The doctor is in – your smartphone Is Sweden ready for

The doctor is in –
your smartphone
Is Sweden ready for
digital and virtual care?
40 %
Over 40 percent of
respondents are open to
virtual care and DIY
(do-it-yourself) solutions
over traditional care options.
See page 11
43 %
43 percent of respondents
believe that virtual care can
lead to faster access to care.
See page 13
www.pwc.se/healthcare
Contents
What about the elderly?
s.14
Summary
s.4
Some definitions
s.6
Are Swedes willing
to give up privacy?
s.18
The demand is
there – are we ready
to meet it?
s.20
We face a number
of health challenges
today
s.7
Appendix: Methodology
Swedes are open
to innovative solutions
s.10
Would you like
to know more?
2 PwC • 2015
s.22
s.24
40%
Over 40 percent of respondents
are open to virtual care and DIY
(do-it-yourself) solutions over
traditional care options.
33 percent are open
to having a live visit
with a physician via a
smartphone application.
33%
20 percent would be
willing to receive care
via videocalls.
20%
74%
74 percent said yes to being
monitored virtually via a
wireless heart monitor.
The doctor is in – your smartphone 3
Summary
Emerging needs and greater demands
Sweden’s healthcare system is regarded as one of the best in the world, with
it ranking highly in relation to health
outcomes and quality of care1. We are
however living in a changing society
with new needs and rising healthcare
costs driven by an ageing population
and increasing incidence of chronic
disease.
In order to effectively meet these
emerging challenges, healthcare must
become more efficient and patient. The
shift beyond digital to virtual care has
the potential not just to modernise the
healthcare system and “do better with
less” in terms of public resources and
tax money, but to also improve quality
and access to health services for a population with increasing expectations
for seamless care.
Digitalisation of care is the new black
While the last few decades have seen
other industries such as banking and
retail becoming more efficient and
consumer-centric through the use of
technology, the healthcare sector is just
beginning to realise the benefits of the
digitalisation.
Through a survey we conducted in
spring 2015, 1,034 Swedes provided
us with their perspectives on digital
and innovative care solutions. Their
answers reveal that there is an openness of Swedes to use new digital and
virtual care, as well as a willingness to
receive care with the help of modern
technologies:
1. OECD Reviews of Health Care Quality Sweden 2013
4 PwC • 2015
• Over 40% of respondents are
open to virtual care and DIY
(do-it-yourself) solutions over
traditional care options.
• 33% are open to having a live
visit with a physician via a smartphone application.
• 20% would be willing to
receive care via videocalls.
• 74% said yes to being monitored
virtually via a wireless heart monitor if the situation called for it.
• 43% believe that virtual care
can lead to faster access to care.
• Only 6% were most concerned
about privacy in relation to virtual care; in contrast, 41% voiced
the quality of care as their biggest
concern.
New rules of engagement and collaboration across boundaries
In a world where digitalisation is
becoming the norm, patients will no
longer wish to be tied to a local hospital or a single care practitioner – they
will be more informed, have higher
expectations and place new demands
on the way they receive care. To make
virtual care a reality, government authorities, county councils and municipalities must not only strengthen their
ability to collaborate but must involve
different sectors and interest groups
in their efforts. In addition, there
needs to be an openness towards new
entrants who can contribute towards
innovation and development in the
healthcare system.
If one in three persons with chronic diseases adopt
virtual monitoring solutions, this could translate
into estimated annual cost savings of
SEK 369 million
Jon Arwidson – Partner,
Healthcare leader
If one in five Swedes choose to hold half of their
primary care visits virtually, this could annually
save the healthcare sector up to
SEK 1,2 billion
Sarah Lidé – Manager,
Healthcare specialist
”Big data” may also make more preventive approaches to care possible. Consumer data is now increasingly being
used in predictive health analytics to
identify at-risk patients and allow for
early care interventions before complications occur.
It is therefore critical that reimbursement systems are developed appropriately to drive the right behaviour
and ensure that the use of digital
and virtual care to improve health
outcomes is rewarded. The openness
among Swedes towards DIY solutions
will empower patients to take greater
responsibility for their own health yet
it will require mechanisms that can
manage and qualify such solutions.
Long-term investments
must reflect the future of care
This report shows that there is an
appetite in Sweden towards digital and
virtual care solutions. This will however
require a change in perspective towards
resources, processes, structures and
mindsets in the way we manage healthcare today.
professionals?
In this report we will highlight these
interesting results and more. We look
forward to discussing this study with
you and other stakeholders further in
order to jointly identify the challenges
we need to overcome and the success
factors we need to have in place to fully
realise the benefits of virtual care.
Should we continue building large
hospitals with many beds, or should we
instead focus on “monitoring centres”
which would allow for continued remote
monitoring over the course of a patient’s
medical condition? Can quick access to
a healthcare professional via a virtual
video meeting reduce costs and increase
a patient’s sense of security? Do we
take digitalisation into sufficient account when we train our future medical
Happy reading and do not hesitate to
contact us for a deeper dialogue!
Jon Arwidson & Sarah Lidé
The doctor is in – your smartphone 5
Some
definitions
Digital
care
Virtual
care
Digital + Virtual
care
Example – Digital care
Example - Digital + Virtual care
Example - Virtual care
• Healthcare professionals use their tablets
and assorted apps, while on their rounds,
to show you how your X-ray appears as
well as using educational videos and pictures to help explain the diagnosis.
• Have an echocardiogram (ECG) at home
using a medical device attached to your
phone, with results wirelessly sent to
your physician.
• Have a live visit with a physician via an
application on your smartphone.
• Have dialysis at a medical clinic
in a retail store.
• Have chemotherapy at home.
What is digital care?
What is virtual care?
Digital care is the use of digital tools and
technologies to deliver and access virtual care and
health information. Digital care includes mobile
health solutions (often known as “mHealth”).
Virtual care allows healthcare professionals to collaborate with each other and deliver care remotely.
This means healthcare providers can collect patient
data and deliver care from a different location than
the patient, using technologies such as video conferencing, so that patients can receive care from the
comfort of their own home or in their local community. This can allow patients to have greater accessibility to care and provide more opportunities for them to
discuss their concerns with a healthcare professional.
Many virtual care services will be delivered using
mobile devices. The device could be a cellphone or
tablet, a wireless medical monitor or some other
device that’s not on the market yet. A healthcare
professional and/or patient could use these devices
to communicate, share information or monitor health
in many different situations.
6 PwC • 2015
Virtual care also includes the involvement of physician assistants, nurses or other medical professionals in
delivering care in non-traditional healthcare settings
(such as in a retail store or pharmacy).
We face a number
of health challenges
today
Healthcare systems around the
world are under tremendous
pressure as the global population
increases, ages and become more
sedentary. By 2020, there will
be more than 7.6 billion people
worldwide2, and if present trends
are any guide, many of them
will have health problems. More
than 30% of the world’s population won’t get enough physical
exercise3; more than 20% will be
overweight or obese4; and more
than 13% will be 60 or older5.
2. Population Division of the Department of Economic and
Social Affairs of the United Nations Secretariat, 3. World
Population Prospects: The 2010 Revision, http://esa.un.org/
unpd/wpp/index.htm
3. World Health Organization, Global status report on
non-communicable diseases 2010 (April 2011), p. 18.
4. World Health Organization, Preventing chronic disease: a
vital investment (2005), pp. 54-64.¨’
5. Population Division of the Department of Economic and
Social Affairs of the United Nations Secretariat, op. cit.
Sweden is no exception
Sweden has a larger share of elderly
people than most countries in the OECD
– 5.2% are over 80, versus an OECD
average of 4.2%6. An ageing population,
plus obesity and lack of physical activity,
combine to increase the risk of heart
disease, diabetes and cancer. These conditions, together with other non-communicable disease (NCDs), are the cause of
63% of all deaths worldwide7.
The World Economic Forum
estimates that non-communicable diseases will create
a global economic burden
amounting to US$47 trillion
over the next two decades.
The World Economic Forum (WEF)
estimates that NCDs will create a global
economic burden amounting to US$47
trillion over the next two decades, with
cardiovascular disease and mental health
conditions being the dominant contributors8. In the same vein, the World Health
Organization (WHO) estimated that
NCDs accounted for 90% of all deaths in
Sweden as of 2011, and this was mainly
driven by cardiovascular disease9.
6. http://www.oecd.org/health/sweden-has-excellent-healthcare-but-must-improve-care-co-ordination.htm
7. http://www3.weforum.org/docs/WEF_Harvard_HE_GlobalEconomicBurdenNonCommunicableDiseases_2011.pdf
8. http://www3.weforum.org/docs/WEF_Harvard_HE_GlobalEconomicBurdenNonCommunicableDiseases_2011.pdf
9. http://www.who.int/nmh/countries/swe_en.pdf
The doctor is in – your smartphone 7
Persons with chronic
diseases contribute
approximately 80 to 85%
of total healthcare costs in
Sweden, and the incidence
of chronic disease also goes
hand in hand with age.
Chronic diseases account
for 80-85% of healthcare costs
The Swedish Agency for Health and Care
Services Analysis estimates that persons
with chronic diseases contribute approximately 80 to 85% of total healthcare
costs in Sweden, with those having two
or more chronic diseases standing for
50% of total healthcare costs10.
The incidence of chronic disease also
goes hand in hand with age – 85% of
Swedes over 65 have at least one chronic
disease, and 66% have two or more11.
This obviously creates demands on
healthcare resources – Sweden spends
more on long-term care for the frail
and dependent elderly than most other
OECD countries, at 3.6% of GDP in 2011,
and both the OECD and the European
Commission estimate that spending on
long-term care in Sweden is set to more
than double by 2050.
The respondent profile in our Swedish
study matches these patterns – 36% have
at least one chronic disease, and the top
two chronic diseases are hypertension
and mental health conditions.
However, these diseases are skewed
according to age groups – hypertension
is most common among those aged 55
and above (26%), while depression,
anxiety or other mental health issues is
the dominating condition among those
between 18 and 34 years of age (17%).
The latter is part of a trend – statistics
from Sweden’s National Board of Health
and Welfare show that the proportion
of young people (15-24 years old) with
mental illness has increased by 30%
between 2006 and 201112.
Figure 1: The incidence of chronic disease increases with age, with hypertension and mental health issues being the top two diseases
borne by respondents
Percentage of respondents with chronic
conditions – by age group
19%
8%
24%
7%
Respondents with chronic conditions – by chronic condition
6%
4%
28%
6%
23%
3%
3%
5%
5%
3%
3%
3%
2%
1%
18-34
35-54
4%
1%
3%
55+
Hypertension
or high
blood
pressure
Depression, Diabetes
anxiety or
other mental
health issues
Asthma
or chronic
lung
conditions
Joint pain
or arthritis
1%
1%
Heart
Cancer
disease,
including
heart attacks
Other chronic
conditions
Has multiple chronic conditions
Has one chronic condition
10. http://www.vardanalys.se/Global/Rapporter%20pdf-filer/2014/2014-2-VIP%20i%20v%C3%A5rden.pdf
11. http://www.vardanalys.se/Global/Rapporter%20pdf-filer/2014/2014-2-VIP%20i%20v%C3%A5rden.pdf
8 PwC • 2015
12. http://www.svd.se/nyheter/inrikes/allt-fler-unga-far-psykiatrisk-vard_8739840.svd
Young adults are most positive
towards mobile solutions
The study shows that it is young adults
who have shown the most inclination
towards new consumer technologies –
among those aged between 18-34 years
old, 63% own at least one health- or
medical-related app, and 37% intend
to purchase a wearable device in the
coming year.
This high level of connectedness and
tech-awareness, together with the challenge that this age group faces in relation to mental health, might explain the
consistently high ranking of mindfulness apps on the Swedish iTunes store13.
Digitalisation creates
more opportunities
The popularity of apps indicates that
there is great interest among patients
and health consumers to seek health
information on their own. This can in
turn means that there may be scope
to meet the demand for care through
virtual solutions for certain patient
groups, such as the opportunity for
chronically ill patients to interact more
frequently with the healthcare system
via digital solutions.
We see the potential of virtual care –
but what do Swedes, especially our
elderly who are carrying most of the
chronic disease burden, think?
Figure 2: Young adults are more open to new consumer technologies
like apps and wearables
Respondents’ attitudes towards mobile solutions – by age group
Has health-related apps
63%
50%
21%
Owns a wearable device
29%
10%
22%
Plans to purchase a wearable device in the coming year
37%
32%
14%
18-34
35-54
13. In our analysis of the top ten free, paid and grossing apps
ranked daily on the Swedish iTunes store during the period
January to May 2015, we found that mindfulness apps were
consistently included among the top ten ranked paid and
grossing apps in the health & fitness category (ranked top ten
in 98% of all days analysed).
55+
The doctor is in – your smartphone 9
Swedes are open
to innovative solutions
We are one of the most connected people in the world; one in
two persons own a tablet, three
in four own a smartphone, and
nine out of ten have Internet and
computer access14. This is consequently changing the way we
access information and services,
not least in relation to our own
health.
44% of respondents are using at least
one health- or medical-related app
Fitness and nutrition apps emerged as
being most popular, being used among
66% and 31% of health app users respectively. We also noticed a slight tendency for those who do not have chronic
conditions to use fitness apps, while the
chronically ill seem to be engaging with
apps that help them manage their diet
and nutrition.
Figure 3: Almost half of respondents have health-related apps
Which of the following healthcare, wellness or medical applications do you have on your phone
or tablet?
Exercise instruction and monitoring
66%
Dieting, weight loss and/or healthy eating
31%
56 %
44 %
First aid and/or other medical information
14%
Sleep
14%
Stress reduction
11%
I have such apps on my phone or tablet
I do not have such apps on my phone or tablet
Medicines and prescriptions
11%
Fertility tracking
8%
Physician appointments
5%
Vital sign monitoring
5%
Live online visits with a doctor, nurse or other medical caregiver
5%
Hospital
4%
14. https://www.iis.se/english/news/swedes-andthe-internet-2014/
10 PwC • 2015
42% are in favour of options
that enable self-care at home
Self-care or DIY care solutions include,
for example, remote diagnosis on tests
that patients can take at home. 61% of
respondents are open to sending a digital
photo of a skin problem to a dermatologist for an opinion.
Other relevant areas include the monitoring of vital signs via one’s smartphone
– this could for instance apply to blood
pressure measurement or the measurement of blood glucose levels – 54% of
respondents are in favour of using such
solutions at home. Though they are
comparatively more skeptical of more
advanced care outside the hospital, such
as chemotherapy, 33% remain positive
even to this type of virtual care.
These findings are consistent with a similar U.S. consumer survey commissioned
by PwC’s Health Research Institute in
201315, with Swedes showing a higher
openness towards virtual solutions relating to diagnosis of skin conditions, urine
testing and the taking of ECGs, while being comparatively more cautious when it
comes to more complex procedures such
as dialysis at home or getting an MRI in a
retail store or pharmacy.
Figure 4: Swedes are open to virtual care
Respondents who were somewhat or very likely to choose the following for themselves if the
technology or service were available
Send a digital photo of a rash or skin
problem to a dermatologist for an opinion
61%
54%
Have an echocardiogram (ECG) at home using a medical device
attached to your phone, with results wirelessly sent to your physician
54%
44%
Check vital signs at home with a
medical device attached to your phone
54%
55%
Do a urinalysis test at home
with a device attached to your phone
52%
42%
Use an at-home strep test purchased at a store
48%
58%
Check for an ear infection at home using
a medical device attached to your phone
45%
47%
Have a pacemaker or defibrillator
checked at home wirelessly by your physician
42%
43%
Have a live visit with a physician via an
application on your smartphone
33%
39%
Have chemotherapy at home
33%
37%
Get an MRI at a clinic in a retail store or pharmacy
25%
34%
Have dialysis at a medical clinic in a retail store
17%
26%
Sweden 2015
USA 2013
15. PwC (2014), “Healthcare’s new entrants: Who will be the
industry’s Amazon.com? See http://www.pwc.com/gx/en/
healthcare/publications/new-entrants.jhtml.
The doctor is in – your smartphone 11
Figure 5: Though the telephone remains the most popular option, respondents are willing
to try out new virtual care solutions
Have you ever attended a doctor’s
appoint­ment by any of the following
methods?
If given the opportunity, which of the following
methods would you be willing to use to receive
care (e.g. attend a doctor’s appointment)?
Via telephone
Via telephone
59%
48%
Via a website
Via a website
20%
29%
Via email
Via email
10%
23%
Via SMS or a similar text messaging service
Via SMS or a similar text messaging service
2%
10%
Using a mobile app
Using a mobile app
2%
18%
Via video call
Via video call
0%
20%
None of the above
None of the above
34%
0
10
20
30
30%
40
50
60 0
33% are open to having a live visit
with a physician via a smartphone
application, and 20% would be
willing to receive care via videocalls
While a majority of respondents
have experienced virtual care via the
telephone (and this remains the most
popular virtual care option), there is an
openness towards new ways of engaging
in virtual care. One in five respondents
would be willing to receive care through
digital consumer technologies, such as
apps and videocalls, even though their
use for in-care visits are almost non-existent today.
74% can consider
being monitored virtually
When asked to consider a situation
where they required regular monitoring
for a heart condition, 74% of respondents said yes to being monitored virtually via a wireless heart monitor, with a
signal automatically sent to a care team
if a problem arises.
This held true regardless of gender,
12 PwC • 2015
10
20
30
40
50
age, and presence of chronic diseases.
These findings underline the willingness of citizens to adopt innovative and
patient-centred solutions that give them
more control over their own health and
the way they receive care.
43% of respondents believe that virtual
care can lead to faster access to care
The survey shows that one of the healthcare system’s biggest challenges is the
availability and access to care precisely
when patients need it. Even though 9 out
of 10 Swedes receive a doctor’s appointment for primary care within the official
targeted maximum waiting of seven
days16, such waiting times are still very
modest at the European level17.
The survey clearly indicates that Swedes
desire solutions which allow them to
access care even more quickly, provided
that quality of care is not compromised.
16. As of spring 2015; see http://www.vantetider.se/
17. http://www.healthpowerhouse.com/files/EHCI_2014/
EHCI_2014_report.pdf
Figure 6: Respondents indicate that access
to care is the area in biggest need of
improvement
Figure 7: Faster access to care is the primary motivation for using virtual care, provided
care quality isn’t compromised
In your experience, which aspect of healthcare in
the Swedish healthcare system needs the most
improvement?
What would be the main motivation for you
to use a virtual care service?
Access to care
Faster access to care
What is your biggest concern when deciding
whether to use a virtual care service?
The quality of care
45%
43%
41%
Saving time and money for the healthcare system
Quality of care received
Losing personal contact with my doctor
10%
25%
23%
Less travel to receive care
The technology fails and puts my health at risk
9%
Communication between your care providers
13%
Saving me time and money
12%
6%
Communication with your care providers
6% 10
6%
People could abuse the healthcare system
More involvement in my own care
Your involvement in your health and your care
4%
4%
6%
Not knowing how to use the technology
Managing my healthcare on my own schedule
4%
4%
Privacy / confidentiality
More collaboration among healthcare providers
1%
34
9%
Not interested
16%
20
20
None of the above
3%
10
23
Keeping my health information private
Better quality of care
10%
0
48
30
40
50
0
10
20
30
40
50
0
10
20
30
40
50
PwC’s analysis
Billions to be saved for healthcare
In the face of rising healthcare costs,
the openness of Swedes towards innovative health solutions such as virtual
care creates the opportunity for significant cost savings within healthcare. If
one in three persons with chronic diseases such as congestive heart failure,
chronic obstructive pulmonary disease
and diabetes adopt virtual monitoring
solutions, this could translate into estimated cost savings of SEK 369 million
annually in Sweden. And if one in five
Swedes choose to hold half of their
primary care visits virtually via video,
this could save the healthcare sector
up to SEK 1.2 billion every year18.
18. Cost saving calculations are based on cost reduction potentials identified in existing international studies and applied to
current healthcare expenditures in Sweden for the various patient
groups.
But the digital and virtual care is not
just about the money - it represents
the opportunity to increase the availability of care and meet new consumer
expectations of participation, transparency and dialogue. Virtual care
can also help to identify signals and
treat patients early before complications occur as a result of existing
chronic conditions, as well as encourage lifestyle changes that reduce the
incidence of chronic conditions. For
instance, an improvement in wellbeing effected through a healthy diet
and regular exercise can reduce the
risk of developing a chronic disease by
50% to 73% depending on the type of
disease19.
19. PwC (2013), “Socio-economic impact of mHealth - An
assessment report for the European Union”. See http://www.
pwc.in/en_IN/in/assets/pdfs/consulting/strategy/socio-economic-impact-of-mHealth-the-European-Union.pdf
The doctor is in – your smartphone 13
What about the
elderly?
Swedes are open towards new
ways of receiving care digitally
and virtually. What is interesting is that this observation
holds true even among the
elderly, who recognise that new
technologies can contribute to
a sense of security as well as an
increased quality of life.
17% of those over 55
are open to conducting a
healthcare visit via video
in the future.
The survey shows an openness towards
digital and virtual care solutions even
among the elderly. Though less than
1% of respondents aged over 55 have
conducted a healthcare visit via video,
17% are willing to do so in the future.
Seamless chains of care and high
care quality are essential
At the same time, the elderly are
qualifying their approach to virtual
care – while the rest of the population
is most concerned with maintaining
quality of care when adopting virtual
care solutions, those over 55 years old
have placed maintaining of personal
contact with their doctor as the highest
priority.
33% of those aged over 55 believe that
not losing personal contact with care
personnel is the biggest challenge in relation to virtual care. Almost as many,
31%, identify quality of care as their
main concern.
Gaps in the elderly’s digital maturity
While Swedes tend to trust official
sources of information, these sources differ – half of respondents aged below 55
go to official websites first, while more
than half of those aged above 55 would
approach their doctor or nurse first.
This could well be explained by a lack of
awareness among the elderly of websites
such as 1177 Vårdguiden (www.1177.
se), Sweden’s portal for information and
services related to healthcare, among
the elderly. An annual survey of care
provision in Sweden, Vårdbarometern
201420, indicated that only 30% of those
aged 60 and over were aware of 1177.se,
while this rose to an average of 61% for
those younger than 60.
20. http://www.vardbarometern.se/PDF/V%C3%A5rdbarometern_2014_%C3%85rsrapport_2015-03-19.pdf
14 PwC • 2015
Figure 8: While quality of care is the primary concern for the elderly, maintaining personal
contact is also crucial
Respondents’ biggest concern when deciding whether to use a virtual care service – by age group
49%
45%
33%
31%
20%
14%
16%
14%
13%
10%
8%
4%
6%
2%
7%
6%
18-34
4% 3%
35-54
4%
3%
6%
55+
The quality of care
Keeping my health information private
Losing personal contact with my doctor
The technology fails and puts my health at risk
People could abuse the healthcare system
Not knowing how to use the technology
None of the above
The doctor is in – your smartphone 15
Finding virtual care
solutions that meet the
needs of the elderly is
particularly important
when taking into account
the differences between
urban and rural areas.
Digital and virtual
care solutions are a cost
effective way to increase
both availability and sense
of security for those who
live far away from the
nearest health centre.
Figure 9: Even among the elderly, there is an openness towards virtual care solutions
Uses today
Willing to use in the future
70%
18–34 years
53%
35%
-9%
44%
23%
36%
+8%
+11%
23%
+20%
27%
25%
+22%
+9%
12%
0%
4%
3%
-11%
22%
13%
0%
70%
35–54 years
61%
-9%
52%
33%
23%
+11%
+13%
55+ years
+21%
22%
10%
0%
70%
32%
24%
22%
10%
1%
0%
60%
-14%
46%
37%
22%
19%
+13%
9%
0%
16 PwC • 2015
-4%
+22%
+9%
3%
28%
Telephone
Email
12% +7%
6%
+9%
1%
Website
Mobile app
8%
35%
17%
+6%
2%
SMS / text
messaging
service
+17%
0%
Video calls
None
-2%
PwC’s analysis
Opportunities to improve the
quality of care for the elderly
The analysis shows that this is an
opportune time to spread the use
of digital technologies and facilities
among the elderly and chronically
ill in order to increase their access
and closeness to care without
burdening the system.
Among OECD countries21, Sweden
has the second lowest number of
medical consultations per capita
– a figure matched by a corresponding low number of consultations
per doctor. Yet, Sweden ranks last
in terms of doctors having adequate
time with the patient, providing
understandable explanations and
giving patients the opportunity to
ask questions or point out concerns.
21. OECD Reviews of Health Care Quality Sweden 2013
The same low figures apply to the
ability of involving the patient
in decisions about their care and
treatment. Here, digital and virtual
solutions can fulfill an important
function in addressing these gaps.
Virtual care solutions that meet the
needs of the elderly is particularly
important when taking into account
the differences between urban
and rural areas. The proportion of
residents in rural areas aged 65 and
above increased from 24% to 27%
between 2005 and 2013, and this is
expected to increase to 31% by the
year 205322. Digital and virtual care
solutions are a cost effective way to
increase both availability as well as
sense of security for those who live
far away from the nearest health
centre.
22. http://www.scb.se/sv_/Hitta-statistik/Artiklar/Sverigesbefolkning-okar--men-inte-i-hela-landet/
The doctor is in – your smartphone 17
Are Swedes willing
to give up privacy?
Patient safety is always a sensitive but important issue, and
the digitisation of care will continue to require high standards
of quality assurance and data
management. We asked more
than a thousand Swedes about
their concerns surrounding
privacy and confidentiality.
The responses to a
situation-based question were clear
We asked our respondents to imagine
that they required regular monitoring
as a result of a heart condition. They
were provided with the option of being
virtually monitored via a wireless heart
monitor, with a signal sent to a care team
if a problem occured. 74% of respondents said yes to such a solution.
Privacy and confidentiality were
not a key concern to respondents
Respondents were then asked to weigh
the importance of privacy in relation to
convenience and comfort, a sense of security, and the ability to quickly receive
help when needed.
Our survey revealed that, if put in a similar situation, a majority of Swedes would
consider convenience and comfort,
having a sense of security, and being able
to quickly receive help when needed as
being more important than privacy and
confidentiality.
Similarly, only 6% of respondents indicated that keeping their health information
private was their biggest concern when
it came to virtual care; instead, what
concerned them most was the quality of
care (41%).
Figure 10: Convenience and comfort, a sense of security, and quick
access to help were seen as being more important than privacy and confidentiality
Privacy and confidentiality
Respondents’ attitude to privacy and confidentiality in relation to comfort and convenience,
a sense of security and the ability to quickly receive help when needed in a given virtual
monitoring scenario
8%
9%
3% 5%
2% 3%
39%
26%
26%
17%
1- Privacy and confidentiality
18 PwC • 2015
31%
26%
2
19%
35%
52%
3
4
My comfort and convenience / My sense of security /
Being able to quickly receive help when needed
My comfort and convenience
My sense of security
Being able to quickly receive
help when needed
PwC’s analysis
Potential to meet new needs
The findings underline the strong
desire of Swedish consumers to use
new healthcare solutions which increase access to and timeliness of care.
Concerns about lack of confidentiality
and privacy are marginal and do not
change their attitude or willingness to
try digital and virtual care solutions.
We should however take into account
that the findings might reflect a limited
awareness regarding the risks relating
to privacy, as well as a strong prevailing trust in the healthcare system to
manage privacy issues.
Regardless, it is important to keep in
mind the respondents’ positive attitude
to virtual care solutions, and these
solutions present an opportunity to
meet the challenges in healthcare
today. This is important to keep in
mind when digital or virtual care
solutions are being developed and
implemented, given that patient
concerns surrounding privacy and
confidentiality is an argument often
used to hinder the adoption of such
solutions, despite the fact that these
concerns are not reflected in the
survey findings.
74 percent of respondents
would say yes to using a
wireless heart monitor
where they can be virtual
monitored from home.
Legislation must thus strike a balance
between giving space for innovative
care solutions to be developed and
adopted, while not neglecting legitimate privacy concerns.
The doctor is in – your smartphone 19
The demand is
there – are we ready
to meet it?
The digitisation of healthcare
is driven by several parties –
patients who want greater availability and an increased sense of
security, as well as a new generation of healthcare professionals
who see opportunities in virtual
care and are not afraid to explore
new digital healthcare options.
Digitalisation can solve a number
of challenges we face today
Sweden, while having a reputable
healthcare system, still has a number
of challenges to overcome. As previously
mentioned, Sweden has the second lowest the number of medical consultations
per capita among OECD countries23, and
similarly low numbers when it comes to
doctors having adequate time with the
patient, providing understandable explanations, giving patients the opportunity
to ask questions or point out concerns,
and involving the patient in decisions
about care and treatment. Another area
where Sweden stands out is the number
of hospital beds in which we are clearly
ranked below average24.
Given Swedes’ digital maturity and
willingness to embrace new healthcare
solutions, Sweden has the potential to
address many of these existing problems
by moving towards a more digitised
healthcare system that incorporates
virtual solutions.
More and more
players are showing interest
Counties, hospitals, doctors, researchers,
patient advocacy groups, and commercial developers are rapidly creating new
digital solutions. There are thousands
of apps available in the major app stores
with varying degrees of accuracy25. There
is thus a need to construct a delivery
system that safely and effectively connects patients with the digital solutions
they need, and bring about the future
that digital and virtual care is promising.
In this future26:
• Healthcare organisations will start to
develop ways to provide healthcare
professionals with the list of digital
solutions (e.g. apps) that have been
tested and approved for use.
23. OECD Reviews of Health Care Quality Sweden 2013
24. http://cdn2.hubspot.net/hub/315629/file-1156697382pdf/Almedalen/Handouts_LIFrapport_Almedalen_v140622.
pdf?t=1404384856634
25. For instance, Gartner estimates that the accuracy of apps
that diagnose ailments or monitor vital signs can range from
an encouraging 98% to a worrying 6%.
26. PwC (2014), “Making care mobile: Shifting perspectives on
the virtualization of health care”. Se http://www.pwc.com/ca/
en/healthcare/roadmap-to-the-virtualization-of-care.jhtml
20 PwC • 2015
• Patients and consumers will be able
to easily identify and access healthrelated products and solutions that
are credible and well-designed.
PwC’s analysis
A coherent strategy is needed
Sweden must develop a clear
coherent strategy for the digitisation
of care and the related transition to
virtual care that empowers patients.
It is also extremely important to be
open to new entrants from other
industries which can contribute to
innovation and development. Further,
with increased access to information,
patients will want the flexibility of
moving between hospitals and medical staff, while having high expectations in the way they receive care. For
such patient-centred care to succeed,
a common national infrastructure
is required that allows interaction
between all parties in the healthcare
system.
• There will be an organised approach
to the delivery and regulation of
digital care solutions, just like we
do with medications in drugstores
– some over-the-counter, some prescription, and some front of store.
Digital solutions can improve
existing levels of quality in care
There already exist good examples of
doctors who have already begun digitising healthcare on their own initiative,
for example bringing their personal
tablets along with them while making
their rounds in the hospital. They use
their tablets and assorted apps to show
the patients how their X-rays look like,
to view educational videos and pictures
that help explain the patient’s diagnosis, and to even translate medical
words and expressions in order to
bridge language barriers27.
27. http://www.sjukhuslakaren.se/2015/02/19/sara-lei-harsurfat-in-i-framtiden/
”Big data” may also make more
preventive approaches to care possible
and allow for a focus on populations
with special needs. Healthcare needs
can be anticipated and efforts deployed at an early stage. Patients may
also take increased analytical responsibility for their own health, but this
Both doctor and patient not only believe
the digitalisation and virtualisation of
healthcare is inevitable, but that they
will enhance healthcare delivery and
practices. Virtual care visits will become
more common, or may even replace a
significant number of in-person visits28.
It not only provides increased availability, it can also lead to significant savings
in terms of cost and effort, especially
development requires a healthcare
system that can handle ”big data”
and enable monitoring and control
remotely.
The state’s role in e-health development needs to be clarified29, as well
as who does what between the state
and other stakeholders. At the same
time there needs to be room for
ground-up innovation that can lead
to sustainable changes in processes,
systems and controls. Here, reimbursement systems become an
important factor – they need to be
developed to reward the right
behaviour and steer efforts in the
right direction.
Digitalisation will clearly affect the
way we build our hospitals and train
our medical of professionals. The
”digital natives” will soon enter the
healthcare system with a natural
affinity to digitalisation; but it is key
that the Swedish healthcare system recalibrates itself to accelerate
progress towards a digital and virtual
care future.
for patients who are frequent users of
healthcare. Support to chronic patients and their loved ones can become
better, and at-home care will become
more frequent. Increased digitisation of
healthcare processes and chains of care
will also mean that a holistic approach
for both the individual patient as well as
the healthcare system as a whole can be
made possible.
A coherent strategy is needed
28. http://www.ntca.org/new-edge/other/takeaways-from-theata-meeting-tradeshow
29. http://www.regeringen.se/contentassets/a58d886fdc7f4efcbfcd02dab5431ecd/nasta-fas-i-e-halsoarbetet-sou-201532
The doctor is in – your smartphone 21
Appendix
Methodology
The data shown in the report is based
on a web survey conducted in April
2015. The survey was sent out to
about 2,600 Swedes, of whom 1,034
responded to the survey, representing
a response rate of about 40%. Respondents were randomly selected between
the ages of 18 to 75 years.
Age
18-24
12%
25-34
15%
34-44
21%
19%
45-54
17%
55-64
65+
16%
0
10
5
15
20
25
Place of residence
19%
25%
29%
27%
0
5
Rural area
10
15
20
25
30
Small town (less than 50,000 inhabitants)
Small-to-medium sized city (between 50,000 to 200,000 inhabitants)
Major city (more than 200,000 inhabitants)
22 PwC • 2015
Level of education
Gender
2% 8%
30%
49%
51%
38%
22%
Male
Elementary school
Female
High school
College / university: Less than 3 years
College / university: Minimum 3 years
Post graduate education
Chronic conditions
Taking care of someone with
a chronic condition
12%
25%
64%
11%
88%
Has one chronic condition
Yes
No
Has multiple chronic conditions
Does not have a chronic condition
The doctor is in – your smartphone 23
Would you like to know
more? Contact us!
Jon Arwidson
Partner, Healthcare leader
PwC Sweden
[email protected]
+46 (0) 10 213 31 02
Sarah Lidé
Manager, Healthcare specialist
PwC Sweden
[email protected]
+46 (0) 10 212 92 08
We would like to thank the following persons
for their contributions to this report:
Sofia Strömbäck, PwC Sweden
Caroline Lingqvist, PwC Sweden
Eva Lidmark, PwC Sweden
Jesper Olsson, Swedish Agency for Health
and Care Services Analysis
24 PwC • 2015
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