Is this a hospital endgame?

An end to the era of big "monolithic" hospitals may be one consequence of looming digital-led healthcare changes, a leading health insurance executive has suggested.

Justin Vaughan, Group Executive, Benefits and Provider Relations for health insurer nib, says while hospitals will remain important their role is likely to change - one overseas expert even says hospital visits in the future will be like "NASCAR pit stops" - as digital innovation transforms healthcare.

"I don't think I would want to be in the business of building large hospitals right now," he says. "Technology will allow people to take more control over their own health and the old-fashioned healthcare model is changing, one that will see more community-based outpatient facilities rather than big monolithic hospitals."

His comments come as nib is introducing new digital initiatives aimed at improving its customer service and establishing the company as a "health partner, not just a payer of claims". Among them is Whitecoat, an online platform to be launched in New Zealand later this year which enables people to make more informed choices when selecting a provider across a wide range of health services.

Although Vaughan says there will always be a need for hospitals, healthcare change is inevitable. "It may not be in New Zealand yet, but change is happening in other countries and it is heading this way; we will see a greater focus on preventative health and the development of personalised treatments."

He says technology like "wearables" (smart devices that can, among other things, check blood pressure, count calories and remind patients of their appointments) is one example of how healthcare change is occurring.

Use of these devices will lead to more effective analysis of a person's health so that individual treatment and/or prevention plans can be designed with more precision than in the past – in turn creating the potential for reductions in hospital stays.

Vaughan's thoughts are in line with international thinking. In the US, Ezekiel J. Emanuel, the vice provost (equivalent to a vice chancellor) at the University of Pennsylvania said earlier this year he believes hospitals will shrink in number and importance as more complex care is safely and effectively provided elsewhere.

"Those that remain will be devoted to emergency rooms, high-tech services or patients requiring brain surgery, organ transplants and the like."

In 2016 Dr Melanie Walker, a member of the World Economic Forum's Global Future Council looking at the future of neurotechnologies and brain science, said she thought the need for hospitalisation would eventually disappear altogether.

"Hospitals of the future will become more like NASCAR pit stops than inescapable black holes as humans live longer and healthier lives," she said. "You will go to hospital to be patched up and put back on track."

Vaughan says healthcare technology is "a journey we're on, one we have to invest in the future to get there. But at the same time we've still got to manage those who are sick now, so it's a fine balancing act."

He says the insurance industry needs to change too: "Traditionally we've been the ambulance at the bottom of the cliff and I doubt there are many people at the moment who would see their insurance company as the first port of call for advice on health services.

"But we need to become more trusted in this way; we need to help our customers focus on prevention, to be seen as a partner in their health," he says. "We are doing ourselves a disservice if we don't help people address issues like understanding the health effects of smoking, alcohol consumption, not taking part in activity or eating too much.

"We need to be focusing on keeping our customers healthy rather than just assisting them when they are sick."

He says Whitecoat is an example. In Australia, where it was introduced five years ago, it has information on 220,000 healthcare providers and attracts 300,000 unique visitors every month.

Vaughan says ultimately Whitecoat is intended not just as an information hub but a platform through which people can book and pay for appointments.

The company has also launched Frankie, a chatbot using artificial intelligence to help nib customers get answers to questions ranging from product information to how to make an insurance claim.

It is able to answer up to 90 questions with more than 800 answer variants. Since launching earlier this year Frankie has had over 1600 conversations, a third of which are held outside normal customer service team operating hours.

In other initiatives nib is partnering with Auckland iwi Ngati Whatua Orakei who are providing free private health insurance for all its registered members. In addition, the health insurer is offering private insurance cover for treatments like Chinese traditional medicine and acupuncture.

This range of new products is aimed at migrant groups – particularly Chinese and Indians – in an effort to "meet the changing face of New Zealand."