By Harjit Gill
Digital Health has accelerated during the COVID-19 pandemic, enabling the health ecosystem, providers and patients to adopt new medical technologies and digital health solutions, specifically in remote patient care and telehealth. However, beyond addressing near-term pandemic issues, the full potential of digital health in tackling chronic care remains untapped.
To achieve this, we need to strike a balance between immediate priorities and investments for a digital future in a value-based care era. With a growing ageing population across the Asia-Pacific region and increased patient demand for access to care at a time and modality of their choice, digital health innovation is no longer an option, but a necessity for health systems if we aspire to emerge stronger from the pandemic.
It is for this reason that the Asia-Pacific Medical Technology Association (APACMed) formed the Digital Health Committee to drive proactive dialogue around key themes such as regulation, reimbursement, interoperability, and cybersecurity.
The committee recently conducted an extensive research on Policy Pathways for Value Assessment and Reimbursement which encapsulates an exhaustive global literature review, combined with field research across the Asia-Pacific. The research was undertaken with an objective of providing recommendations to policymakers for better value assessment and reimbursement of digital health solutions and India and Australia were the two archetypes studied for the purpose of this research.
This involved speaking to payers (public and private), healthcare practitioners, and other ecosystem players and it was deduced that the Digital Health policies of today are typically sitting in a chasm between “no evidence, no adoption” and “no adoption, no evidence”.
To ensure the sustainable adoption of Digital Health, nations need to place greater attention on evidence-based value assessment, legitimized funding and reimbursement frameworks.
Interestingly, for both archetypes studied – Australia (mature health system seeking to optimize UHC) and India (developing health system seeking to achieve “4.0” status), the core issues identified as part of the current landscape boiled down to policies that either inappropriately treat Digital Health as an unmonitored B2C platform, or the exact opposite – as a classic medical device. The three key challenges identified were, the lack of value assessment framework, fragmented coverage efforts and complex evidence generation.
Collectively, the efficacy of Digital Health can be improved to achieve the healthcare quality that our populations deserve, and simultaneously accelerate the time-to-market for innovations that will have wider socio-economic benefits. To begin this journey, it is critical to understand the unique socio-economic and health system challenges that countries in Asia Pacific could typically face.
India for instance, is a much younger population with only 6.4% aged above 65; the poverty rate steep and internet penetration lower (34.4%) in comparison to other developed nations. The healthcare system in India is still evolving with only 3.6% GDP allocation towards healthcare and only 30% for healthcare facilities supported by public entities. The country also has a very low ratio of doctors and beds per capita.
Incorporating Digital Health formally into the UHC (Universal Health Coverage) ambition in India will be very important especially considering COVID-19 and the challenges that it has been imposing on the country recently.
Australia – which holds population that is less than 2% of our first archetype nation, India, also has a higher elderly population (nearly 16% aged 65+) posing its specific healthcare challenges. However, with a lower poverty rate, and higher rate of literacy, it is placed much higher on the innovation index. Higher internet penetration has put it in a more advantageous position towards adopting Digital Health. In comparison to India, the healthcare system in Australia is much more evolved with three times the GDP for healthcare, doctors and beds per capita. The country, therefore, is well poised to take up the matter of expanding reimbursement codes to a wider range of Digital Health technologies and beyond UHC.
These two archetypes in the Asia Pacific region depict the diversity in terms of Digital Health preparedness and grounds for implementation and requirements in policymaking. Therefore, in order to build a well serving approach towards Digital Health, the APACMed Digital Health Committee recommends beginning with Situational Analysis – to determine the baseline size of disparity and inequality in the health system. Taking note of the two archetypes mentioned earlier, it may not be an exact fit, but the spirit behind the two options should be well-intended.
Establishing a Digital Health-specific categorization that is in line with international standards and clearly distinguished from the traditional medical devices will help lend clarity in policymaking.
The Committee also recommends formally incorporating Digital Health into national planning cycles. The creation of a multi-stakeholder taskforce across public and private sector, including a mechanism for international best practices sharing on Digital Health is needed to ensure seamless execution and implementation. People factor is another critical aspect that should not be overlooked, in which we have to ensure the right workforce levels, skills, capacities, training for Digital Health valuation and reimbursement. The physicians and technicians who use these technologies should be trained well and the local government and patients who benefit from these enhancements should advocate the need for newer reimbursement models.
The figure below outlines a three-step approach for policymakers’ consideration to realizing the derived value in Digital Health access, outcomes, cost effectiveness and funding transparency.
We look forward to having more stakeholders from the health technology industry come together to discuss ways to enhance the legitimacy of Digital Health as a formal tool for our populations in the Asia-Pacific. Only by adopting an all-hands-on-deck approach, we can truly harness the potential of this necessary and path-breaking tool.
Harjit Gill is CEO of APACMed
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