Navigating the Future Healthscape

Predicting the future is hard. Countless highly regarded people have a proven record of being terribly off in their views of what is yet to come.

Predicting the future is also heavily skewed towards tragic endings. It's only natural. The demise of humankind has been anticipated by nearly every generation and, fortunately, we are still standing. To every tempest that ought to destroy us, we found stronger countermeasures. Smallpox? The vaccine. Global famine? The Green Revolution.

Now, it should come as no surprise that current predictions for healthcare are grim. It shouldn't surprise you either to hear that we already have some ideas on how to navigate the troubling currents. We have to harness them if we want to set a safer course for the generations to come.

Tides are rising, shining silver

When I first stumbled upon the term "Silver Tsunami," I understood why it stuck. Short, poetic, with a whiff of catastrophe. It is often used by the media to describe the aging of the population — the moment a massive generation of baby boomers meets plummeting birth rates [1].

Only later did I learn that critics find it discriminatory and inherently ageist, framing aging as a disaster. Some now prefer the "Longevity Era." That is a beautiful statement on how humankind is getting remarkably good at not dying, but despite my best effort to find the same love for the term, it misses a massive point. What we are witnessing is The Grand Age Pyramid Flip: a total inversion of our demographic foundation. The "Tsunami" part is not a comment on people riding the wave; it's a warning that the social contract, drawn with assumptions of five workers to a single elderly, won't hold in this new reality.

In healthcare specifically, it means a fundamental repurposing of the entire infrastructure. The needs of the elderly are distinctly different from what we have built over the years, spanning from transportation and intervention to prolonged care. We won't resolve this by simply adding more beds.

Could you lend some hands, please?

For one, you need someone to stand by the bedside, and the demographic flip math is brutal. The demand for quality care rises, while the pool to draw new medical talent shrinks. Inevitably, we are heading towards a ratio that is mathematically unjust [2] — one that expects a few young hands to carry an ever-growing weight of care.

The alarm in healthcare has been wailing for years, pushing workers into 14-hour shifts and chronic burnout. It is no wonder we are witnessing an exodus from the frontline. Nurses and clinicians are facing an environment that is just not sustainable and are increasingly jumping overboard in search of roles that do not demand such a tremendous personal toll. It's a self-perpetuating cycle.

While wealthier nations might think they've patched the systemic leak, it's merely a stopgap. Drawing healthcare workers from developing countries to keep their own hospitals afloat is not sustainable, as the whole planet is destined for the same fate. Not to mention, it is quite shortsighted to assume that the rest of the world will allow their future to be drained endlessly.

Journey to never-better

Our environment changes constantly. For the longest time, humanity lived in a world of scarcity, peril, and "quick" death. Don't get me wrong, those times being over is bliss. It's simply that we were never shaped for lengthy journeys over vast oceans, merely for short coastal trips. We must find solutions to the new ailments this voyage brings.

Chronic illnesses are more prevalent than ever. There are multiple reasons for this state of affairs. These start with the fact that we actually know they exist, are followed by an observation that we live long enough for them to develop, but do not end before noting that our everyday choices push our biological machines to the unthought-of extremes. Calorie-rich diet of ultra-processed food. Chronic stress. Addiction-based lifestyle and over-stimulation. To mention a few.

Treatment is no longer a one-off fix; there is no finish line and the target is not to get better. Rather, each chronic patient fights to not get worse and requires constant oversight, putting a strain on the system for years, if not decades. Even if the burden is minimal, it accumulates. The throughput shrinks [3]. We need more navigators.

Lured by the Siren Songs

Medical knowledge is advancing at unprecedented speed, yet the patient has never felt more lost. This is hardly an accident. Our economy has undergone a radical transformation: no longer do we focus purely on creating value, but on identifying, exploiting, and monetizing human weaknesses.

Healthcare has become a secondary concern to the way the global marketplace functions. Psychological vulnerabilities became opportunities. In this setting, medical authority is an obstacle to profit, and so the modern marketing seeks to undermine the experts, encouraging to "choose our own reality" and equating the clinical advice with virtually any other opinion.

The distance between a specialist and a layperson widens and communication breaks down. Increasingly, the patient is no longer a participant, but a target for competing interests — susceptible to any whisper offering an easier solution. Ultimately, it is the doctor and the system that pay the price of overlooked or mistreated problems.

We can't really wait the flip over. Quite likely, that is just our new, permanent reality. At least for the foreseeable future.

Profit Through Prevention

All the problems mentioned you probably have heard of in one way or the other. So what are the pillars upon which we are building our response?

The first is reshaping the incentives on which the providers and payers, the main actors of the system, operate. You can't expect to treat a thirty-year condition with a thirty-minute consultation. It is way more sustainable to manage a patient's health in their 30s than to pay for their complications at 60. Consequently, healthcare will be less and less about Fee-For-Service and more about Value-Based Care, where the provider's profit is directly tied to the lack of need for acute intervention.

The transition from reactive to proactive care is happening, maybe not at the pace we would like. The USA, the country most advanced in this process, has proven that this new approach is of Byzantine complexity, not frictionless, and there are serious problems to consider, like the incentive to neglect. Yet, my bet is that the winners in the healthcare space won't be those with the most hospital beds, but those who are the best at keeping people out of them.

Wall-less Hospitals

The second backbone of the future healthcare is a new infrastructure. Not physical; the digital and autonomous. One that scales at a fraction of the cost of steel-and-glass hospitals and ensures proactive care ceases to be a luxury for only the selected few, provided we finally find a way to bridge the piling silos of legacy data.

An increased fraction of modern care is happening in the comfort of one's home and the trend will only accelerate. On one side, the patient requires every instrument that enables their individual, remote journeys without feeling abandoned. On the other, we need to empower a single team member to manage a thousand patients on a daily basis without burnout and dying the death of a thousand clicks.

At least half the time of medical staff is spent on tasks that do not require a medical degree, such as bureaucracy and routine measurements — things possible to automate and often entirely reducible. The recent advancements in robotics, LLMs and the agentic AI platforms offer a world where the heavy-lifting is done nearly without supervision.

The regulatory and liability frameworks for now refuse to hand over crucial, decisive health aspects to the machines and for a good reason. Even if they turn out to be more reliable, the emotions come into play and we are left with questions that gnaw at our ethics. Who is to blame, when the machine fails?

The Literacy of New Era

The definition of human and how to be one is a topic that is constantly under writing. There are probably few new chapters to add.

Truthfully though, I don't think these measures are enough. At least not alone. They are a patch applied to a broken system to make it more performant and a failure to capture the culprit. We are still trying to fulfill the old social contract while in need of a new one.

So far it has been "tire yourself to the limit, and we will fix you later", but when an individual can no longer expect the environment to keep that promise, the system should empower the patients themselves. I suspect we are re-entering the world of what I call Fractional Roles, where extreme specialization in just one aspect is highly unlikely. Nigh everyone is bound to become a part-time nurse and caregiver.

Practical health and well-being must be treated the same way reading and writing are approached, as building blocks for the "Manual for being human". It should start with school, grow into one's identity and the medical education should pretty much never end or we are doomed to fall prey to misinformation. Again.

Curated and validated information streams, close to the recipients and ready to fight for their hearts to the bone, will be all the more valuable. It won't be a surprise if "Virtual Clinics" burgeon — entities with minimal or no physical footprint that are trust-hubs designed to manage your health before it ever requires a physical intervention.

And the hardest lesson we have learned about healthcare? We need to make it attractive and actually engaging.

Piotr | co-founder and CTO of Exura

Notes

[1] It is projected that the proportion of people over 60 is about to double by the year 2050. Source: WHO Ageing and health

[2] The healthcare workers shortage is real and happening right now. WHO already estimates that we will be missing ~11 million workers by 2030. Source: WHO Health workforce

[3] Chronic diseases already account for roughly 80 percent spending in some of the developed countries. Certainly in USA. Source: CDC