Chapter 7 - AI + political economics in healthcare: globalized, digitalized, divided

Abstract

Chapter seven considers the AI digital transformation of healthcare systems in the context of their overarching political economics (focusing on AI-driven efficiency and equity challenges to keep the chapter appropriately focused but still as comprehensive and manageable in scope as possible). It begins with the evolutionary biology, digitalization, and globalization of health care before moving onto the macro (ideological) and micro (financial) political economics trends that drive and determine much of the structure, operations, and trajectory not only of health care but also of the very reasons and ways AI is being used to transform its systems. The chapter then seeks to build on this baseline to consider advances in sustainable political economic design of AI-enabled healthcare, including its strategic feature (inclusive or local globalism), structural feature (democratic welfare model and disparities), and adaptive features (affordable AI ROI or return on investment). It then considers competing political economic models for healthcare systems (largely shaped by their overarching societies in which they are embedded), including nationalized, privatized, and globalized models. It pays particular attention to emblematic case examples of China's centralized or more autocratic nationalized model, the British and Indian democratic nationalized model, the U.S. democratic privatized model, and the emerging global model (of friend-shoring or reshoring of globalized healthcare systems as a network of value blocks bridging competing underlying cultures and ideologies, overarching political economics, and international healthcare supply chains). The chapter then pivots to major local political economic trends in AI-enabled health care, including the emerging value-add proposal of health ecosystem partnerships: Big Tech+Big Insurance=Big Medicine. It considers the role of large private technology corporations (Big Tech) in digitalizing healthcare, including the critique they are risking “digital colonization” exploiting systems and patients and instead have more promise with “open health care” as mutually consensual and beneficial partnerships, including with horizontal-vertical integration. The chapter analyzes additional challenges in Big Insurance (in both the risk and benefits of large private payors for healthcare systems) and the emerging novel solution to the above challenges of “resilient integration” in a comprehensive end-to-end structural approach to AI-enabled healthcare systems.