Future Health Scenarios – serie

The scenario project on the future of mental health care focuses on this question: what developments are possible over the next two decades in the area of mental health and the associated need for care, what are their implications and to what extent can they be influenced? The project is thus concerned both with mental health problems and with specialized care services. The two topics do not full coincide, in that only a small proportion of mental health problems, perhaps 10-20%, receive specialized treatment. The investigation involves on the one hand a review of the literature and the data analysis and on the other, intensive consultations with panels of experts. The panels were formed around four themes, namely dementia, schizophrenia, occupational incapacity due to mental disorders, and emotional and behavioural problems in children and adolescents. The developments which the experts felt to be most likely over the next 20 years are brought together here in reference scenarios; other, very different trends, less likely but no less important, are covered in two alternative, exploratory scenarios for each theme.Objectives for the year 2010 which, though bold, are nevertheless viewed by the experts as attainable are set out in target-setting scenarios, indicating the measures and interventions needed for their achievement. In particular the target-setting scenarios set out the measures which need to be taken in the areas of diagnostic practice, prevention, training, treatment and care.

How can the public health system best be organized in the future and which factors are the main determinants thereof? These are the key questions in the scenario report "The Future of Public Health: A Scenario Study". The report is the result of a study commissioned by the Steering Committee on Future Health Scenarios and carried out by a research team of the TNO Institute of Preventive Health Care and the STG Scenario Committee on the Future of Public Health. The report focuses on activities in collective prevention of diseases, generally known as primary prevention. The future images developed make use of two examples: the control of infectious diseases and public health for the elderly. Indesigning those scenarios, two sets of possible trends were combined: centralization versus decentralization and nationalization versus privatization. These combinations resulted in three scenarios: a local government scenario, a central government scenario, and a private enterprise scenario. The consequences of these future alternatives were developed in terms of their effect on organization, policy control, financing, information supply, expertise and effectiveness.Although the report primarily focuses on the public health system in the Netherlands, the analysis of the processes examined, and the alternative scenarios based on them should also be though-provoking for readers throughout the world.

What proportions will the HIV/AIDS epidemic assume and how many new HIV infections can be averted by HIV/AIDS prevention campaigns? How much care and support will people with HIV and AIDS need and what successes can be expected within the care sector? What will be the social consequences of AIDS and how can ostracism and the social isolation of people with HIV and AIDS be avoided? These and other related questions form the subject of this book, which examines the sociocultural and economic impact of AIDS in the Netherlands up to the year 2000. The book presents a study carried out by the Netherlands Institute of Mental Health (NcGv) and the National Instutute of Public Health and Environmental Protection (RIVM) under the direction of the STG Scenario Committee on AIDS. The researchers look back at the epidemiological, sociocultural and economic impact of AIDS in the Netherlands during the first decade of the epidemic and, on the basis of this, use scenario analysis to project the impact of AIDS up to the year 2000. The future projections relate both to the impact of AIDS and the maximization of efforts to combat the disease.In addition to a scenario exploring the impact of AIDS if developments continue unchanged, alternative scenarios are also put forward. These focus on the impact of significant changes in such diverse fields as sexual behaviour, injecting drug use, the effectiveness and organization of HIV/AIDS prevention programmes, and the demand for delivery of care. The book concludes that the impact of AIDS will only become fully apparent in the second decade of the epidemic. The authors consider the implications of this conclusion for HIV/AIDS prevention programmes, research, care and the efforts to counter the socially undesirable impacts of AIDS.

This CNSLD report is the second specialized report of the Chronic Diseases Scenario Project. The report examines the way in which the number of patients, the number and severity of exacerbations and complications, the quality of life and the demand for health care due to CNSLD will develop up to the year 2005. The report begins with a description of the present scale of the problem and developments in the recent past. A summary of experts' ideas about the future precedes a description of various kinds of future health scenarios. The report concludes by identifying priority areas for government policy CNSLD is a growing problem. Key questions accordingly consist of the need for an expansion in health care and health care reforms and the prospects for preventing the disease itself, and its exacerbations and complications. The report should therefore be of interest to all parties involved in the care of CNSLD patients.

This report focuses on the organization of primary and home care in the future. Realistic possibilities are outlined in scenario form, with positive and negative aspects being brought out in each case. Together with expected trends in health and sickness the report charts the developing pattern of care needs and consumption. The prospects for home care are examined notably in relation to complex medical conditions and patients with multiple pathology. The essential conditions for home care are presented, linked to various categories of patients. These extramural network, extramural centre, transmural network and deconstruction scenarios represent different approaches to the organization of care delivery. Possible ways of putting the various approaches into practice are indicated in this report. Preceding the scenario report proper is an outline of the structure of the Dutch health care system.

Which developments can be expected to take place in the dental health of the Dutch population in the decades to come, and what are the influential factors? What effects might the changing supply of dental professionals, the additional substitution of responsibilities from dentists to dental hygienists and the possible reforms in health care insurance have on the nation's oral status? These are some of the central questions discussed in this report by the Scenario Committee and the research group. For this purpose, the Committee developed a computer simulation model of dental health care which was used to analyze future scenarios. The future scenarios described in this report clearly show that a number of crucial decisions must be taken if dental health care is to remain accessible and available for all sections of the population in the future.

This book is an edited and updated version of the report 'Arbeid, gezo- heid en welzijn in de toekomst; toekomstscenario's arbeid en gezondheid 1990-2010' commissioned by the Steering Committe on Future Health Scenarios and published by Bohn, Stafleu and Van Loghum, Houten/- Antwerp in 1991. The authors wish to express their grateful thanks for the constructive comments they received from many people during the writing of this book. The following persons, however, deserve to be mentioned by name: E.W. Bergsma M.A., Prof. F.J.H. van Dijk, Dr. C.L. Ekkers, Prof. F. Huygen, Dr. M.A.J. Kompier, Prof. J.P. Mackenbach, Dr. P.A. van Wely and Dr. J.H.B.M. Willems. SUMMARY Aim and scope of the study The main aim of this book is to show how the field of work and health will develop until the year 2010 under certain economic and other con- ditions. This is done on the basis of a Delphi study carried out with the cooperation of 120 leading experts in the Netherlands. A secondary aim was to investigate the present state of work and health in the Netherlands with the aid of available statistical sources.

The first STG report to embody scenarios on population ageing, health and care appeared in 1985. This report describes developments since 1985, reviewing the current position and setting out updated scenarios. The 1985 report set out three scenarios, in which the central focus was on the developing future patterns of demand for care by the elderly. The present report also sets out three scenarios, centring on the demand for care, in which account is taken of a variety of factors; it also details four strategic scenarios whose central focus is the developing supply of care, and which set supply and demand one against the other. Three of the strategic scenarios - emphasizing, respectively, intramural, extramural and informal care - suppose the demand for care to be met in full; the fourth scenario, which rolls current policies on the care of the elderly forward into the future, pinpoints discrepancies between the need for care and the extent to which that need is likely to be met, making clear in so doing that a review of long-term policy for the elderly is urgently needed.

This report is the third specialized report of the Chronic Diseases Scenario Project. An exploration has been made of the likely trends in the number of patients, the number and severity of consequences and complications, the quality of life and the demands likely to be made on the health system as a result of rheumatoid arthritis up to the year 2005. Rheumatoid arthritis is a growing problem. Key issues therefore include the need for expansion of health care facilities and health care innovations and the prospects to prevent the disease itself and to cope with its consequences and complications. The report is therefore of relevance to all groups involved in the care of rheumatoid arthritis patients and for society as a whole.

With an ageing population, an increasing number of chronic sick, a growing range of treatment options and a developing European market, the one certainty is that medication patterns will change radically in the future. How the future might look, in terms of quality, volume and cost of pharmacotherapy, is the subject of this report. Four scenarios for the future are set out, all of which take account of already visible trends. Sobriety in sufficiency envisages rational and restrained consumption patterns. Risk of avoidance is dominated by fears of iatrogenic harm and hence minimal drug use. Free market unfettered, finally, is marked by a Europe without frontiers and minimal state intervention. The reader is encouraged to reflect on the future of medicines in health care.

As noted in the Foreword, this report is the second of several volumes resulting from this study of future health care technology. The purpose of the study, as formulated by the STG, was to analyze future health care technology. Part of the task was to develop an 'early warning system' for health care technology. The primary goal of the project was to develop a list or description of a number of possible and probable future health care technologies, as well as information on their importance. Within the limits of time and money, this has been done. This report is the description of anticipated future health care technologies. However, given the vast number of possible future health care technologies, complete information on the importance of each area could not be developed in any depth for all technology. Therefore, four specific technologies were chosen and were prospectively assessed. These future technologies were examined in more depth, looking particularly at their future health and policy implications. Subsequently, the project was extended to September 1987, and two additional technologies are being assessed.

As noted in the Foreword, this report is one of several volumes resulting from this study of future health care technology. The purpose of the study, as formulated by the STG, was to analyze future health care technology. Part of the task was to develop an 'early warning system' for health care technology. The primary goal of the project was to develop a list or description of a number of possible and probable future health care technologies, as well as information on their importance. Within the limits of time and money, this has been done. However, given the vast number of possible future health care technologies, complete information on the importance of each area could not be developed in any depth for all technology. Therefore, four specific technologies were chosen and were prospectively assessed. These future technologies were examined in more depth, looking particularly at their future health and policy implications. Subsequently, the project was extended to September 1986, and two additional technologies were chosen for assessment.

This publication represents the report of the Scenario Committee on Ageing. In addition to the scenario report, a background report containing the basic analysis employed in the scenarios on ageing has been prepared.

This report, Anticipating and Assessing Health Care Technology, is the first report from the STG Commission on Future Health Care Technology. The STG (Stuurgroep Toekomstscenario's Gezondheidzorg) was established in 1983 as an independent advisory group to the State Secretary for Welfare, Public Health, and Cultural Affairs (WVC) to assist in long-range health planning efforts. Thus far, STG commissions have examined cardiovascular disease, cancer, aging, and life styles as issues of importance to the health of the Dutch population in the future. Obviously, health care technology is of great concern to the government. On the one hand, technology is one of the major tools to promote a healthy population. On the other hand, the costs of health care have been rising at an alarming rate in recent years. It was these two facts, along with the social consequences of certain technologies such as genetic screening, that led the STG to establish the Commission on Future Health Care Technology in 1985. The European Office of the World Health Organization (EURO) cosponsored the project. The Health Council (Gezondheidsraad) agreed to cooperate with the project by furnishing space and intellectual and logistical support. The goal of the Commission's work is to develop sufficient information on future technological developments in health and health care to assist planning for their consequences. Subsequent reports will give more detail on future health care technologies and will provide in-depth assessments on a few specific technological areas.

As noted in the Foreword, this report is one of several volumes resulting from this study of future health care technology. The purpose of the study, as formulated by the STG, was to analyze future health care technology. Part of the task was to develop an 'early warning system' for health care technology. The primary goal of the project was to develop a list or description of a number of possible and probable future health care technologies, as well as information on their importance. Within the limits of time and money, this has been done. However, given the vast number of possible future health care technologies, complete information on the importance of each area could not be developed in any depth for all technology. Therefore, four specific technologies were chosen and were prospectively assessed. These future technologies were examined in more depth, looking particularly at their future health and policy implications. Subsequently, the project was extended to September 1986, and two additional technologies were chosen for assessment.

As noted in the Foreword, this report is one of several volumes resulting from this study of future health care technology. The purpose of the study, as formulated by the STG, was to analyze future health care technology. Part of the task was to develop an 'early warning system' for health care technology. The primary goal of the project was to develop a list or description of a number of possible and probable future health care technologies, as well as information on their importance. Within the limits of time and money, this has been done. However, given the vast number of possible future health care technologies, complete information on the importance of each area could not be developed in any depth for all technology. Therefore, four specific technologies were chosen and were prospectively assessed. These future technologies were examined in more depth, looking particularly at their future health and policy implications. Subsequently, the project was extended to September 1987, and two additional technologies were chosen for assessment.