White

Paper

Natalia Bojdo

Money in medicine
What to spend on and what to save on?
Table of Contents
3 Introduction

6 Global healthcare financing models

• Healthcare system in the Czech Republic
• Healthcare system in Germany
• Healthcare systems in the Nordic Countries
• Denmark
• Sweden
• Healthcare systems in the U.S.

11 Expenditure in medicine – structure and trends

13 Areas requiring increased financial outlay

• Diagnosis and treatment
• Staff
• State of healthcare in developing countries
• Technological innovations on the medical services market

17 What can we save on and how to do it?

• Discovering and minimizing losses- the role of technology and adequate software
• Big data and AI – treatment efficiency and time saving
• Re-hospitalizations – remote monitoring of patients
• Early diagnosis – increasing the chances of curing the patient and the healthcare system
• Extending the independence of seniors and people with disabilities – support for new technologies
• Health costs of military conflicts

24 Conclusion

25 Endnote
Introduction
There’s nothing more important than
our good health – that’s our principal
capital asset.”
Arlen Specter
For centuries, health has been seen as an individual good. The condition for access to healthcare was primarily
a person’s material status and the ability to finance treatment. Over time, we realized the impact a well-organized
healthcare system has on society (and the economy). Access to high-level medical care shows a positive
correlation with GDP growth and better productivity. Therefore, it is necessary to treat health as a public good1.

At the same time, the development of medicine, increasingly advanced methods of treatment and the need to
provide facilities with modern equipment cause an inevitable increase in costs. In such a situation, only a small
percentage of patients are able to cover the costs of, for example, cancer treatment or stays in an intensive care
unit, or benefit from extensive life-saving operations out of their own pockets. Outpatient specialist care now
seems to be more financially accessible, but it is still beyond the reach of a large part of society. A significant
threat is the issue of continuity of treatment or postponement of a medical visit in a situation of sudden loss of
income. Such phenomena were observed for instance during the economic crisis in 20082.

Apart from the purely altruistic aspects of caring for the health and life of citizens, strictly economic aspects
also speak in favor of universal access to healthcare. Untreated or late-diagnosed chronic diseases, including
cardiovascular disease and malignant tumors, are the leading cause of mortality among people of working age,
and are a common cause of temporary or permanent incapacity for work3. Therefore, the governments of all
countries should care about creating health policies that ensure the whole society has equal, universal access to
modern medical care4.

The foundations of modern public healthcare systems can be found at the turn of the nineteenth and twentieth
centuries. One of the precursors of the popularization of healthcare was the Chancellor of the German Empire
– Otto von Bismarck. Despite his conservative views, he saw the need for reform to protect workers first
and foremost. Bismarck’s reform assumed the creation of health insurance funds, financed by compulsory
contributions, paid by employees and employers5,6.
This model became the foundation on which modern healthcare systems were created, based on universal health insurance. It is
founded on the assumptions of social solidarity – the contribution paid by people subscribed to the health insurance fund allows
the financing of benefits in the event of an illness or accident, thus spreading the risk and protecting against the socio-economic
consequences of incapacity for work. This model allows the possibility of co-payment for medical services and the functioning of non-
public insurance institutions. The Bismarck model is the basis of modern healthcare systems, functioning, among others, in Austria,
Belgium, France, the Netherlands and Switzerland.

An alternative model was created in the UK in 1948 and is still the basis for the National Health Service (NHS). Its creator is considered
to be William Beveridge, a British politician and economist. His report became a project of profound reforms introduced after the
Second World War. Beveridge’s model assumes financing healthcare from taxes and other public sources. As social security was
recognized as a necessary condition for progress, this model was intended to guarantee universal access to healthcare, regardless of
wealth and employment. According to this assumption, the burden of financing and organizing the healthcare system is taken over by
the state and government agencies.

In the Soviet Union and the countries of the former Eastern Bloc, including the People’s Republic of Poland, healthcare was subject
to the assumptions of central planning. Medical care was provided only by healthcare providers dependent on state bodies, financed
from the state budget. In turn, healthcare systems based on the free market mechanism, the most independent of state institutions,
are based on the residual model. In such circumstances, the financing of services is based on direct coverage by patients (out-of-
pocket) or through voluntary, non-compulsory health insurance (offered by non-profit or for-profit organizations).

Money in medicine is a vast and complicated topic. Most specialists will agree with the statement that there could always be more
of it and there would be no problem to find areas for its distribution. However, the funds are limited, so shaping the budget should be
an extremely carefully thought-out process. Are there areas where we can save? What do we need to spend more on? These are the
questions this white paper seeks to answer.
Global
healthcare
financing
models

He who has health, has hope; and he

who has hope, has everything.”
Thomas Carlyle
Healthcare system
in the Czech Republic
In terms of healthcare organization, the Czech Republic stands out from other countries of the former Eastern
Bloc. Conditions such as the need to carry out a political transformation and accession to the European
Union influenced the current shape of the Czech healthcare system significantly. The establishment of new,
independent state structures, as well as the transition from a centrally planned economy to one managed
by market mechanisms, was a difficult and time-consuming process. However, the example of the Czech
Republic shows that it is possible to organize an efficient healthcare system in a post-communist state.

In the Euro Health Consumer Index, published in 2018, which evaluates European health systems, the Czech
Republic ranked 14th. This is the best result among all the countries of Central and Eastern Europe included in
the ranking7. The factor that distinguishes the Czech healthcare system is primarily the amount of expenditure
on health. In 2018, according to Eurostat data, that amounted to 7.65% of GDP8. By comparison, the British
health system, rated below, accounted for around 10% of GDP in the same year9.

The main sources of financing healthcare in the Czech Republic are compulsory health contributions,
which by law constitute 13.5% of salary (4.5% is covered by the employee, the remaining 9% is paid by the
employer). In certain situations, for example in the case of children, pensioners, women on maternity leave or
unemployed jobseekers, the contribution is paid from the state budget. The Czech healthcare system is based
on competition between payers. Citizens can decide to belong to the Universal Health Insurance Institution
or one of the industry health insurance funds, with everyone having the right to change the place of payment
of health contributions once a year. Health insurance provides financing, among others, for services in the
field of diagnostics and hospital treatment, outpatient care, prevention or rehabilitation. One of the important
elements affecting the smooth functioning of the Czech healthcare system is the possibility of charging the
recipient an additional fee. Treatment in the hospital emergency department or sudden use of the care of a
dentist involves the need for a fee of CZK 90. This solution reduces queues in emergency care facilities and
guarantees shorter waiting times for patients whose health condition requires immediate assistance10.
Healthcare system
in Germany
In the Euro Health Consumer Index, the German healthcare system ranks 12th in Europe11. At the same
time, the Federal Republic of Germany spends the highest percentage of GDP among the European Union
countries on healthcare (11.47% in 2018)12. German hospitals, including Berlin’s most famous Charité, are
among the best in the world. The financing of healthcare in Germany is based primarily on compulsory
health contributions, as in the classic Bismarck model.

The central element of the system is the Health Fund, dealing with the collection of contributions and
then transferring funds to local health insurance funds. Currently, there are 103 health insurance funds
operating in Germany (as of 1 January 2021), and their number is constantly decreasing, mainly as a
result of the merger of insurance companies, which makes it possible, among other things, to reduce
administrative costs13. Their task is to conclude contracts with healthcare entities regarding the provision
of services to insured persons. Individual health insurance funds compete with each other, including
the amount of the rate and the available benefits.

German citizens whose earnings exceed about EUR 50,000 per year are exempt
from paying the health contribution. They can join private insurance, often
offering a higher standard of benefits. Steps are also being taken to
popularize telemedicine, both in doctor-patient contact and
between primary care physicians and hospitals14.
Healthcare systems
in the Nordic Countries
The Scandinavian countries are famous for their high standard of living. This is influenced by many factors,
but high quality of healthcare is one of the keys. Norway, Denmark and Sweden ranked 3rd, 4th and 8th
respectively in the 2018 EHCI ranking.

Denmark
The distinguishing feature of the Danish healthcare system is the process of centralization of healthcare
facilities, which began in 2007, and the significant reduction in the number of hospitals with emergency
departments15. This process has undoubted advantages, such as an increase in productivity, while reducing
administrative costs. However, it carries the risk of excluding people living in areas that have been deprived of
previously functioning emergency departments, and places a higher burden on medical staff in permanently
functioning facilities.

However, it was not limited only to closing branches. Attention was also paid to the development of
prevention and outpatient care, in order to reduce the number of hospitalizations. The construction of 16
highly specialized hospitals was also initiated, which will allow treatment to be carried out in centers offering
treatment at the highest level, while reducing expenses.

Denmark is also a pioneer in the field of digitization of healthcare, treating it as an inseparable element of
an effective system. This is evidenced by the functioning Shared Medication Record, a system that allows
personnel of every level of the healthcare system to access information about medicines taken by their
patients16.

Sweden
Healthcare is seen as a public good in Sweden. A decentralized healthcare system is intended to provide all
citizens with the necessary services, in accordance with the principles of solidarity, equality and respect for
human dignity. Under a law adopted by the Riksdag (the unicameral parliament of the Kingdom of Sweden)
in 1982, the right to decide on health-related issues was given to local self-government bodies (counties
and municipalities). The financing of the Swedish healthcare system is based primarily on tax revenues, the
amount of which is set locally, and the compulsory health contributions to the Swedish Public Insurance
Authority17.

The Swedish healthcare system performs well in various types of rankings. However, it also struggles
with some problems – above all, the long waiting time for medical services. Taking into account the funds
allocated to medical care reaching 10.9% of GDP, it seems that the source of the problem is not a lack
of financial resources. The example of Sweden clearly shows that, in order to guarantee good access to
healthcare, it is also necessary to implement appropriate management solutions18.
Healthcare systems
in the U.S.
The most expensive healthcare system in the world is medical care in the United
States. The annual sum spent on healthcare in the U.S. is about USD 8,200 per citizen. By
comparison, the European Union average is just under USD 2,000. It is worth emphasizing
that, in the United States, patients finance only about 20% of all health services out of their
own pockets19. The public sector’s share of funding for health services is around 42%, while in the
European Union it is around 74%20.

One of the worrying phenomena is the large number of uninsured people21. It is about 45 million inhabitants – U.S. citizens, but also
immigrants without citizenship (both legal and illegal). About half of them are moderately wealthy, rather young people who do not
buy health policies of their own free will. In the United States, there is a government Medicaid program for people living below the
poverty line (income below about USD 23,000 gross per year, per family). It also covers people receiving social assistance benefits
due to a difficult financial situation or permanent inability to work. It covers the total costs of healthcare, including the cost of
medicines and long-term care. Medicaid is also one of the most important sources of funding for long-term care in special care
clinics.

Another major government program is Medicare, which provides health insurance for citizens over the age of 65, people with
disabilities, and those suffering from certain chronic diseases, such as kidney failure. Patients covered by this program often
purchase private supplemental health insurance policies to secure services not covered by Medicare. Medicare members are forced
to pay a fairly high contribution — for example, in the case of an episode of illness requiring hospitalization, the patient must pay
about USD 750. Medicare does not fund much of the cost of medication, dental treatment, the purchase of glasses, and stays in a
long-term care facility.

The share of private medical insurance in the financing of healthcare accounts for about 62%. Most private health insurance is
funded in part or in full by employers. There are various forms of private health insurance in the U.S. market. The simplest form is
traditional insurance consisting of insurance premiums paid by the employer or patient to the insurance company. The amount of
the premium depends on the benefit package specified in the contract. In the event of illness, the benefits are paid directly to the
service provider on the basis of its bill. The price list of services specified in the contract between the insurance company and
the healthcare unit applies.

It is difficult to clearly assess the effectiveness of the American healthcare system. On the one hand,
the survival rate after cancer diagnosis is the highest, which may indicate high-quality medical care22.
On the other hand, however, life expectancy is not impressive, especially when compared to
health spending23. In this case, the main factor is poor illness prevention in uninsured
people. Women’s mortality from coronary heart disease is steadily decreasing,
which has not yet been achieved at EU level24,25.
Expenditure
in medicine
– structure
and trends

The first wealth is health.”

Ralph Waldo Emerson

Happiness and health are closely related26. A factor that has recently had a particular impact on this relationship is the SARS-COV-2
virus pandemic. The threat of a new infectious disease has significantly changed the way most of the population perceives health.
Not without significance was also the increase in the intensity of stress and anxiety related to the pandemic27. It has taken the main
place in public debate and private conversations, often evoking negative emotions. The spread of the SARS-COV-2 virus has had
a significantly negative impact on the global economic situation28. The long-term consequences of the pandemic have adversely
affected the situation in many areas of the economy and public life, including the healthcare system.

The financial resources allocated to healthcare have been increasing continuously for many years around the world29,30. Paradoxically,
the SARS-Cov-2 pandemic contributed to a historic decline in spending in the health services sector in the United States in 202031.
The reason was, among other things, difficult access to services, such as outpatient care, preventive examinations or postponement
of admissions and elective procedures, due to the transformation of specialized hospital wards into covid wards. The consequences
of delayed diagnosis and treatment are worrying – we already know that some patients simply did not live to see them.

1,4 mld
In 2019, healthcare spending amounted to nearly EUR 1.4 billion across the European Union. Government
programs provided funding for 28.2% of all healthcare expenditure in the European Union, while compulsory
health insurance and medical savings accounts covered 51.5% – and these two sources accounted for 79.7% euro
of total funding for medical care in European Union countries. In the same year, more than half (53.5%) of
healthcare expenditure in the EU was allocated to medical and rehabilitation care, and almost a fifth (18.4%)
was used for medical supplies. Hospitals spent the largest sum on healthcare, accounting for more than a
third (36.4%) of all costs in the EU. Outpatient healthcare providers (25.5%) and retailers, and other providers
of medical goods (17.5%), were the second and third highest spending healthcare providers32. 28%
Nowadays, governments around the world are facing several new challenges in healthcare.
These include, but are not limited to:
• an increase in life expectancy, the associated ageing of the population
and a higher incidence of geriatric diseases33, 79%
• increasing expenditure on the treatment of chronic diseases and their complications
• civilization diseases, including diabetes, hypertension and cancer
• new infectious diseases and an increased geographical range of “old” diseases
(malaria, Ebola outbreaks in the north)
36%
The losses to the global economy as a result of the pandemic will certainly not help in the development of the
health sector. For example, financiers from the Asian Development Bank (ADB) have estimated that economic
losses in Asia and the Pacific alone could amount to between USD 1.7 billion and 2.5 billion, depending on the total duration of
lockdowns34. A rapid response from governments around the world in the form of easing monetary and fiscal policies, direct coverage
of revenue losses, and increased health spending could mitigate the economic impact of COVID-19 by 30-40%.

Spending on healthcare in European countries was much higher compared to 2019. Accurate estimates are difficult due to the
fragmentation of data provided by entities dealing with the functioning of health systems in specific countries35. For example, in the
Czech Republic, at the end of April 2020, parliament approved the government’s proposal to increase the state payment (subsidies
from the state budget for health insurance). These funds represent an additional CZK 21 billion (EUR 778 million) in 2020 and an
additional CZK 50 billion Czech (EUR 1.85 billion) in 202136. However, this is a drop in the ocean of expenses that the Czech Republic
has incurred as a result of the pandemic. The dispersion and lack of clarity of such relevant data makes it difficult to understand the
actual picture of the costs of the pandemic.

The pandemic caused by the COVID-19 virus has exposed the difficulties that the healthcare system has faced so far and generated
new problems, while verifying the level of preparation for a crisis situation.
Areas requiring
increased
financial outlay

According to the World Health Organization, the level of financial outlay dedicated to healthcare is directly related to the
level of health of societies37. According to the Deloitte Insight report “2020 Global Healthcare Outlook – Laying a foundation
for the future”, in the coming years, spending on healthcare around the world will grow by nearly 5% per year. The biggest
challenges of health systems will be improving the working conditions of medical staff, rising costs and pressure for
increased efficiency, personalized and innovative medical care and digitization38.
 Staff
Solving staffing problems in the health service is a fundamental
area requiring an increase in financial outlays in European
countries (and others). The growing demand for skilled
healthcare workers is a challenge for both public and private
healthcare systems – for example, in Germany, there will
be a shortage of 1.3 million medical personnel in 2030.
Competitive pay is only part of the solution. It is necessary to
improve employment conditions, in particular by minimizing
administrative responsibilities and investing in medical
universities to train future staff. An additional solution is the
implementation of liberalized regulations allowing medics
from abroad to work39. The widespread implementation of
telemedicine and AI products can also help streamline work in
times of staff shortages.

Diagnosis and treatment

It is well known that early detection of diseases, especially cancer, significantly increases the
chances of recovery. In the case of civilization diseases, diagnostics is crucial for maintaining
health and prolonging life. Unfortunately, the process of diagnosis and treatment of patients is
hampered by the underfunding of the public healthcare system in many countries, which creates
problems with the distribution of funds and results in imperfect prioritization
and barriers to the use of medical services40. In order to meet the challenges
associated, among other factors, with the global ageing of the population,
it is necessary to develop geriatric medicine, and increase the
possibilities of access to high-quality health services and modern
rehabilitation and care services.
State of healthcare in developing
countries
Although developing countries have focused on the quantity rather than the quality of health
services, much evidence suggests that the quality of care must be at the center of
any discussion about better health. In a study evaluating pediatric care in Papua
New Guinea, 69% of healthcare workers said they had only checked two
of the four criteria for studying cases of pneumonia. Only 24% of
employees were able to indicate the correct treatment for
malaria, and when clinical appointments were observed
at care points, only 1% of the examiners met the
minimum exam criteria41.

The structure of healthcare in developing regions is

largely dependent on the influence of developed countries,
which play an important role in their history. The countries of
Africa and Asia, which were once colonies of the United Kingdom, have
a healthcare system and educational programs based on British patterns. The
situation is similar in the former colonies of France, Holland and Belgium. Significant
differences can be found especially in terms of administrative resources and regulations,
which is largely due to political and social instability. These countries often depend on the help of
international organizations, mainly due to a lack of resources42.

According to the Lancet Global Surgery 2030 report, nearly 17 million people die annually due to lack of access to
surgical care – most of them in developing countries. More than 93% of the population of sub-Saharan Africa does not have
access to safe and timely operations43. Therefore, the support of non-profit organizations is essential. Since 1978, the Mercy Ships
organization has been sending “floating hospitals” – ships on which even very advanced operations are carried out. The largest of
them, Global Mercy, will be able to carry out more than 150,000 surgical procedures during the 50-year life of the facility.

Another organization influencing the improvement of the quality of healthcare in areas affected by long-term crises (for example
in Syria, Yemen, South Sudan, the Democratic Republic of the Congo, Nigeria and Afghanistan) is Médecins Sans Frontières. They
provide medical assistance to those who need it most – those injured as a result of armed conflicts, victims of military operations
or natural disasters. They help people excluded from the healthcare system by giving them, among others, access to life-saving
medicines.

These are just examples of humanitarian organizations, without which the health of a huge part of the world would
be in a much worse state. It is also worth mentioning the key work of the World Health Organization, which
monitors the most important medical issues in the world and coordinates international activities, The
Red Cross, which provides medicines and training for medical personnel and more, AmeriCares,
International Medical Corps, Catholic Relief Services, etc.
 Technological innovations on
the medical services market
In the era of the IT, the communication revolution and progressive globalization processes, innovation is a prerequisite for maintaining
the competitiveness of enterprises, including on the medical services market. They are an inseparable element of economic and
social life, so they must meet the changing needs of patients, resulting from globalization, increased awareness and a competitive
market. These phenomena force medical facilities to look for new solutions on the health services market in order to increase the
effectiveness and attractiveness of services.

Thanks to the development of science and medical technologies, the healthcare system is currently under the influence of the
revolution of individualized care, nanomedicine, advances in imaging techniques and the use of communication and information
technologies. Service providers from this industry face the problem of ageing of the population, the growing number of chronically ill
patients, and the increase in cancer and civilization diseases. As a result, healthcare costs are rising and the burden of responsibility
for patients is increasing. Technological innovation is the hope of alleviating or solving these problems in the medical sector44.

The development of ICT has directed progress towards remote monitoring of patients, support for diagnostics and rehabilitation of
patients, creating a new branch – telemedicine. It is a new, complementary to inpatient care, platform of cooperation with the patient,
without the need for personal contact with a doctor, where medical services can be delivered directly at home.

The technologies with the best chances of development in Europe are:

analysis of biomedical signals directly biomaterials effective in the treatment

telemetry from the patient and from their of diseases, for instance of the skeletal
environment system

solutions to improve the quality of life fully remote telemedicine assistance in

systems for automatic detection of
of chronically ill, disabled and elderly diagnostics, as well as in laparoscopic
threats and warning about them
people and endoscopic therapy

ultrasonic characterization of tissue assistive devices for people with composite materials for external
structure sensory impairment dentures45
What can we
save on and
how to do it?

In each of the European countries, tens of billions are spent annually on hospital treatment, but the money is still not enough.
Hospital directors and managers have to deal with astronomical debts and ever-increasing costs. They patch budgets by
looking for cheaper substitutes, and the law in many countries means that the decisive factor in choosing a given product
or service is only the price – there is a lack of quality analysis, product service, its use or the time necessary to use. Savings
in healthcare are a complicated issue because the long-term effects of cost cutting can be completely opposite to what
is desirable. For example, ending a patient’s hospitalization too early often leads to complications and requires another
admission to the ward, which is reflected in the financing of treatment. Inadequate pay policy leads to high employee
turnover and recruitment problems, which in turn often paralyzes the functioning of the facility. In that case
– what can we really save on?
Discovering and minimizing losses
- the role of technology and adequate
software
One of the ways to heal the finances of the medical industry finding of equipment, which simply wastes their time. On the
can be Lean Management, used by the Swedes. The method other hand, in the event of “loss” of equipment or a device,
derives from the production processes of Japanese automotive it is necessary to purchase a new one. These costs can be
corporations, famous for their efficiency, and consists in significantly reduced with Asset Tracking systems. They give
accurately counting the time spent on specific activities. This the possibility of immediately finding the location of devices and
is of great importance, because as much as 70% to 90% of a people – thanks to the constant monitoring function, the actual
hospital’s costs are generated by procedures performed by location of both equipment and staff or patients is determined.
staff. Contrary to appearances, expenses for medicines and Constant access to information saves valuable time that can
other materials usually do not exceed 10% of the cost. The key be used to better care for patients. These types of solutions
to success is not to reduce the wages of medical workers, but can also be helpful for visitors to navigate inside a medical
to make better use of their working time46. Is there a simple way facility. An additional advantage of the system is the ability to
to streamline administrative processes? The solution may be detect any shortages of stored funds in relation to real demand,
adequate software. setting the expiration dates of medicines or determining the
location of expensive medicines. It can also be used to ensure
An example of software that automates many administrative the completeness of surgical accessories, and to provide
processes and increases the efficiency of the entire medical information about the dates of recent sterilizations.
facility is the Comarch Optimed NXT HIS (Hospital Information
System) class system. The software facilitates and supports
the work of medical staff in various areas of patient service – in
the office, ward or operating theatre. Thanks to the centralized
system, employees can get information about a patient’s stay
in the hospital, right at their bedside, with a few clicks. The
process of patient identification is much simplified thanks to
scanning the code from the information band, which allows
staff to quickly order tests, read the latest results and order
medicines, reducing the costs associated with paper printouts.
Another advantage of the system is its simplicity – as ease
of use allows personnel to learn quickly how to work with the
system. The doctor can monitor a patient’s health status for
a given day, or monitor their vital signs on an ongoing basis,
and automatically generated reports allow quick conclusions
and implementation of treatment. The system really improves
work and is implemented both in medical facilities with many
specializations, regardless of their size.

Another challenge for medical facilities is

to have a large number of resources
and estimate their availability.
Personnel often deal with
time-consuming
Big data and AI – treatment
efficiency and time saving
Solutions offering effective analytical tools have been becoming
more and more popular in recent years – which also applies
to Big Data, the analysis of large volumes of data. Data are
generated by all kinds of research, clinical trials, publications
and, above all, the patients themselves – in the form of
extensive medical records. Research shows that the use of big
data analytics in medicine can contribute to improving patient
service, implementing appropriate ways to treat patients, as
well as creating systems that counteract epidemics and other
threats47.

The phenomenon of big data in the healthcare sector should

be considered from an epidemiological, clinical and business
point of view. From a clinical point of view, the goal of big data
analysis is to improve the condition and health of patients,
enable long-term forecast of their health, and implement
appropriate therapeutic procedures. Paradoxically, the analysis
of a large amount of data will allow medical establishments to
personalize medicine, by adjusting the direction of treatment
for a specific patient. From the epidemiological point of view,
which seems to us to be extremely important today, it is crucial
to obtain accurate forecasts of the course of an epidemic in
order to effectively implement preventive programs. Without big
data analysis, the fight against the COVID-19 pandemic would
be much more difficult. In turn, in the business context, big data
analysis will enable the provision of personalized packages of
commercial services or determine the probability of individual
diseases and infections . Big data analysis also gives the
48
In the era of cardiac diseases, which are the main cause of
death in the world, solutions that effectively support doctors are
necessary49. One of them is a system using artificial intelligence
– Comarch CardioVest. It consists of a wireless, comfortable
vest for long-term cardiac diagnostics and an analytical
platform that, thanks to learning algorithms, automatically
detects irregularities in the ECG record. Comarch CardioVest is
used for preventive examinations, diagnostics and monitoring
of patients. The device uses textile electrodes that do not
require sticking to the skin (which significantly improves the
comfort of the subject). The technology allows reliable, safe and
long-term recording of heart rate using an ECG signal.

opportunity to observe unexpected conclusions or correlations
by studying huge amounts of data.
Technologies such as artificial intelligence, machine learning
and big data are having an increasingly real impact on the
medical services market. It is true that the dynamics of
the changes taking place, and the scope and nature of the
implemented innovations, vary from country to country, but the
direction is common - it allows us to think about the medicine of
the future, thanks to which we will live better, safer and, above
all, longer. The use of intelligent process automation creates
an opportunity for an increasingly higher level of cooperation
between humans and the technology created by them.
Re-hospitalizations
– remote monitoring of patients
Telemedicine connects technological progress and patient
needs with modern information and communication tools, thus
crossing the barriers of traditional healthcare systems. The
American Society for Telemedicine (ATA) defines it as “a form
of exchange of medical information at a distance by means
of electronic communication, in order to improve the patient’s
health” and defines it as not only a novelty, but above all a
necessity .
50
More and more medical facilities decide to use remote
methods. In 2018, the American Medical Association (AMA)
conducted a study that found that 15% of doctors use
telemedicine51. A year later, a similar study conducted by the
telemedicine company American Well indicated an increase
to about 22%52. Although we do not yet have exact data, it is
safe to assume that this is currently much higher – mainly as a
result of the SARS-COV-2 pandemic.
One of the most common solutions in the field of telemedicine
is remote monitoring of patients. This consists of monitoring
the health of patients outside medical facilities thanks to
appropriate measuring devices, applications and systems.
The main goal is to minimize the re-hospitalization of patients
who do not follow medical recommendations. It might seem
that these are individual cases, but research shows that, for
example, in the treatment of hypertension diseases, the average
non-compliance with doctor’s recommendations by patients
is 44%, and in some countries (such as Poland) it reaches as
high as 60%.53. From an economic point of view, this is a loss
for all parties involved – the sick, the health service and even
the economy. The patient’s deteriorating health results in re-
hospitalizations, examinations, absenteeism from work and
rising costs of care.
Remote monitoring of patients makes it possible to monitor the
effects of pharmacotherapy and observe trends and dynamics
of changes in the measurement of vital signs. This form of
treatment allows doctors to increase the percentage of people
who follow medical recommendations. An ideal tool for remote
monitoring of patients is Comarch HomeHealth, which is
applicable in the case of therapy of chronically ill people and
patients after hospitalization. It can be used for individual as
well as many patients (for example, in nursing homes). The
Comarch HomeHealth system consists of:
• a mobile application, operated on a smartphone, which
guides the user step by step through all measurements and,
above all, reminds them to perform them. Then it sends the
results to the Comarch e-Care telemedicine platform, where
they are automatically analyzed by the system and described
by medical staff. The application collects data, thanks to
which both the patient and the doctor have access to the
information, and in the event of results exceeding the norms
medical staff can react quickly.
• integrated measuring devices - depending on the patient’s
needs, the set of equipment and individual functions of
the application are adjusted. The patient can use, among
others, scales with a composition analyzer, spirometer, ECG
recorder, glucometer, blood pressure monitor, pulse oximeter
or thermometer.
Another device that allows remote and automatic monitoring
of the health of patients is Comarch CardioNow, for people
with heart disease. The device accompanies the patient around
the clock, and if disturbing symptoms are detected, it informs
the medical staff about it. It works in three modes of operation
– Holter ECG (an ECG record is sent after the end of the
examination), TeleHolter (an ECG record is sent live) and Event
Holter (an ECG fragment is sent at the patient’s request). The
Electronic Patient Diary allows the marking of activity, stress
or emotions, which can be seen by staff during signal analysis.
This contextual information can be crucial for the correct
interpretation of data.
Today, patients are more and more aware of their needs
– they expect not only high-quality medical services, but also
convenience and personalization. That is why it is so important
for medical facilities to change their strategies and meet these
needs accordingly. Remote monitoring of patients allows the
transfer of many procedures outside the walls of hospitals to
patients’ homes, increasing their comfort during treatment,
while relieving facilities and improving the effectiveness of
therapy.
Early diagnosis – increasing
the chances of curing the
patient and the healthcare system
Long waiting times for appointments for doctors in public
institutions, rising costs of private visits, widespread lack of
time and poor quality of medical care services are standing
in the way of early diagnosis, which plays a key role in the
effectiveness of treatment. Screening tests are extremely
important - they allow doctors to detect the beginnings of
or risk of a disease, which applies especially to civilization
diseases. This gives the opportunity to make changes that will
reduce the chance of developing the disease.
The implementation of preventive examinations on a large
scale would allow a significant reduction in the number of
cases and complications associated with late diagnosis and
implementation of treatment. The result would be savings,
both for the patient and the healthcare system54. Access to
prevention and health promotion is becoming easier and more
attractive for potential recipients, thanks to, among other
solutions Comarch Diagnostic Point - which offer easy and
quick access to high-quality medical services, without the need
to visit a doctor.
Diagnostic Points can be located in different places - in a
company, school, shopping mall, airport, gym, office, or even
on a plane or a ship. Any measuring devices are available to
users, and include pulse oximeter, scales for body composition
analysis, blood pressure monitor, stethoscope, ECG recorder
and thermometer, which allow them to independently perform
basic health parameter tests. The results can be discussed with
a specialist via the dedicated Comarch e-Care telemedicine
platform, without the need to make an appointment, or to visit a
clinic or hospital.
doctor. The system also gives the opportunity to arrange a visit
or video consultation.
Another important factor helping to get a quick and accurate
diagnosis is the meticulous collection of personal medical
records. In addition to collecting documents, it is necessary to
store them properly. Understanding a patient’s state of health
and making the right decision about the direction of treatment
is easier when information about the medical history is available
and well organized. This is especially important in a situation
where an accident occurs, and rapid access to data on the
patient’s state of health will save their life.
In order to avoid time-consuming searching for medical
documentation before visiting a doctor, as well as to
have access to it in emergency situations, each of us has
the opportunity to use the mobile health book Comarch
HealthNote. application. It allows the collection of up to
date and comprehensive medical documentation, which can
be made available directly to the doctor. In addition, users
can enter measurements of health parameters, record any
disturbing symptoms, and even use video consultations. All
information is always available at hand, and its security is
ensured by the Comarch EHR cloud platform. The mechanisms
used in it are adapted to particularly sensitive medical data, so
there is no risk of their loss or leakage.

Intuitive operation of the application, which guides the user

through all tests, makes the Diagnostic Points adapted to the
needs of seniors, people with disabilities and others. After the
process, the patient’s results, interview and questionnaires are
sent to the Comarch e-Care platform, where the medical staff
analyze data and recommend further actions. The subject
receives a report with recommendations, and, when the
results deviate from the norm, they are informed
about the need to contact a specialist
Extending the independence of seniors
and people with disabilities – support for
new technologies
Although the most active users of new technologies are young
people, seniors can also gain a lot from their capabilities. New
technologies, including telemedicine and telecare solutions, can
help extend the independence of seniors, who often struggle
with multimorbidity, taking large amounts of medication and
frequent visits to specialists. The scale of the problem will only
increase. European demographic projections clearly point to
the rapid ageing of the population – between 2000 and 2050
the world population of people over the age of 60 will double
from about 11% to 22%55. In turn, between 2010 and 2060, the
percentage of people over 65 will increase from 17% to 30%,
but the largest population growth is observed in the oldest
age group over 80 - according to the European Commission’s
forecasts, this will be an increase from 4.7% in 2010 to 12% in
206056.
rate, the wristband is also equipped with a pedometer, gives
voice prompts, and informs the caregiver if the device is on.
This technology is trusted by individuals, companies, insurers
and local government units – the “Małopolska Tele-Angel”
Project58 has been implemented in the Małopolska Region
since March 2018, the aim of which is to improve the quality of
life of dependent residents of the region. As many as 10,000
dependent Małopolska residents benefit from the support of
the Comarch WristBand and the Telecare Center. Employees of
the center receive data from the devices and can connect with
the wearers and, if necessary, contact their family or call an
ambulance.

The observed direction of demographic and social changes has

an impact on a significant increase in the incidence of chronic
diseases and their effects, and thus the demand for medical
care and care services. It is estimated that as many as 85% of
older people suffer from at least one chronic disease or feel the
effects of past accidents, which in every second respondent
lead to permanent damage to health and disability57. Meeting
these health needs, combined with the growing demands and
expectations regarding the quality of services, requires changes
in the form of healthcare provided. Greater support for seniors
in the place of residence is needed, in which new medical
technologies are extremely helpful.

An example of a solution supporting the functioning of seniors

and people with disabilities is Comarch Life WristBand, which
enables measuring the pulse, immediate contact with assigned
phone numbers and locating the wristband user. In other words
– it is a digital caregiver informing the right people about the
patient’s state of danger and their location. The wristband is a
solution that relieves caregivers of the elderly, and at the same
time shortens the response time in a life-threatening situation –
as a wristband wearer can automatically connect to emergency
services using the SOS button. In addition to measuring heart
Health costs of military conflicts
Taking care of the health and safety of citizens are key priorities for governments around the world.
Ultimately, they decide how to spend tax money. We are well aware that the proportions of these
expenditures can vary and often perfectly reflect the priorities of the ruling groups.

The United States is the world leader in healthcare expenditure, spending more than USD 9,000 per capita
annually — more than 1.5 times more than Norway (spending USD 5,361 per capita). The U.S. is also at
the forefront of military spending, with more than USD 2,086 per person, or nearly USD 700 billion a year59.
These figures are most certainly connected

U.S. veterans are still feeling the enormous physical and psychological health effects of the wars
in Afghanistan and Iraq, and the state bears their costs. Care for veterans of wars fought after 11
September 2001 will be between USD 2.2 trillion and USD 2.5 trillion by 2050, even though the total
number of living veterans from all wars in the U.S. dropped from 25.3 million to 18.5 million. The costs
associated with caring for war veterans after 11 September will peak only decades after the conflict, as
their needs increase with age60.

In 2018, a group of researchers from Harvard Medical School and the University of the Health Sciences
conducted the longest continuous follow-up of people with war injuries along with an estimate of the cost
of their treatment. Research shows that expenses in the case of people with health problems resulting
from injuries related to fighting compared to people injured in the civil sector are 30% higher61.

Conflicts have been connected with humanity since the dawn of time; however, there are many methods
of solving them. Apart from ethical and humanitarian aspects, we have known for a long time that
aggression and military action simply do not pay off. They result in more people with disabilities, who are
chronically ill, and whose physical and mental treatment is long-lasting, sometimes continuing for the rest
of their lives. Often, veterans are unable to work, which is a burden not only on the health system, but also
on the whole society.
Conclusion
How much a country spends on healthcare relative to other goods and services in the economy, and how this changes over
time, depends not only on the level of health spending, but also on the size and state of the economy. It is estimated that,
in 2019, European Union countries spent an average of 8.3% of their GDP on healthcare62. In turn, the expenses of medical
institutions are primarily related to the profile of their activity and the size of the entity. The question of allocating money and
identifying areas that require funding is usually not a problem. The challenge is to prioritize appropriately, especially in the
face of demographic and economic change, and to find a way to make savings.

Healthcare systems around the world are evolving in response to a number of factors, such as:

• new medical technology and improved knowledge

• new health services and greater access to them
• changes in health policy to address specific diseases and demographic changes
• new organizational structures and more complex funding mechanisms

It is increasingly recognized that new technologies (including remote patient monitoring, electronic health records and
relevant software) provide better access to healthcare and guarantee a wider choice of services for patients. Their use brings
many advantages – to a large extent economic, both for medical staff and patients. Above all, it gives relief to the system and
provides resources for people who need inpatient care.

Properly spent funds for medicine should be treated as an investment in a healthy, happy and productive society. This applies
to prevention, which will allow early detection of chronic diseases and cancer, as well as senior care. The success of this
investment largely depends on thorough analysis, objective observations and honest conclusions, but also on the selection
of suitable partners. At Comarch, we believe that the issue of healthcare is the basis of a thriving economy and social well-
being, which is why we will continue to support medical facilities, patients and their families.
Endnote
1  aghupathi V, Raghupathi W. Healthcare Expenditure and Economic Performance: Insights From the United States Data. Front Public Health. 2020;8:156.
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3 https://www3.weforum.org/docs/WEF_Harvard_HE_GlobalEconomicBurdenNonCommunicableDiseases_2011.pdf
4 Lewandowski, R. (2015). Modele systemów opieki zdrowotnej na świecie. W: M. Kautsch (Red.), Zarządzanie w opiece zdrowotnej:
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6 Białynicki-Birula, P. (2007). Funkcjonowanie współczesnych modeli ochrony zdrowia. Zeszyty Naukowe/Uniwersytet Ekonomiczny w Krakowie, (759), 5-21.
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Comarch Healthcare
Comarch is an international company with over 25 years of global experience. We are an end-to-end
IT healthcare provider, driven by our customer needs, always ready to deliver a tailored solution while staying
true to our core values: being flexible and maintaining the happiness of the end-user. We offer a comprehensive
ecosystem of products, consisting of EHR, telemedicine, hospital and medical AI clouds. Integration of these
platforms ensures coordinated healthcare and supports patients, their families, and medical personnel.

Copyright © Comarch 2023. All rights reserved. www.healthcare.comarch.com

05.01.2023, version 2.0