The Sanitas health insurance foundation wants to know what people in Switzerland think about digitalisation and explore how it affects the way they think and act. The results of the studies and surveys are designed to encourage public debate.
As digitalisation in the health sector progresses, an individual’s state of health is increasingly being translated into figures. Capturing data by means of self-tracking via a watch and smartphone or by a doctor or therapist – all the way through to genetic screening – paves the way for more accurate health forecasts and can identify the risk of developing specific diseases. Monitoring life and health data in this way also gives rise to greater control. But what impact does this have on the healthcare system’s principle of solidarity?
The Sanitas health insurance foundation commissioned the independent think tank of the Gottlieb Duttweiler Institute (GDI) to investigate the relationship between datafication, trust and solidarity in society and the healthcare system.
Assuming that artificial intelligence were to predict a serious illness for you if you did not change your behaviour. Would you continue to live as before? Even if other people were aware of it? Even though you might be a burden to the community with high health costs later on? Greater data-based transparency promises advances in future healthcare, but also runs the risk of eroding the principle of solidarity with regards to basic health insurance.
The GDI study outlines four extreme scenarios for a future health system. One of the ways in which they differ is in the role played by the government: How quickly should the state intervene? And another is in relation to how the health data is used: Is it used primarily for surveillance or should it help people to reach their health goals?
The Big government scenario depicts a powerful state with strict conditions for solidarity-based support. People are obliged to share their health data and are pushed to lead a healthy life. Public health and the surveillance society go hand in hand. We are already seeing trends like these today in Asia.
The Big self scenario aims to encourage individuals to live healthily without laying down the law. The government plays an important role here, but sticks to regulating the use of data and making it easier to adopt a healthy lifestyle. This scenario builds on developments that are widespread in Europe.
The Big business scenario groups people with similar health profiles in risk pools. These risk pools call for the disclosure of data to rule out unfavourable risks. A scenario like this poses the risk that individuals will not be able to insure themselves adequately against illness, as is the case in the USA today.
The disclosure of data also plays a key role in the Big community scenario. In this case, however, it is based on voluntary solidarity: people share their data with one another without demanding “healthy” behaviour from others. In fact, the diversity of data is seen as a strength that enriches the data model and thus makes it more robust.
Illustrations: Studio Topie, www.kombinatrotweiss.de
In which direction is Switzerland headed?
As things stand today with the Swiss health system, it is closest to the Big self scenario, with the government supporting and seeking to empower individuals. Datafication acts as a catalyst which, given the steadily rising health costs, could trigger shifts – towards more state intervention and less tolerance and solidarity among insured persons with different health conditions. The survey results of the Sotomo “Data society and solidarity” studies (2018-2020) indicate that the very existence of digital control options automatically encourages people to demand stricter conditions. People who think they live more healthily than others expect to pay lower health insurance premiums and want to see their contributions to the solidarity-based support system reduced.
The GDI study “Are smartwatches eroding solidarity? Scenarios for a data-driven healthcare system” trains the spotlight on the mechanisms underlying solidarity in a data-driven healthcare system and calls for all stakeholders to take part in the debate to help shape its future.
The COVID-19 pandemic has given digitalisation an even greater boost. Many people were initially unused to digital services such as video telephony and online shopping when social distancing measures were introduced, but they quickly became part of everyday life. The survey highlights how digitalisation is affecting the population during the pandemic. One surprising result is that the perceived digital pressure to perform has reduced.
In general, digitalisation has fewer negative connotations than it did a few years ago. After around a year of the COVID-19 pandemic, there has only been a slight increase in the continued high use of digital channels and services. Only use of video telephony has doubled, and older people are catching up to the younger generation when it comes to using streaming services such as Netflix.
A year ago, young people in particular felt under much greater pressure to perform and were more stressed as a result of the digital transformation, but partial lockdown has seen an unexpected turn-around, with respondents in January 2021 reporting far less subjective pressure to perform at work, in the health sector, in relation to social media such as Instagram and Facebook, and even in the area of sport. The challenges posed by digital tools seem to have eased considerably with people working from home and limited social contacts. Or perhaps they are just put into perspective by the exceptional circumstances of the pandemic. It remains to be seen how the population will use these experiences in a positive way when things get back to normal after the pandemic.
About the study: From 8 to 18 January 2021, 2,344 people took part in an online survey organised by the sotomo research institute. Targeted respondent selection and weighting ensure a representative sample that is close to the composition of the Swiss population aged 18 and over.
Corona crisis eases digital pressure to perform: This development is particularly pronounced in the working world, with only 18% reporting increased pressure due to the digital transformation compared to 45% in the previous year. Activity in social networks has slowed, with corona forcing people to stay at home and take things easier in the social marketplace. As there is less fear of missing out (FOMO), people tend to make less use of social media channels (80% compared to 92% at the start of 2020) and feel under less pressure to perform. In the same way, the use of social media among young adults in particular is significantly lower.
Fig. 25: Perceived pressure to perform by measuring performance and life data – by age
“Digitally tracking performance and life data leads to more opportunities for comparison. Are there areas where you feel additional pressure to perform because of this?”
Trust is the basis for sharing health data: At 62% and 44% respectively, personal benefits and benefits for people in general are key factors in whether people are willing to share health data. However, trust in the data recipient is valued most highly by participants, coming in at 70%.
Fig. 33: Factors for sharing health data
“Which factors determine whether you will share your health data with a person/organisation?”
Life tracking changes behaviour: Some 41% of respondents actively measure the number of steps they do each day, and almost half believe that this has changed their behaviour. This means that a whopping 20% of the Swiss population believe that they walk more frequently and/or longer than before due to counting their steps. And roughly one in two people report that tracking their sporting performance digitally has changed their habits.
Fig. 23: How regular tracking of different activities affects behaviour
“Which ones have led to you changing your behaviour in the long term?”
Covid tracing and online registration – population is ambivalent: Respondents are more wary of data misuse when entering data in online forms, e.g. when visiting a restaurant than when using the Swiss Covid tracing app. Nevertheless, online registrations are used more often than the Covid app. People to the right of the political spectrum and those with a lower level of education are particularly critical of contract tracing with the Covid app, which primarily serves the general population. This goes to show once again that people are more willing to share their data when they benefit personally, e.g. to gain entry to a restaurant or attend an event, despite any data protection concerns they may have.
One particularly surprising result was the fact that a very high number of respondents – 45% – agreed that, in the event of a pandemic in the future, we should follow the example of countries such as South Korea or Taiwan, where data protection was minimised in favour of temporary mobility surveillance via mobile phone data in order to successfully prevent the spread of the virus. This opinion was largely the same across the political spectrum, but older people were more in favour of it than younger people.
To sum up: in the event of a new pandemic, around half of the population would be in favour of temporarily restricting data protection in return for greater freedoms in everyday life.
Fig . 28: Consent to monitoring of mobile phone data to contain a pandemic
“Countries like South Korea and Taiwan reduced data protection during the coronavirus pandemic and monitored mobile phone data to contain the spread of the virus early on. If there is another pandemic, should Switzerland implement a similar programme to monitor mobile phone data temporarily for the duration of the pandemic?”
Solidarity in healthcare of the future: With regard to preventive care, half of respondents believe that an unhealthy lifestyle leading to high health costs later in life at the cost of the general population shows a lack of solidarity. Two-thirds of people on the right of the political spectrum share this opinion. At the same time, 42% don’t believe that an unhealthy lifestyle shows a lack of solidarity, even if the person concerned is aware that they have an increased predisposition to a particular disease.
Fig. 49: Agreement with the statement: Unhealthy behaviour shows a lack of solidarity – by political affiliation
“During an examination, someone finds out that they have an increased predisposition to cardiovascular disease. This person continues to eat unhealthily and doesn’t get enough exercise. Does this person show a lack of solidarity because they’re risking high health costs for the general public?”
With regard to the possibility of personalised healthcare in the future, 80% of respondents believe that even expensive special therapies for cancer should be paid for under basic insurance if there is a good chance of successful treatment. This is the case even though this could lead to higher health insurance premiums. In other words, survey participants expressed their support for solidarity-based financing of the achievements of personalised medicine.
There was greater diversity with regard to the question of whether “new and more expensive personalised treatments” should be covered under basic insurance – even if this leads to a rise in premiums for everyone. Almost a third answered “Yes, definitely”. However, two-thirds of participants wanted certain conditions to be met first, For example, that the treatment would significantly improve the patient’s quality of life.
Survey participants were also asked to weigh up the cost/benefit ratio in relation to the financing options.
The respondents’ answers show that, if the development of personalised health continues, greater political involvement will be required to redefine the framework of the healthcare system.
Fig. 46: Paying for expensive personalised medicines under basic insurance: essential conditions
“In the future, new personalised treatments will be possible, but they can be very expensive. Should these treatments be paid for under basic health insurance even though this increases premiums for everyone?”
The digital society is all about surfing, googling, logging in and leaving data traces. And the corona pandemic is rapidly pushing digitalisation into new areas of our life. What did people see as the opportunities and threats of the data society before the coronavirus hit? How do they feel about the growing measurement and tracking of our lives? And how does this impact social solidarity?
The results of the 2020 “Data society and solidarity” survey show that people are ambivalent. They make good use of digital services, but worry about their data being passed on. They value social solidarity, but are increasingly calling for insurance premiums to be linked to people’s behaviour.
From 9 to 16 January 2020, 2,297 people completed an online survey about their behaviour and attitudes in relation to solidarity in the context of digitalisation. Targeted respondent selection and weighting ensure a result that is representative of the Swiss population aged 18 and over. The survey was conducted on our behalf by sotomo research centre, Zurich.
Summary of selected findings
The second representative online survey, which focuses on solidarity in a digital world, took place in February 2019. How is the Swiss population engaging with the growing trend towards digital tracking? Which form of solidarity do people value? And how have the use and attitudes towards digital services changed since 2018?
The first survey trained the spotlight primarily on life tracking with smartphones, the willingness to share data, thoughts on data tracking and data privacy, and people’s expectations of what it will be like to live in a society in a digital future.
The Swiss actively record their digital life and behaviour data. However, while many people are happy to use digital technology in their private life, their view of a society that is increasingly being shaped by digital tracking is less positive.