2. Trends in the healthcare sector and healthcare R&I system

As stated in the Horizon 2020 − Work Programme 2018-2020 Health, demographic change and wellbeing, Europe is facing four main challenges related to healthcare:

  • The rising and potentially unsustainable health and care costs, mainly due to the increasing prevalence of chronic diseases, to an ageing population requiring more diversified care, and to increasing societal demands
  • The influence on the health of external environmental factors including climate change
  • The risk to lose the ability of healthcare systems to protect the populations against the threats of infectious diseases (as witnessed by the COVID-19 pandemic)
  • The presence of health inequalities and problems in access to health and care.

These challenges are not only leading to an increase in the demand for healthcare services but are also driving towards more personalised treatments while healthcare systems are facing constant pressure to reduce costs, to improve the quality of healthcare provisions, and to focus more on prevention and health promotion.

Thus, innovation is becoming a critical factor for healthcare organisations to successfully face these challenges.

However, orienting and managing innovation processes can be problematic. The scientific and technological breakthroughs which are transforming the future of medicine and health inevitably produce new risks and have societal implications that need to be addressed proactively. In the same way, the introduction in the health systems of a steadily growing number of Health 4.0 and other innovative new technologies (e.g., wearable devices, robotics, genomics, artificial intelligence, 3D printing, mobile applications, etc.) raise complex challenges for all the relevant stakeholders of the R&I healthcare system, including policymakers, regulatory authorities, payers, physicians, and patients.

Examples of trends, partially overlapped, occurring at the crossroad between science, innovation, and health are mentioned below.

  • Digital The digital transition occurring in the healthcare sector is showing great potentials in transforming working models and in improving the patients’ clinical experience. However, it entails new ethical, legal, and social implications to handle, related to the design, development, and deployment of mobile health, telehealth and telemedicine solutions, the creation of open data platforms, and new digital data infrastructures (reliability, security, privacy, and data management issues), the interoperability among technological systems and healthcare providers, or issuer related to the digital divide issues.
  • Self-management innovations. Another trend is the adoption of technological devices allowing patients to cooperate in healthcare treatment. It is a promising approach to improve outcomes and reduce the healthcare costs associated with chronic conditions.
  • Patient-centred care (PCC) approach. The increasing involvement of patients in all decisions about their health is becoming a new paradigm for cost-effective provision of health care, even though it is facing also obstacles related to, e.g., the organisation of healthcare service providers and the professional culture of health workers.
  • Precision medicine. Precision medicine is an emerging approach potentially able to profoundly modify healthcare systems and represents a great opportunity for the advancement and the optimisation of care treatments. However, it could have also negative impacts, for example, worsening the existing health-care disparities or even introducing new forms of inequality among different segments of the population.
  • Public participation in health policy. Patients and citizens are increasingly recognised as key actors and partners in the decision-making processes pertaining to healthcare and health research. This is also leading to new forms of scientific citizenships or “active patienships”.
  • Participatory medicine. This concept partially overlaps with other trends mentioned above. It refers to the demand for a general paradigm shift in medicine toward the so-called “P4 Medicine”, i.e., a Predictive, Preventive, Personalized, and Participatory medicine.
  • Open innovation 2.0. In this case, the focus is on the adoption of the open science and innovation principles to healthcare, allowing, for example, the development of open platforms for social innovation and for the involvement of patients in the innovation process (Patient Innovation).
  • User-driven innovation. This trend has to do with the growing tendency also in health-related innovation to tailor new products and services to users’ needs, recognising then a proactive role in the innovation process.

These trends, already very fast because of the globalisation and other driving transformational forces, are now further accelerating because of the COVID-19 pandemic. They also require better integration of organisational, clinical, societal, and ethical considerations into the research process as well as into the design and development of medical innovations

Health systems face persisting challenges also at territorial level. They include, for instance:

  • Providing equal access to care to the population living in remote regions
  • Ensuring timely access to health services,
  • Achieving greater care coordination for people with chronic diseases.

The “glocal” dimension of recent health crises (as the surge of COVID-19 pandemic) amplified these challenges and highlighted the priority need to achieve “better health for all” at the territorial level.

The territorial level plays a pivotal role also for what concerns health research and innovation. Based on an innovation system approach, healthcare innovation can be understood as “driven by localized and endogenous interactions across various units and organisations, coordinating mechanisms (i.e., the institutional milieu), and growing interdependencies across different domains (i.e., scientific research, regulation, delivery of patient care and the market process)”.

It is to highlight that the increasing involvement of stakeholders in both healthcare provision and innovation may entail complex social negotiation processes, due to conflicting interests and views, with significant differences in the balance of power of the different stakeholder groups. This is also the reason why healthcare innovations “rarely achieve widespread uptake even when there is robust evidence of their benefits (and especially when such evidence is absent or contested).

Besides the resources inserted in the text of this Chapter, here below other few useful readings are provided, concerning ongoing trends and changes affecting the health sector

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