055, not do something to reduce these costs21? What role could investing in the appropriate healthcare ICT for example play in this regard, considering that many of the risk factors for these conditions are preventable for example? The same questions apply to other “high-burden” diseases such as obesity/diabetes, mental illnesses, and substance use/dependence not just the U.K, but in most of Europe, where they constitute significant disease-burdens. These disorders need prioritizing and measures taken to reduce their prevalence and their burden in both human and material terms, and governments in countries where they are prevalent cannot afford to do otherwise. Considering that these diseases are preventable in the main, this says something for the sorts of health information, and communication technologies that these countries would need to invest on in the years ahead in order to tackle these problems. Let us illustrate this point further with some figures. In 2001, the US Surgeon General’s report estimates of the direct and indirect costs of obesity were US$117 billion (US$61 billion direct costs; US$ 56 billion indirect costs), albeit underestimates, the condition’s effects on social well-being, and among those outside the labor force excluded25. In 2001, the direct and indirect economic costs of physical inactivity and obesity in Canada were US$5.3 billion (EUR 3.5 billion), US$1.6 billion (EUR 1.1 billion), and US$ 2.7 billion (EUR 1.8 billion) in direct and indirect costs, respectively. In the same year for obesity, the costs were US$4.3 billion (EUR 2.8 billion), US$ 1.6 billion (EUR 1.1 billion) and US$2.7 billion (EUR 1.8 billion), in direct and indirect costs, respectively, both physical inactivity and obesity, in total, 2.6 % and 2.2 %, respectively, of the country’s total healthcare costs26. In 2001, estimates also revealed that treating obesity in the U.K, cost the NHS roughly GBP 500 million (EUR 715 million) annually, and with costs to the entire economy of reduced productivity and lost output added, another GBP 2 billion (EUR 2.8 billion) annually. The devastation that Typhoon Bilis, which hit the Philippines and Taiwan on July 14, 2006, and China, caused is another example of the need to appreciate the health issues of each country fully in order to better determine the most appropriate healthcare ICT required in the delivery of cost-effective and qualitative health services to the country’s peoples. The floods and storms of the Typhoon killed at least 115 persons, in China’s southeast Fujian, Hunan, and Guangdong provinces27, more than 100 people in Hunan province alone, thousands of homes and hectares of farmland, swept off, train services, disrupted, and power lines cut, torrential rain predicted to continue across southern China for the next many days. Such rain only in June 2006 killed at least 349 people also in China. In fact, seasonal heavy rains and typhoons cause hundreds of deaths in China yearly. Should the country not invest in and deploy the appropriate healthcare technologies to address the varieties of health issues that these natural disasters cause? Do these examples not underline the contextual approach that healthcare ICT vendors should adopt regarding their strategies in their markets of interest? The healthcare ICT sector is no doubt evolving in many countries, including those in the regions under consideration. However, this evolution would likely have a pattern, based on the issues and approaches we have discussed thus far among others. These issues would be different for each country, and indeed, for each region, but what would be the same for all is the need to achieve the dual healthcare delivery objectives mentioned earlier. Besides considerations for individual’s health, investing in healthcare information and communication technologies would also be a means to an end, that of sustainable economic development. These are two potent reasons that governments cannot afford to shun the important role that these technologies could play in their achieving these health and economic objectives. We have not identified the markets for specific healthcare information and communications to any precise level for the same reasons we have advanced in this discussion regarding the need for process cycle analysis to a more or less extent in the particular setting in which we are interested. To do otherwise would either mean having particular information on the specific healthcare ICT projects that that setting, a country, health region, or hospital, for example, has lined up, or merely speculating on them. It is possible to obtain the former information from the appropriate sources since it would probably be on open tender, but it is important to be able configure a strategic view on the direction the health system of interest is headed as this might be crucial for the distinctions value proposition that confer competitive advantage.
Part of the process analysis involves also determining the technical issues involved in healthcare ICT diffusion, implementation, and utilization in these settings, which would also likely reveal the nature and extent of their markets. Interoperability for example, is a major technical issue in healthcare ICT implementation in many countries, although it has other dimensions for examples, research and development, regulations, and standards, among others. In this connection, some developers are addressing the interoperability issue from a Service Oriented Architecture (SOA) software design perspective, for example, hoping by overcoming the challenge to launch a new age of efficient network services, cross-organizational business collaboration and novel services with valuable applications in the health industry. SOA is essentially a novel, software development methodology that rather than of individual programs that perform, a variety of functions enables the design of individual functions that could blend to offer a variety of diverse services, the programs compiled when required and extensively reused, SOA thus lithe and cost-effective. It is also likely to be invaluable in connecting organizational, services, platforms, and networks, facilitating the seamless information communication and sharing that the typically disparate systems in the health sector needs, yet the need to scale the interoperability hurdles, literally, is crucial for this to happen. That this requires addressing at levels other than the technical is not in doubt considering the need for business to drive IT rather than the reverse, which again underscores the need for process analysis, which reveals underlying issues and processes and the best health information and communication technologies to modify/improve them. The IST-funded, ATHENA project, for example, involves research, research, technological and industrial partners, and aims to develop solutions to the different interoperability issues that firms confront at various levels, such as data, services, processing and business levels28. Researchers are utilizing semantics, mostly semantic data transformation to help translate information stored in different formats and systems among dissimilar enterprises, focusing in the service area, on model-driven SOA to address the issue of running different applications on diverse architectures, for examples, Web services, Grids or P2P28, and a ‘process abstraction concept’ at the process level for automated cross-organizational processing. The researchers’ success with the latter for example would mean no longer the need for wagering between efficiency and security in connecting corporate applications for information sharing to protect some crucial data from general view, a scenario that applies in particular to health systems, besides companies’ supply chains, for example. With ATHENA, the abstraction concept translates to every business partner or authorized user-department in a health system is able to define public processes positioned above its internal, private processes keeping private and confidential processes, and data cloaked, simultaneously. In other words, the researchers hope to develop an integrated yet secure milieu. According to Rainer Ruggaber at SAP Research in Germany, one of the principal developers of SOA solutions, “Though this concept is not new, the value of our solutions revolve around the creation of an integrated but secure environment. It means that my internal processes are linked to my public processes which in turn are connected to your public processes and to your internal ones but where outside access to the private processes of both sides is restricted.” There is no doubt interoperability solutions in SOA will have important applications in any sector including the health sector where efficient, seamless information communications and sharing are key processes in its operations. For example, the SOA-based, SODIUM project has developed two prototype systems addressing risk management and healthcare utilizing a standards-based approach to determine, compose, and execute mixed web, peer-to-peer and grid services, trials underway in Romania and Norway. Its scientific coordinator, Aphrodite Tsalgatidou recently noted, “SODIUM is providing solutions on top of existing standards to create a unified way to discover and compose heterogeneous services…The main challenge for us is to achieve syntactic and semantic interoperability.” He added, “In crisis management, for example, emergency services have to use a variety of services some of which will be P2P, others will be Web based and others will be Grid based. All of them have to work together.” As noted earlier, there are varieties of natural and manmade disasters that countries in both Europe and East Asia regularly confront. With risk and crisis management, being no doubt domains where interoperability is crucial, would countries in these regions not therefore need to explore the potential of ATHENA, and similar technologies, for example? Have the researchers not for example, and as we have advocated thus far, critically examined the issues involved in interoperability, decomposed them, and determined their underlying processes and those that need modifying and improving for more efficient and cost-effective, systems interoperability, in fact able to offer novel and intuitive value propositions in the process? In fact, another SOA-based project, ORCHESTRA, aims to address procedural, technological and communications challenges that compromise efficient risk management. According to project coordinator José Esteban, “Our architecture will allow interoperable risk management services to be created to overcome the barriers between different actors who use different procedures, databases, systems, and languages…The standards-based approach aims to ensure compatibility between systems, databases and services including those that are already in use by different public administrations across Europe.” These technologies would certainly be useful in healthcare delivery, and would play a key role in improving interoperability standards. In fact, the ATHENA project has fashioned the Enterprise Interoperability Centre (EIC) to use ATHENA results for forging accord, and as Ruggaber noted, “The EIC is currently working on business profiles for interoperability focusing on public business processes and building on existing messaging standards. Initially starting in the construction sector it will continue with scenarios in the automotive industry, healthcare, and logistics”, the EIC aiming to facilitate the collaboration of stakeholders in securing the wider applications of research findings. ATHENA is also involved in the Enterprise Interoperability Research Roadmap that the European Commission would publish in July/August 2006, and intends to contribute to EU policies aimed at improving systems interoperability among European firms. These examples buttress many of the points we have made about the importance of process cycle analysis. The direction of the dyadic between Europe and East Asia with regard the healthcare ICT markets would in future hinge on this sort of analysis. New and sophisticated information technologies emerge routinely, many with features applicable to healthcare delivery although not necessarily set out to deliver such services. The question is whether ICT software and other vendors are aware of developments in the health industry or are at all interested in them. The examples of ATHENA and others mentioned above indicate that at least some are collaborating with research and other organizations to design and develop ICT focused on issues that bear direct relevance to healthcare delivery. However, the markets for healthcare ICT is unimaginably wide open considering the innumerable processes that currently hamper healthcare delivery efforts, hence yearning for technologies to improve them. The issue of hospital wait lists for example, plagues many European and East Asian countries, and these issues no doubt could benefit from appropriate healthcare ICT applied to addressing some of the underlying issues and processes involved. Would a healthcare ICT vendor that conducts process cycle analysis in its preferred market in order to understand fully these underlying processes, and then designs and develops the appropriate technologies to tackle the issues successfully not likely to find sufficient market opportunities to recoup its costs, for example, or be gratified additionally by the social grace of perhaps saving lives? These are clearly questions that these companies would need to ask in time seeking market opportunities in the health sector, not just in Europe and East Asia, but also worldwide.
