Research methodology

Shaping the future of health together

Research overview and objectives

Since 2016, Royal Philips has conducted original research to help determine the readiness of countries to address global health challenges and build efficient and effective health systems. In the context of ever-growing pressure on resources and costs, the Future Health Index focuses on the crucial role digital tools and connected care technology can play in delivering more affordable, integrated and sustainable healthcare.

In 2016, the Future Health Index measured perceptions of healthcare to produce a snapshot of how healthcare is experienced on both sides of the patient-professional divide. In 2017, it compared these perceptions to the reality of health systems in each country researched. In 2018, the Future Health Index identified key challenges to the large-scale adoption of value-based healthcare and overall improved access. It assessed where connected care technology can help speed up the healthcare transformation process. In 2019, the Future Health Index explored technology’s impact on two aspects of the Quadruple Aim: the healthcare experience for both patients and healthcare professionals and how technology is moving us to a new era of continuous transformation.

Now in its fifth year, the Future Health Index 2020 report builds on the findings of the previous reports by examining the expectations and experiences of younger healthcare professionals aged under 40 and how they can be empowered to meet the demands of tomorrow’s healthcare.

As the first global survey of its kind, the Future Health Index 2020 report features intriguing insights into the next generation of healthcare professionals, a group that will form most of the healthcare workforce over the next 20 years. The research explores this group’s expectations around technology, training and job satisfaction, and the reality of their experience as healthcare professionals.

The research gives a clear mandate to healthcare leaders to respond to the concerns of this young generation of healthcare professionals and highlights three areas to address as a matter of urgency: education and training, technology, and workplace culture.

The research for the 2020 Future Health Index was conducted in 15 countries (Australia, Brazil, China, France, Germany, India, Japan, the Netherlands, Poland, Romania, Russia, Saudi Arabia, Singapore, South Africa and the United States of America).

To provide a holistic understanding of the current healthcare systems around the world, the 2020 study combines quantitative surveys and qualitative online focus groups conducted from January-February 2020 among the following key stakeholders:

· Healthcare professionals in 15 countries (quantitative)

· Healthcare professionals in 5 countries (qualitative)

2020 Quantitative Survey Methodology

In partnership with SERMO, an independent global market research firm, a survey was fielded from November 15 to December 27, 2019 in 15 countries (Australia, Brazil, China, France, Germany, India, Japan, the Netherlands, Poland, Romania, Russia, Saudi Arabia, Singapore, South Africa and the United States of America) in their native language. The survey was conducted online and offline (as relevant to the needs of each country) with a sample size of 200 per country for healthcare professionals under 40 years old. The exceptions were Singapore and Australia, who each had slightly smaller samples. The survey length was approximately 15 minutes.

The total sample from the survey includes:

· 2,867 healthcare professionals under the age of 40 years old (defined as all medical staff, including doctors, nurses, surgeons, radiologists, etc.), who have completed their first medical or nursing degree.

Below is the specific sample size, margin of error at the 95% confidence level, and interviewing methodology used for each country.

Weighting

Total Country Weighting:

The 15-country average is an average calculation whereby each country’s sample size was weighted to have the same value, as such ensuring that each country has an equal weight in this total. The same was done for all regional totals, as well as emerging country and developed country totals.
Country classifications are according to the International Monetary Fund.
For the Future Health Index 2020 report, Brazil, China, India, Poland, Romania, Russia, Saudi Arabia and South Africa are considered emerging countries.
For the Future Health Index 2020 report, Australia, France, Germany, Japan, the Netherlands, Singapore and the US are considered developed countries.

Statistical analysis

A statistical analysis was performed to explore the relationship between the type of hospital/practice (in this instance, ‘smart,’ ‘digital’ or ‘analog’) and younger healthcare professionals’ agreement with several questions asked in the Future Health Index 2020 survey. The analysis showed that there is, in fact, a statistical relationship between the type of hospital/practice and certain aspects of their careers.

The following survey questions were used for this analysis:

To what extent do you agree or disagree with the following?
The reality of my career lives up to the hopes and expectations that I had during my medical education
I regularly experience work-related stress
I have considered leaving the healthcare profession as a result of work-related stress
Advancements in medical technology make me excited about the future of the healthcare profession
How satisfied or dissatisfied are you in your work as a healthcare professional?
In Saudi Arabia shown as “How satisfied or dissatisfied are you in your personal decision to become a healthcare professional?”

A chi-square test of independence was performed for the analysis of each of these survey questions. All results showed the relationship between these variables was significant at the p<.001 level.

Question Localizations

In some instances, certain questions needed to be adjusted slightly for relevance within specific countries. Care was taken to ensure the meaning of the question remained as close to the original, English version, as possible.

2020 Qualitative Interviews Methodology

To provide context to the quantitative data (as described above), the research was supplemented with two waves of online focus groups with doctors. Wave one, conducted from January 10, 2020-January 13, 2020, had 36 participants across the following markets: Brazil, the US, France, Germany and Australia. Wave two, conducted from February 3, 2020-February 6, 2020, had 41 participants across the following markets: Brazil, the US, France, Germany and Australia. Online focus groups were conducted in participation with SERMO, an independent global market research firm.

Sources – 2020 Report: The age of opportunity

Survey data

In partnership with IPSOS and SERMO, independent global market research firms, the surveys were fielded from March 4 to May 19, 2019 in 15 countries (Australia, Brazil, China, France, Germany, India, Italy, The Netherlands, Russia, Saudi Arabia, Singapore, South Africa, Poland, U.K. and U.S.) in their native language. The survey was conducted online and offline (as relevant to the needs of each market) with a sample size of 1,000 per market for the general population and 200 per market for healthcare professionals [1]. The exceptions were the US and Germany, who each had slightly larger samples of healthcare professionals. For the individuals (general population) audience, the survey is representative of key demographics e.g. age, gender, region, location type (i.e. rural/urban), income/SEL/education and ethnicity (where appropriate to ask). This was achieved through a mix of balancing [2] and weighting. In Saudi Arabia and Brazil, the survey is nationally representative of the online population. The survey length was approximately 15 minutes for the US, Germany, and the Netherlands, and approximately 10 minutes for the remaining markets.

The total sample from the survey includes:

3,194 healthcare professionals (defined as those who work in healthcare as a doctor, surgeon, nurse practitioner, registered nurse, licensed practical nurse or nurse across a variety of specializations)
15,114 individuals (representative of each country’s respective adult population).

At the 95% confidence level, the 15-country total for the general population has a margin of error at +/- 0.8 percentage points and the 15-country total for the healthcare professional population has an estimated margin of error [3] of +/- 1.7 percentage points.

Below is the specific sample size, margin of error at the 95% confidence level, and interviewing methodology used for each market.

[1] For the purposes of this survey, healthcare professionals are defined as those who work in healthcare as a doctor, surgeon, nurse practitioner, registered nurse, licensed practical nurse or nurse across a variety of specializations.

[2] Interlocking quotas were used for age and gender. All other demographics had non-interlocking quotas.

[3] Estimated Margin of Error is the margin of error that would be associated with a sample of this size for the full healthcare professional population in each country. However, this is estimated since robust data is not available on the number of healthcare professionals and specialty mixes in each country surveyed.

[4] US healthcare professionals sample: 278 in total; this includes an additional sample of 75 healthcare professionals from large hospitals. Germany: healthcare professionals sample: 281 in total; this includes an additional sample of 75 caregivers and nurses. When comparing Germany or the US to other countries the additional samples are removed to ensure samples are comparable. The additional samples are also removed from the 15-country average and any other regional averages.

The Weighting (General Population only)

Local Market Weighting:
For the general population sample, all countries were weighted to be representative of the national population based on census statistics (where available) for key demographics. The weighting was applied to ensure the sample is representative of individuals age 18+ in each country. In Brazil and Saudi Arabia, the sample is representative of the online population in these countries.

Total Country Weighting:
The 15-country average is an average calculation with each country’s sample size weighted to have the same value to ensure each country has an equal weight in this total. The same was done for all regional totals.

Sources – 2019 Report: Transforming healthcare experiences

Survey data

For the third report of the Future Health Index in 2018, a variety of third-party sources as well as original research from the 2016 and 2017 Future Health Index data was used. Additionally, data from chapter one of FHI 2018 was also referenced. Please see below for a full list of third-party sources and further details on the survey methodology.

Furthermore, nine key opinion leaders (KOLs) across the Netherlands, US, Spain, France, South Africa, UK and Germany were interviewed to examine the major barriers to telehealth and provide recommendations as to how elements of healthcare can be improved and drive change.

KOLs were chosen on the basis of their industry expertise in relevant areas, such as telehealth and the general healthcare landscape, and were conducted from March 2018 to September 2018 via telephone or video-chat service (e.g. Skype, etc.).

A list of KOLs interviewed is included below:

Volker Amelung, Specialist Professor for International Health Systems Research at the Medical University of Hannover
Franck Baudino, CEO and founder of French telehealth company H4D
Rafael Bengoa, co-director of the Institute for Health & Strategy in Bilbao, Spain, and a senior leadership fellow at Harvard University
Rachel Binks, consultant nurse for digital and acute care at Airedale Foundation Trust in the UK and clinical lead for the Immedicare telehealth initiative for care homes
Dave deBronkart, a former cancer patient and noted advocate of connected care known as ‘e-patient Dave’
Rocco Friebel, a former senior analyst at the Health Foundation and Assistant Professor of Health Policy at the London School of Economics
Simon Spurr, co-founder of HealthCloud, a South Africa-based digital health group
Christoph Wald, chairman of the Department of Radiology at Lahey Hospital & Medical Center and professor of radiology at Tufts University Medical School in the US
Leonard Witkamp, director of the KSYOS Telemedical Center in the Netherlands

Sources - 2018 Report 3: Telehealth: Delivering value across institutional and geographical borders

Survey data

For the second report of the Future Health Index in 2018, a variety of third-party sources as well as original research from the 2016 and 2017 Future Health Index data was used (see survey details below). Additionally, data from chapter one of FHI 2018 was also referenced. A full list of third-party sources, is included below.

Furthermore, 12 key opinion leaders (KOLs) across the Netherlands, US, UK, Australia, Germany, China, Sweden and Estonia were interviewed to provide recommendations and produce tangible guidelines as to how elements of healthcare can be improved and drive change.

KOLs were chosen on the basis of their industry expertise in relevant areas, including connected care technology and the general healthcare landscape, and were conducted from July 20, 2018 to August 9, 2018 via telephone or video-chat service (e.g. Skype, etc.).

A list of KOLs interviewed is included below:

Lucien Engelen, Director of the REshape Center in the Netherlands, a department of Radboud University Medical Center
Grahame Grieve, Principal at Health Intersections
Madis Tiik, former CEO Estonian E-Health Foundation
Mahiben Maruthappu, CEO and co-founder of UK-based social care startup Cera
Volker Amelung, Specialist Professor for International Health Systems Research at Medical University of Hannover
Christiane Grünloh, PhD student at KTH Royal Institute of Technology, Stockholm
Dean Sittig, Prof of Biomedical Informatics at University of Texas Health Science Center
John Moore, Director – Customer Lab at Bupa
Joris Wakkie, Chief Medical Officer at Aidence
Wu Ji, Associate Professor at Tsinghua University, Beijing
Bryan Williams, Chair of Medicine at University College London
Hawley Montgomery-Downs, Professor at West Virginia University

Sources - 2018 Report 2: Moving data to the heart of health systems

Survey data

In the first report of the Future Health Index in 2018, we analyzed 45 different metrics and grouped them together in key pillars:

1. Value Measure
2. Current State (of Data and Care Delivery)

The Value Measure is a new indicator of the value delivered by healthcare systems of developed and developing markets. It combines factors associated with value-based care and access to care, arguably the ultimate goals of modern healthcare. It consists of three parts:

1. Access (i.e. how universal, and affordable, is access to healthcare in the designated market?)

2. Satisfaction (i.e. to what extent do the general population and practitioners in the designated market see the healthcare system as trustworthy, and effective?)

3. Efficiency (i.e. does the system in the given market produce outcomes at an optimum cost?)

The second pillar, Current State measures current levels of adoption of key digital enablers:

1. Data (collection and analytics) (including wearables, Electronic Health Records (EHRs), Intelligent Care)

2. Care Delivery (Telehealth and Diagnostic & Treatment Solutions)

Each pillar consists of several sub-metrics. Within each pillar, the metrics are normalized to ensure comparability across countries and are scored to fit onto a 0 to 100 scale. Specifically, metrics related to market size are normalized per capita, per hospital bed or per physician in each country. The market size metrics were scored relative to the highest scoring country (with a population over 1,000,000) among the available dataset. For other metrics, including those for the Value Measure and technology infrastructure metrics, scoring is either relative to the highest scoring country (with a population over 1,000,000) among the available dataset, or, based on any optimal baseline number set by global authorities e.g. standards/goals set by the United Nations Sustainable Development Goals (SDGs). By excluding countries with less than 1,000,000 population, we exclude outliers which may create unrealistic potential to reach 100.

A metric which does not follow this pattern of normalization is:
The risk of impoverishment due to surgical care – this metric is reported as a percentage, so it is simply inversed and no further normalization is needed.

In a next step, the scores for each metric are then averaged to calculate each sub-index score and those sub-indices averaged to create each pillar.

The 45 individual metrics analyzed use a combination of third-party data and original research collected via a survey conducted in 2017 and 2018 in partnership with a global market research firm (see survey details below).

Sources - 2018 Report 1: Building health systems for better outcomes

Survey data

The survey data was collected January 18, 2017 to March 3, 2017 for 15 of the 16 countries analyzed in 2018 (Australia, Brazil, China, France, Germany, Italy, The Netherlands, Russia, Saudi Arabia, Singapore, South Africa, Spain, Sweden, U.K. and U.S.) in their native language. Survey data for India was collected during February 16 to March 26, 2018 in a manner consistent with the other countries in 2017. The survey had an average length of 25-30 minutes. A combination of online, face-to-face (computer-assisted) and phone (computer-assisted) interviewing was used.

The total sample from the survey includes:

3,254 healthcare professionals (defined as those who work in healthcare as a doctor, surgeon, nurse practitioner, registered nurse, licensed practical nurse or nurse across a variety of specializations)
24,654 adults (representative of each country’s respective adult population). Third-party data was sourced from a number of organizations including the World Health Organization, The Commonwealth Fund, and the World Bank. A full list of sources is listed below.

The full 2017 methodology is available in the 2017 report.

2016 Report: The capacity to care

Survey data

The survey data was collected February 24, 2016 to April 8, 2016 in 13 countries (Australia, Brazil, China, France, Germany, Japan, The Netherlands, Singapore, South Africa, Sweden, UAE, U.K. and U.S.) in their native language. The survey had an average length of 25-30 minutes. A combination of online, face-to-face (computer-assisted) and phone (computer-assisted) interviewing was used.

2,659 healthcare professionals (defined as those who work in healthcare as a doctor, surgeon, nurse practitioner, registered nurse, licensed practical nurse or nurse across a variety of specializations)
25,355 adult patients (defined as those 18-years-old or older who have visited with a healthcare professional in the last three months)

The full 2016 methodology is available in the 2016 report.

Shaping the future of health together

Shaping the future of health together