People’s health and healthcare in western societies currently face a number of serious challenges. We observe the following trends and challenges pertinent to the development of CCTR.
Growing number of older people
In the Netherlands the number of people over 65 is currently 15% and this number will increase to some 25% by 2050 (CBS Bevolkingsprognose).
Increasing care demand
Mainly as a result of the ageing population, but also as a result of unhealthy lifestyles, there is a sharply increasing incidence and prevalence of chronic health conditions. About 25% of people in the Netherlands currently suffer from a chronic disease, and the expectation is that this average will become much higher (in 2025 it is estimated to be around 23% for the 20 most prevalent chronic diseases alone; Hollander et al., 2006).
Decreasing number of people available to work in healthcare
Parallel to the increasing care demand is a relative decrease in the number of employees available to work in the healthcare sector. Combined with the increasing demand for care, this will lead to shortages on the labor market.
A strong tendency towards extramural care and prevention
In the past decades many clients, traditionally living in care facilities, now live independently or with support in extramural settings. This trend will continue. Moreover, government policies increasingly focus on healthy lifestyles and behavior instead of on care and disease.
Emancipation and empowerment of patients (and professionals)
Current visions on prevention and care, like Wagner’s Chronic Care Model, strongly emphasize the importance of timely self management and empowerment, both of citizens and professionals. This demands a cultural and societal paradigm shift from receiving cure and care towards proactive preventive behavior and lifestyle.
Increasing healthcare costs
The costs of care are high and they are still increasing. For example, the cost of healthcare in the Netherlands in 2003 amounted to 57.5 billion euro’s and in 2005 this figure was 68.5 billion euro’s, which is about 13.5 % of GDP (Krommer et al., 2006). It is expected that if policy remains unchanged, then the cost of care will increase by between 3 and 6% annually in the coming years.
The challenges these trends pose:
- prevention of disease and its functional consequences
- integrated prevention and care must be delivered more efficiently, with optimal use of the self-management potential of patients, and getting both formal and informal caregivers involved.
What can be done outside institutionalized settings should in fact be done there.
The substantial increase in the required amount of care cannot be managed proportionally with the number of people available to work in healthcare. This imbalance can be substantially reduced by introducing innovative care concepts with state-of-the-art technology that enables extramural diagnostics, monitoring and treatment. This will lower the pressure on intramural care, increase the self-management capabilities of patients and enable them to live more independently and to participate longer in society.