13 Aspects of Sustainable Healthcare

Healthcare should be universally accessible, ensuring that no one is left behind. This includes providing care to the most vulnerable populations and those living in remote or underserved areas. From a population health perspective, low-level primary care is much more important than high-end specialized treatment for improving overall life expectancy. Many diseases can be effectively treated with low-cost medications, such as those for high blood pressure. Therefore, it is crucial to have accessible primary care to detect and treat many common health problems. Technology, such as AI, sensors, and tests, will be a great help in lowering costs and making care more accessible.

Cost is a major barrier to healthcare for many people. Sustainable healthcare should be affordable to all, irrespective of their economic condition. With scientific progress, more diseases will become treatable and even curable, leading to rising costs, no matter how well-designed the health system might be. The challenge remains to make the “biggest bang for the buck,” i.e., to implement metrics for rational decisions on where to allocate scarce resources best. New treatments are always more expensive, and sufficient funding is needed for pharmaceutical companies to invest in further research. Often, this means a trade-off between rising costs in the short run and potentially better treatments in the long run, which will become affordable after patent expiration. The way of the “blockbuster” drugs shows that they make pharma companies wealthy for a while and then lead to cheap generics that can improve healthcare for all in need. In some cases, such as new genetic treatments that might cure diseases like sickle cell, the costs may be high in the short run yet offer great promises in the long term. A combination of governmental policies and competitive elements delivers the best results, clearly showing that free trade alone cannot be successfully applied to healthcare.

Alongside accessibility and affordability, maintaining high standards of care is essential. Quality of care encompasses effective, safe, and people-centered services. Implementing clinical practice guidelines and protocols, quality improvement initiatives, and patient safety programs is crucial. The biggest impact will come from applying principles of evidence-based medicine. To gather more "real-world evidence," data from various sources such as patient feedback, behavior, sensors, tests, and genetic information need to be used. The challenge is to determine what works best, rather than relying on biased tradition or experience. Quality has two aspects: how the treatment is perceived by the patient (patient experience) and how well it works from an evidence-based, statistical, and economic viewpoint. Both aspects must be developed further, and technology will be crucial. AI will not replace physicians, but few will work in the future without its support to make the best possible treatment decisions.

Investment in a skilled, motivated, and well-distributed healthcare workforce is crucial. This includes doctors, nurses, and other healthcare professionals. One of the key challenges is that work in healthcare is often harder and less well-paid than in other fields. There is a lack of healthcare personnel in most countries, largely due to the lower attractiveness of day-to-day work. While working in healthcare has a high reputation, employee satisfaction is often far from sustainable levels. There are many aspects to address this issue—often, what people want is a better work-life balance rather than having to make sacrifices that seem inevitable, such as working more than 50 hours per week, as 50% of US doctors do. AI, telemedicine, process improvements, and better working schemes are urgently needed to reduce the non-patient-related work, which comprises the biggest part of the daily schedule.

The use of digital technologies, AI, and data analytics can improve diagnostics, disease management, patient monitoring, and supply chain management. Using Artificial Intelligence (AI) for precision medicine, Big Data for epidemiological studies, or Internet of Things (IoT) devices for remote patient monitoring are just some examples of how technology will make healthcare more efficient and, thus, more sustainable. 

Access to essential medicines, vaccines, and medical technologies is a key aspect of sustainable healthcare. Collaboration with pharmaceutical companies and medtech industries is important in this context. Emphasizing on Research & Development (R&D) for neglected diseases, ensuring the availability of Essential Medicines as per the WHO list, and encouraging innovation through technology transfer agreements or Public-Private Partnerships (PPP) are key aspects to support sustainability from a global health perspective. The recent initiative of the German biotech company BioNTech to provide local vaccine production "BioNTainers" to Rwanda is a lighthouse example of supporting underserved areas with vaccines.

Infrastructure such as hospitals, clinics, and labs should be evenly distributed, well-equipped, and efficiently managed. This also includes robust telemedicine capabilities. Building Health Information Systems (HIS) or Electronic Health Record (EHR) systems, optimizing healthcare logistics through Supply Chain Management (SCM) solutions, and creating smart hospitals are essential. As hospitals are the most resource-intensive treatment options, home or local care options, cooperating in a network with specialized clinics, are the preferred pathways. Hospitals will rely on energy efficiency with better-monitored infrastructure technology, focusing especially on heating and cooling, security, and flexibility, as well as optimized information delivery and monitoring from a cockpit perspective tailored to each user role, from hospital managers and doctors to patients and technical staff.

The healthcare sector itself should reduce its environmental footprint. This includes sustainable procurement, waste management, energy use, and supply chain practices. Implementing Green Health initiatives, reducing carbon emissions in line with the UN Sustainable Development Goals (SDGs), and using Life Cycle Assessment (LCA) to evaluate the environmental impact of healthcare products and services are important. 

Efficient, equitable, and sustainable financing mechanisms are needed to fund healthcare services. This could involve various strategies like public-private partnerships, insurance schemes, or innovative funding models. Instituting mechanisms such as Performance-Based Financing (PBF), or innovative funding models like Social Impact Bonds (SIBs), long-term value partnerships, or  blended finance mechanisms are important. Exploring health insurance models, such as community-based health insurance, and decentralization schemes as seen with the NHS or the Danish model, to build new “superhospitals” can be a way forward. 

An integrated, patient-centered approach that coordinates care across different levels and providers can significantly improve outcomes and efficiency. Developing coordinated care models such as Accountable Care Organizations (ACOs) or Patient-Centered Medical Homes (PCMH) can be instrumental in implementing care pathways and transition-of-care models for chronic conditions.

Educating individuals and communities about health and healthcare can empower them to take charge of their own health and make informed decisions. Implementing health education programs that apply principles of the Health Belief Model (HBM) or Theory of Planned Behavior (TPB) is essential. Promoting digital health literacy in the age of eHealth and mHealth can be effectively achieved by utilizing the possibilities of digital interactions and AI.

Good governance, robust policy frameworks, and strong regulatory systems are crucial for ensuring all other aspects of sustainable healthcare. Ensuring policy coherence through Health in All Policies (HiAP) approach, and enforcing strong regulatory systems such as Good Manufacturing Practices (GMP) in pharmaceuticals or Quality Management Systems (QMS) in healthcare organizations are essential. Key aspects of sustainable health will be driven and influenced by governmental bodies e.g. on an European level (e.g. European Green Deal), US, Chinese or Indian level, influencing smaller countries and fundamentally improving health for their citizens.