The Estonian, solidarity-based healthcare system is under immense pressure due to an aging society. We are currently in a critical state of redefining the relationship people have with their health to prolong the years lived healthily. Since prevention is cheaper than treatment, personalised medicine could be our way out.
The Ministry of Social Affairs claims in their analysis published in 2021 that if, between 2022-2024, no supplementary monetary resources are found, the National Health Insurance Fund is forced to decommission some aspects of the service provision, which means that health services may become less accessible.
Estonians are not most health-conscious
Furthermore, Estonia’s population is aging. While years lived healthily have seen a slight upwards trend since 2018, the data is clear that fewer people will be paying social taxes and recent studies show that Estonians are not Europe’s most health-conscious. With over 48% of current general practitioners over 60 years of age and 11% over 70, the shortage of general practitioners, especially in rural Estonia, poses a problem since new graduates’ first choice is not to become general practitioners.
Affordable, accessible, and high-quality healthcare is one of the pillars of a well-being society; the above gives cause for concern. Therefore, Estonia needs to transform how healthcare is provided to sustain the public health provision and its funding. Increased data exchange on various levels and enhanced analytical capabilities could create new opportunities on different institutional, organisational, and service user levels.
Personalised medicine consists of a person’s genetic data, environment, previous health data, and lifestyle habits. However, the biggest obstacle is implementing genome-wide data – developing the necessary technical capabilities, updating the legal system, and providing training for healthcare workers.
The idea of personalised medicine developed from a Biobank project started in the early 2000s that was meant for scientific research only. However, with the development of science using genome-wide data, new ambitions grew out of the initial project. Currently, it means that the biggest obstacle is the law. The Human Genes Research Act that entered into force in 2001 has to be updated. At this point, it limits the possibilities to use the genome-wide data for healthcare purposes and is only made available for research. Hence, without the necessary legal updates, personalised medicine cannot be implemented on a broader scale. The second biggest challenge lies in providing essential training for the healthcare workers so they would know how to use the new methods and be aware of the benefits it adds to medical practices.
It is a significant change in society and mindset today; people are used to contacting health providers when they already have a problem. However, if people understand better how to manage their health risks and focus on prevention, hopefully, it will allow them to keep themselves healthier. This will save money in the healthcare sector in the long run. Since we live in an aging environment, it is of utmost importance to put more effort into preventing different health problems rather than taking care of the illness since prevention is always cheaper.
The taxpayer-funded national health service provider, Estonian Health Insurance Fund, funds a large portion of medical services. Everyone in Estonia who is insured will be able to visit a general practitioner, receive a myriad of other necessary treatments, buy discounted medication, and so on.
If Estonia has private insurance-based healthcare similar to the USA, personalised medicine could negatively affect people genetically predisposed to more significant health threats since insurance companies would be aware of healthcare risks before they actually become a reality. This could be presumed from the fact that currently, insurance companies charge more money for chronically ill people. Personalised medicine could awaken a discussion in Estonia if healthy people with healthy lifestyles paid fewer taxes, for example, since they don’t have a significant toll on the healthcare system.
The four principles against the transformation
The public value derived from the transformation is a healthier and more prosperous society that does not have difficulties sustaining accessible healthcare. From 1995 to 1998, the European Commission supported the “Basic Ethical Principles in European Bioethics and Biolaw” research project (1995–1998). It aimed to identify the ethical principles of autonomy, dignity, integrity, and vulnerability as four important ideas or values for European bioethics and biolaw. While initially created in a slightly narrower context, when viewing these four principles against the transformation, we may come across several conflicts:
- Autonomy – Will the citizens be able to decide on how much of their data is being used and how easy it is to opt out should they wish to do so? More importantly, will citizens understand all purposes for which their data is being used.
- Dignity – The person should still be viewed as a person with flaws and limitations and not a project on how to optimise the state budget.
- Integrity – Health professionals and scientists must follow specific rules and regulations. If this is not done, public value can be destroyed due to trust and governance issues.
- Vulnerability – An increase in the number of people who may be disadvantaged due to their genetic predisposition.
As the implementation of personalised medicine is in its early stages, it is difficult to predict the exact effect it would have on the broader public. Even so, the potential benefits of personalised medicine helping people stay healthier for longer by mapping out different health risks would alleviate the immense pressure on our healthcare system. For this to work, we must consider all the ethical implications of this innovation so that people can access personalised medicine without all the negative consequences.
I would like to thank Gerttu Osa and Rebeka Neitsov for contributing to this article.
Speakers’ Corner is an article series where the e-Estonia Digital Transformation advisers talk about the digital society and their personal experiences related to using public e-services.
digital transformation adviser at the e-estonia briefing centre