Reimagining the future of the Nordic welfare model

Without fundamental changes to health and social care, the healthcare economy in some of the rural communities in the Nordic countries might collapse within just three to four years. This is the prediction from the project leaders of the Nordic initiative Healthcare and care with distance-spanning solutions (VOPD – Vård och omsorg på distans). Increased digitalisation could be the key to safeguarding the Nordic welfare model.

70 per cent of municipalities in a vulnerable position

The challenge of providing continued quality healthcare and social care is becoming an increasingly pressing issue. People are getting older and there is a persistent outmigration from rural areas, especially among young people and the working-age population. This erodes the tax base that is supposed to finance the growing demand for healthcare and social care services.

“Some of the municipalities actually have a dependency ratio of more than 100%,” says VOPD project manager Niclas Forsling, referring to the ratio between the working-age population and the so-called dependents – the young and the elderly. “Hence, every working person has to support more than one person who is not part of the labour force. This is not a viable situation.”

As part of the VOPD project – Healthcare and care through distance-spanning solutions – Nordregio is now publishing a report focusing on the regional development aspects of digital health and social care. Alongside the report, the research centre is releasing a State of the Nordic Region special issue on the link between digitalisation and the wellbeing of the Nordic populations.

The constant ageing of the population, especially in rural areas, is a central theme in both reports. In some of the rural communities, more than one third of the population is aged 65 or more.

”A municipality is considered to be in a vulnerable situation if more than 19.5 per cent of the population is aged 65 or more,” says Bengt Andersson, Senior Advisor at Nordic Welfare Centre. “In fact, this is the case in more than 70 per cent of all Nordic municipalities, which underscores the urgency of transforming our health and social care provision.”

Digital transformation has already begun

Nordregio’s VOPD report describes the Nordic countries’ ambitions concerning digitalisation in healthcare and social care, taking its outset in case studies from rural municipalities and regions in the five Nordic countries, Greenland and the Faroe Islands. The distance-spanning solutions studied in the report include everything from video consultations in primary care to different technologies to enable elderly people to stay longer in their own homes, rather than moving into a care facility.

”Digitalisation is one of the biggest transitions we’re going through, not only in healthcare but in all sectors of government, society and the economy,” says Louise Ormstrup Vestergård, Research Fellow at Nordregio. “It’s an essential tool to handle some of the big challenges that we’re facing. In this context, the needs of the ageing population as well as the growing number of people with one or more chronic illnesses are particularly interesting to study.“

Vestergård explains that the digital transformation has to happen on many different levels. First of all, the overall framework has to be in place, including a legislation that permits the necessary development to happen and a strong and stable digital infrastructure.

“Within the healthcare system itself, one of the most prominent issues is to put in place electronic systems to share information about patients and citizens across healthcare sectors,” says Vestergård. This enables a smooth transition between the different sectors, for example when a patient is discharged from hospital and transferred to elderly care. “It’s really one of the essential digital solutions to provide better, more integrated and more patient-centred care.”

Different benefits from area to area

In order to better understand the benefits for different areas, Nordregio has studied the geographical accessibility of healthcare and social care facilities in the VOPD case study regions across the Nordic countries.

”We’ve mapped the locations of all service functions in primary care, healthcare and social care, and then calculated the number of people living within a certain travelling time of these facilities,” says Oskar Penje, GIS analyst at Nordregio. In addition to the location distribution of services, the geographic conditions and factors such as road networks and population density are among the defining factors for accessibility. “The benefits of digitalisation will be the largest in remote, sparsely populated and geographically challenged rural areas.”

Change in culture and perception

With regards to the economy of the digital transition, Anna Lundgren of Nordregio, Senior researcher and project manager of the two projects, points to two key observations. One is that digitalisation requires large initial investments, whereas the benefits are reaped over time.

“The other is that we’ve seen several examples where the benefits of digitalisation are realised in areas completely different to the one that made the investment. This reduces the incentive and implies that we must address digitalisation of these services from a more systemic perspective.”

The researchers emphasise that while the economic and technical aspects of the transformation must be carefully considered, the main challenges are related to organisational and cultural change.

“This is a matter of changing the way in which we perceive and deliver healthcare and social care services,” says Bengt Andersson. “Working with digitalisation requires leadership and good change management to ensure that the changes to the service provision are anchored throughout the entire organisation and that the healthcare staff is well-prepared for the future.”

Read more about change management and implementation in Roadmap for service innovation, a strategic tool developed within the Norwegian National Welfare Technology Programme.

”Perhaps most importantly, implementing more digital solutions is about empowering the population,” Niclas Forsling adds. ”Our experience shows that people feel very empowered when they can use digital and distance-spanning solutions to conduct self-monitoring activities and become more engaged in their own care.”

Up-scaling successful initiatives

One of the initial tasks of the VOPD project was to map out the digital solutions already in use in the Nordic countries, which resulted in the publication 24 practical examples from the Nordic Region. In fact, many of the required technologies already exist.

”A lot of the digitalisation effort in health and social care in the near future is going to evolve around the possibilities of up-scaling existing solutions,” says Oskar Penje. ”We’re going to see a lot of good local initiatives, implemented in one region, but the real success depends on our ability to spot the technical solutions that can be scaled up and integrated elsewhere, too.”

Webinar: Health & Well-being in the Nordic Region

On 21 October, Nordregio hosted an online launch of three studies on Nordic well-being, health care and digital tools that regions have already successfully implemented. If you missed the launch, we invite you to watch the recording.

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