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Can digitization bridge the healthcare gap?

Date:13 April 2023
Professor Albert Boonstra
Professor Albert Boonstra
Currently, about 16% of the workforce in the Netherlands works in healthcare. These include doctors, nurses, caregivers, and therapists. Together, they provide care in the form of hospital care, mental health care, nursing care, home care, care for disabled people, and youth care. In 2023, the total demand for care is expected to be around 100 billion euros. Experts expect this demand to increase sharply in the coming years. This is due to an aging population, more chronically ill people, and new medical options.

If the healthcare policy remains unchanged, no less than 25% of the working population will have to work in healthcare in 2040 to meet the demand for care. This is not feasible for a well-functioning society. Many people will also be needed in other domains, such as education, security, manufacturing, and services. An even further growing healthcare sector will hamper the development of these other sectors. This gap between available and needed healthcare workers can be called "healthcare gap". The urgent question is how this gap between healthcare demand and supply can be bridged.

Many believe that digitization can play an essential role in bridging this gap. Minister Kuipers of Health, Wellbeing, and Sports is one of them. In an interview on November 13, 2022, he stated on the TV program Buitenhof that digital technologies will make healthcare more productive and efficient and help close the healthcare gap. This vision is crucial to the Integrated Healthcare Agreement in the Netherlands.

Various examples illustrate these positive expectations for digital innovation. eHealth, big data, telecare, telemonitoring, robots, and artificial intelligence are the buzzwords here. Medical check-ups can be performed with devices operated by patients at home, doctors need only look for outliers. Robots can help the elderly, so home care workers can coordinate automated care remotely. Artificial intelligence can be used to make medical diagnoses, reducing the need for medical specialists. With video consultations, general practitioners and hospitals need fewer physical visits. With online psychological help, algorithms can replace some of the work of psychologists.

However, the critical question is whether digitization makes healthcare more productive and efficient and contributes substantially to closing the healthcare gap. Macroeconomic research does not point in that direction. Robert Solow's famous productivity paradox of 1987 (‘You can see the computer age everywhere but in the productivity statistics’) is still relevant today. In many sectors, especially services, no positive relationship between digitization and productivity has been demonstrated. Digitization often leads to more and sometimes better care. It does not result in lower care volume, higher productivity, or lower prices.

Our research into digital healthcare innovations also does not point to productivity improvement through digitization. Many digital innovations, such as the digital family physician, make primary care more accessible and increase rather than decrease the demand for care. Electronic patient records (EHR) sometimes improve the quality of care. These records can control medications and make patient data more accessible, including to patients themselves. At the same time, many healthcare providers complain about the time consumption and increased bureaucracy caused by these systems. Artificial intelligence can contribute to the faster and better interpretation of medical images. However, applying AI often leads to more examinations, increasing the volume of care and increasing rather than decreasing overall costs.

Digitization in healthcare regularly leads to increased demand for care, sometimes better healthcare, and sometimes more work or worse care. A significant increase in healthcare productivity due to digitization has not yet been observed. I conclude that the view that digitization is essential to bridging the healthcare gap is wishful thinking and not based on sound research. To close the healthcare gap, policymakers and politicians must make painful choices instead of seeking refuge in a digital utopia.

For more information, please contact professor Albert Boonstra (