Fitter, happier, more productive ... our health system in 2050

AUSTRALIA 2050 – I’d like you to imagine for a minute that you are living in Australia in 2050: August 1 2050, to be precise.

It’s one of those days that makes you glad to be alive: a cool morning in Melbourne under the bio-canopy that now keeps the globe at a reasonable temperature.

You feel good as you lie in bed, looking out through your window at the apartment of your elderly neighbour, Zac Chi.

Chi, 87, is woken by his biosensor to ensure that he gets the appropriate “dose” of exercise to keep his body in good shape.

He’s being monitored by his primary health-care coordinator who receives daily readouts of his blood sugars, blood pressure, basic metabolic rate and a host of other health parameters that allow for rapid intervention before any life threatening event occurs.

All this information is collected on the health database and stored both centrally and on the microchip inserted under Chi’s skin so it’s readily accessible to any health professional Chi consults.

Chi finishes his exercises and has a breakfast comprising food especially matched to his metabolic genetic profile and provided to him through his local pharma-hypermarket. It delivers all he needs.

He then logs into his “virtual health connector” – a very sophisticated television/computer to have his daily virtual health session with his health facilitator.

This includes mind/body training as well as feedback on his body parameters.

Next, he has to review his health education program to ensure he has enough “credit points” to maintain his class A status on his health savings account.

This provides him with almost total cover for any serious health problem provided it’s not self-induced.

Lunch and then visiting friends and family fill the rest of the day; or perhaps a trip to the post surgical centre, where his best friend is recovering from a stem cell lung replacement.

Chi returns late in the day and links with his grandchildren in London via a wall-sized television screen.

It provides tactile sensation allowing him a virtual hug and a good night kiss after he has read them a bed-time story – one of the few reminders of his youth when his father used to read stories to lull him to sleep. It is now well accepted that these tactile links with friends and family are important therapeutic elements of life .

Is this what it will really be like in Australia in 2050? Possibly.

Our current system

Australia has one of the best health systems on the planet but one that is unfortunately financially unsustainable.

Rapidly rising health costs which are predicted to reach around 20% of Gross Domestic Product by 2020 demand radical reform and this needs to happen within the next decade if we are to maintain a system that provides high quality care at a reasonable cost for all.

So what would work? Let’s imagine the following. The health system of 2050 will be focussed on patients, who will have a much greater degree of health literacy; and it will be delivered from a primary care or prevention perspective.

People will know their bodies and how to look after them. And appropriate incentives will be built into the health system to encourage people to take care of themselves.

Everyone will have a genetic profile at birth that will reveal, to a large extent, what diseases they might be prone to during their lifetimes.

This will help health facilitators – everyone will be assigned one of these – ensure individuals take appropriate care of themselves and that that those diseases to which they are prone ( from their genetic profiling ) can be detected early or that preventive measures can be maintained through out life .

The information will be linked to an individuals health savings account, which will provide the payment mechanism for health and wellness care.

This account will require significant payments by the individual if they suffer a preventable illness.

Health savings accounts (both government-funded or privately paid for to provide choice) will be provided for all, paid for by a combination of individual contributions and taxes – a sort of health ‘superannuation’.

The smaller number of doctors will work with teams of other health workers to provide chronic disease prevention and management.

These health workers will learn their skill though education (both real and simulated) mainly in primary-care and ambulatory care facilities – a far cry from practice earlier in the century when most health professional training was carried out in hospitals.

All health workers will be salaried with appropriate incentives for expertise, responsibility and with elements of performanec bonuses.

Many health interventions – even quite sophisticated surgeries – will be carried out in day-care facilities.

They’ll be followed up with appropriately sophisticated home care or rehabilitation for those who require a little bit more support.

Hospitals will focus on major trauma, although that will be very much reduced by smart transport systems and road regulations that dramatically reduce road accidents to a minimum by preventing contact between vehicles except in exceptional circumstances.

Hospitals will also tend to be condition specific – staffed by well-trained, multi-disciplinary teams and focussing on such things as neurosciences, infections, cancer and musculoskeletal conditions .

But they will all include centres for regenerative medicine or surgery where stem cell technology will be used to rebuilt damaged or old organs. The cells used will be derived primarily from the patients themselves.

The virtual information age will have transformed the way we train health workers and deliver health services – and how we pay for these services.

The challenge will be to maintain individual choice but recognise that all have a responsibility to the society in which we live to maintain that community in the best possible way.

For Chi, though, things could definitely be worse. Having spoken to his grandchildren in London, he links up with his ladyfriend Cathy for a few rounds of virtual bowling – guaranteed to get his heart pumping – before hitting the hay.

As for you? You check the display on your bedside biosensor then fall into deep, untroubled sleep while your latest educational program plays subliminally through your brain.

This is part two of The Conversation’s Australia 2050 series.

Are you an academic or researcher with a vision for Australia in 2050? Send us an email, subject line: Australia 2050.

Peter Brooks receives funding from.NHMRC HWA Telstra Corporation