For home care entrepreneurs to successfully launch their innovation, they need to put end-user needs at the forefront, learn the differences between healthcare systems across Europe, and be aware of the technology barriers that may hinder adoption. In this article, Bax & Company Innovation Consultant David Chadima explores these three key factors to consider when innovating home care in the EU.

Healthcare systems across the European Union (EU) are under constantly growing pressure. In 2021, one-fifth of the EU’s population was aged 65 or over, and this number is expected to keep rising (Eurostat, 2021). The average lifespan of an EU citizen is continuously increasing due to the general high quality of life in Europe. Consequently, there’s a larger demand for higher-quality healthcare services. As the elderly population accounts for the majority of hospitalisations, it is challenging for hospitals to sustain the healthcare delivery for all patients while improving the quality of care. Another issue is the shortage of healthcare personnel, with 22 EU countries already reporting scarcity and the World Health Organisation (WHO) projecting a deficit of 18 million healthcare professionals by the end of 2030 (Limb, 2016). Thankfully, home care offers the opportunity to tackle these challenges, as it can decrease the burden on healthcare systems. Nonetheless, in order to provide a sufficient alternative to traditional healthcare in medical centres, home care must be enabled by technology and innovation.

In 2022 we are witnessing increased priority given to home care and the related innovations resulting from the Covid-19 pandemic. Quarantine forced many to remain homebound for several months which has impacted how society functions in the present day (Volpp, K.G., Diamond, S.M., Shrank, W.H., 2020). It was also a time of rapid adoption and development of new clinical models at home, which allowed the uptake of new home care enabling technologies (Blanchfield, B.B., Jubelt, L.E., Meyer, G.S., 2021). The present situation offers a great opportunity for home care innovators to bring their ideas alive, but the journey towards a successful market launch and adoption of home care innovation is not an easy one. In the following paragraphs, we set out three vital considerations for entrepreneurs developing home care innovations.

1. Who are the end users of the product or service and what are their needs?

Every new product or service should be tailor-made for its end user. That’s why the first step an entrepreneur should take is to determine the end user of their product or service.

There are two possible end users in home care – care providers, and patients. Innovations are often addressed to both groups but can also be designed to target one group specifically. In any case, these target groups must be engaged during the process of early innovation development to ensure that the innovation truly matches the real needs of users and therefore serves its purpose. Studies are proving that innovations designed and introduced without the input of homecare workers result in deteriorated working conditions and harm the wellbeing of home care workers (Bensliman, R., Casini, A., Mahieu, C., 2021). For care providers, meaningful innovation emerges as a combination of what they perceive as an aid to their daily practical tasks and what is compliant with the bureaucratic rules and economic rationality (Yakhlef, A., & Essén, A., 2013). Patients also seek the practical implications brought to them by the innovation, including the example of telemedicine practices, which are seen as suitable for specific individuals or medical circumstances, as opposed to all (Hardisty et al., 2011).

Home care innovation needs to be contextualised to the individual patient’s health status, capability, and situation, in order to achieve the best outcomes (Radhakrishnan et al., 2016). There are various factors that can cause difficulties and inconveniences to patients and families and should be identified as well as tackled at the very beginning, prior to development.

2. Home care systems, reimbursement mechanisms and regulations around the EU

While the basic principle of granting free access to healthcare for everyone stays the same, each country in the EU has a unique healthcare system of its own with different structures and relationships between insurers, providers, and patients (Bekey, 2019). Home care is no exception to these differences, so innovators need to be prepared for the varying structures alongside the related reimbursement mechanisms.

For an entrepreneur, the most common scenario is to design and position the innovation as eligible for cost reimbursement by insurers. The customers, being the care providers or the patients, in most cases work together with insurers and cannot afford an innovation that would not be at least partly reimbursed. There are a few exceptions of private entities, that don’t mind investing higher resources into the purchase but in general, innovations need to fit the insurance mechanism of individual EU countries. Next to that, the innovations must apply to the regulation on both the EU level as well as on the level of the individual EU states. Some of the more advanced home care innovations are classified as medical devices and therefore fall under stricter legislation. Such innovations need to undergo a conformity assessment to check their precise performance and safety (EMA, 2022), which can vary among different EU countries.

One last consideration that can affect the launch of a home care innovation in the EU is the type of home care system. Overall, there are two types of home care systems in the EU, the centralised one which is operated by the state, and a decentralised system which transfers the responsibility to the municipal or regional level. The governmental level of control is most centralised in Belgium or France, while the most decentralised is in Iceland or Italy (WHO, 2012). The two systems have their specifics which can play a role when designing innovation and should be considered together with regulation and reimbursement mechanisms.

3. Adoption and technology barriers

When speaking of home care, we often refer to patients who are of higher age, as 70% of home care patients are 65 or older (Mitzner et al., 2009). Many home care innovations are digital or at least require a certain set of basic technical skills to be operated. In that sense, several technology barriers should be considered when developing a home care innovation. These barriers can be categorised under the term usability – the ability of the tools to accomplish the task they are designed for. (Parks et al., 2021). Even though it may seem to the developers that their innovation essentially delivers the desired outcomes, some of the technology barriers do not have to be necessarily visible at first glance, prior to market launch. Examples of usability are size and space requirements, portability, material and colour, clarity of instructions, trustworthiness or safety. All these examples were identified by patients, families, or home care nurses working with different types of innovations. Such findings point towards a pragmatic approach when designing a home care innovation, which supports the first point of tailoring to the exact needs of end users.

Home care provides invaluable support to EU healthcare systems in dealing with rising care demands and the number of hospitalisations in Europe’s ageing population. Home care is, and will be, one of the key aspects in sustaining the quality and access to healthcare for everyone, while offering a great market opportunity to new entrepreneurs. However, when planning to launch a home care innovation in the EU, one must be prepared to execute thorough and well-thought planning. It all starts with selecting the end user and designing the innovation around their needs. In the case of planning to enter multiple EU markets, the type of home care system, reimbursement mechanism and regulation must be considered. This step might even involve a single market adaptation. Moreover, technology barriers must be overcome to ensure the proper adoption of the innovation. These are all equally important factors to be considered on the challenging road of home care innovations towards a successful market launch.

References

Bekey. (2019). Healthcare systems in the USA and Europe. Retrieved from: https://bekey.io/blog/healthcare-systems-in-the-usa-and-europe-differences-challenges-trends

Bensliman, R., Casini, A., Mahieu, C. (2021). “Squeezed like a lemon”: A participatory approach on the effects of innovation on the well-being of homecare workers in Belgium.  https://doi.org/10.1111/hsc.13506

Blanchfield, B.B., Jubelt, L.E., Meyer, G.S. (2021). Home-based care is ripe for innovation and implementation post COVID-19.  Retrieved from: https://www.hfma.org/topics/cost-effectiveness-of-health/article/home-based-care-is-ripe-for-innovation-and-implementation-post-c.html

EMA. (2022). Medical devices regulation. Retrieved from: https://www.ema.europa.eu/en/human-regulatory/overview/medical-devices

Eurostat. (2021). Population structure and ageing. retrieved from: https://ec.europa.eu/eurostat/statistics-explained/index.php?title=Population_structure_and_ageing

Hardisty, A. R., Peirce S. C., Preece A., Bolton C. E., Conley E. C., Gray W. A., Rana O. F., Yousef Z., Elwyn G. (2011). Bridging Two Translation Gaps: A New Informatics Research Agenda for Telemonitoring of Chronic Disease. International Journal of Medical Informatics 80 (10): 734–44.

Mitzner, T. L., Beer, J. M., McBride, S. E., Rogers, W. A., & Fisk, A. D. (2009). Older Adults’ Needs for Home Health Care and the Potential for Human Factors Interventions. Proceedings of the Human Factors and Ergonomics Society … Annual Meeting. Human Factors and Ergonomics Society. Annual meeting, 53(1), 718–722. https://doi.org/10.1177/154193120905301118

Limb, M. (2016). World will lack 18 million health workers by 2030 without adequate investment, warns UN. DOI:10.1136/bmj.i5169

Parks, R., Doutcheva, N., Umachandran, D., Singhe, N., Noejovich, S., Ehlenbach, M., Warner, G., Nacht, C., Kelly, M., Coller, R., & Werner, N. E. (2021). Identifying Tools and Technology Barriers to In-Home Care for Children with Medical Complexity. Proceedings of the Human Factors and Ergonomics Society Annual Meeting, 65(1), 510–514. https://doi.org/10.1177/1071181321651214

Radhakrishnan, K., Xie, B., Berkley, A., & Kim, M. (2016). Barriers and Facilitators for Sustainability of Tele-Homecare Programs: A Systematic Review. Health services research, 51(1), 48–75. https://doi.org/10.1111/1475-6773.12327

Volpp, K.G., Diamond, S.M., Shrank, W.H. (2020). Innovation in Home Care: Time for a New Payment Model. 323(24):2474–2475. doi:10.1001/jama.2020.1036

WHO. (2012). Home Care across Europe, Current structure and future challenges. Retrieved from: https://www.euro.who.int/__data/assets/pdf_file/0008/181799/e96757.pdf

Yakhlef, A., & Essén, A. (2013). Practice innovation as bodily skills: The example of elderly home care service delivery. Organization, 20(6), 881-903.