There are many people who cringe when they think about what is going to happen to healthcare under a Trump administration. Healthcare is a subject which has wormed its way into everyday conversation since Ronald Reagan was in office. Back then “entitlements”, specifically social security, were a supposed “third rail” that could not be touched, whittled down or even frozen.
Fast forward to the present.
Regardless of what you think about immigrants, poor people, old people, sick people or children, there is one fact that is inescapable. The basic notion of the “welfare state” is being re-examined. It is not just the United States where this is a hotly contested issue.
The drivers? Exploding costs and aging demographics along with creaky infrastructure and outdated service models.
The scandal facing the NHS in mid May over a massive hack made possible by outdated software is just one example of how fragile established western healthcare systems currently are.
That the system needs to be fixed is not controversial. How to fix it is another issue.
In the United States, there is huge pressure on Republicans to overhaul Obamacare. And it is fair to say that there are no easy fixes to a system in the United States that is unbelievably complex, expensive, and which has gaping holes in it. Out of desperation, one proposal to cut costs in the United States is to incorporate blockchain technology. In Europe, where the social state as a concept has not died, blockchain has already begun to be examined as a cost-saver in both the public and private insurance industry.
Blockchain could help to reduce healthcare costs. One of the biggest drivers of healthcare costs in the United States and other places is the administrative time, cost and paperwork necessary to run a regulated industry. A key benefit of using blockchain will be lower costs of healthcare administration due to economies of scale that will provide much needed relief to state and national budgets. This means that the forecast explosion of costs might be better contained.
Rising healthcare costs are further complicated by privacy laws that aim to protect health related information. In the United States, this falls under HIPAA. Otherwise known as the Health Insurance Portability and Accountability Act, this Clinton-era legislation has very strict rules about how health records can be shared. Blockchain in this environment provides a secure way for databases to talk to each other, and offers a solution to the privacy conundrum laid out for IT professionals in this space since 1996.
For this reason, introducing blockchain represents one of the first true opportunities to “fix” a horribly broken system – in the U.S. and elsewhere.
In Europe, where the concept of inclusive healthcare is akin to a sovereign right, this conversation has already started.
Implementing blockchain will not simply be a matter of sending “bitcoins” to doctors for payment. It will be about the widespread use of “smart contracts”. The earliest use cases across the industry are mostly related to health record management and access, as well as insurance claims.
Blockchain may be a secure technology, but creating a fully digitised healthcare system raises serious privacy concerns. If people are enrolled in systems where they can be tracked for life, what happens to that information and who has the right to access it? How will such interactions be designed to protect the individual in a world where nothing, suddenly, is truly private. How can people with pre-existing medical conditions be sure that their information won’t fall into the hands of insurance companies who will use the information to charge higher insurance premiums or to deny coverage?
These new healthcare systems will need to be designed with privacy issues kept firmly in mind. An old and crumbling system is about to be replaced with a technology whose impact is as yet largely unfelt. And for the most part, it will be Generation X and Y who will be tasked with building these systems. The privacy rights of young people and many voiceless individuals on the fringes of the system will be affected. This could serve as a clarion call to those who have long been left out of the healthcare debate, but more likely it underlines the importance of safeguarding the privacy rights of groups who are presently unaware that their fundamental rights are hanging in the balance.
In sum, blockchain will absolutely play a defining role in healthcare reform. How and where it will be applied is still unclear. However, it is likely to play a central role in redesigning healthcare systems for the 21st century in America and beyond.
Marguerite Arnold is the founder of MedPayRx, a blockchain healthcare startup in Frankfurt. She is also an author, journalist and has just obtained her EMBA from the Frankfurt School of Finance and Management.