1. 1 THE NET IMPACT ON HEALTH DIVIDE FACTS PACK Naples, 13th March 2000

2. 2 Health care systems face a problem of overcomplexity and inefficiency Health systems (as all over-developed systems) are suffering a crisis of efficiency Such a crisis is (and this is the case for almost all over-complex systems) due to lack of information (which is too poor or too little vis a vis the ever increasing number of available options) and to lack of effective choice. Internet can produce a major changes but it will need radical changes in policies. Objective of project is to identify such needed changes.

3. 3 84% 18% 11% 93% of total world population lives in developing countries.. … but all total world GDP they get and… … of all total world health expenditure … … of world total disease burden (in terms of days lost to illness) Source: WHO INEFFICIENCY AT WORLD LEVEL THE HEALTH DIVIDE IN FOUR NUMBERS

4. 4 Inefficiency at developed countries level We are spending increasingly more on health care … Source: WHO (some numbers still missing in the time series), Vision analysis

5. 5 … to get increasingly smaller gains in health standards Source: WHO (some numbers still missing in the time series), Vision analysis

6. 6 Therefore it seems healthcare systems do show increasing inefficiencies Source: WHO (some numbers still missing in the time series), Vision analysis

7. 7 Inefficiency at LDC level Developing Countries Health Systems seem not only financially constrained but internally inefficient Micro evidence (based on specific disease related treatment) shows that cost of preventing most of deaths in LDC is 12$ Macro evidence (based on statistical correlation between hc spending and mortality) shows that to reduce deaths of one it is necessary to increase health expenditure of an average LDC of 50,000 $ Source: WHO

8. 8 Internet can be a powerful factor of change but it will not change a thing unless radical institutional reorganization take place Internet can - technically – create a major change: thanks to ICT, obtaining information becomes much less costly as the span of the choice is no longer constrained by physical location. We also all know that internet can - effectively - do still very little. This is because it would imply a reallocation of power and resources and there is great resistance to this.

9. 9 LDC could actually have a digital advantage Developing countries may have a digital competitive advantage. Resistance to chance is much lower (they do not have, for instance, heavy national healthcare systems to be radically restructured). Moreover the people (at least in some of the LCDs) seem to show ICT skills and propensity which are not much lower than the ones of the developed countries. LDC do still have a problem of basic infrastructures and fixed investments to be done, but digital divide can – for at least countries like India – be, in reality be a relative competitive advantage to be leveraged to fill more traditional divides.

10. 10 Digital Divide vs Traditional Divide on selected countries

11. 11 Digital Divide vs Traditional Divide on selected countries

12. 12 E Health strategies in developing countries will then be conceived within a different framework as opposed to developed countries Technologies impact can be immense both in developed and in developing countries but also that to build up an information based health system mean two very different things two clearly different strategies. In developed countries the frontier where Internet will push the most significant gains is in the relation between people and healthcare systems. A number of citizens in developed countries have, by now, developed long enough learning experience as health services consumers, high enough health expenditure level and good enough IT skills and personal infrastructure in order to make possible for them to access more directly services.

13. 13 E Health strategies in developing countries will then be conceived within a different framework as opposed to developed countries In developing countries most important changes will be, instead, within the healthcare systems and to be more precise between the front end doctors and the rest of the (international) healthcare infrastructure. Internet will make easier for the front end professionals to access and share knowledge and technologies which are very rare in most of Third World countries. These professionals are developing via the Internet a network of theoretical excellence and on the job experience: the Internet will be the opportunity to transform who are sometimes left alone heroes in part of a larger organisation able to distribute and retrieve what is needed in very short time.