Tipos de Comunicación. Según Morales, A (2008) Existen dos tipos de comunicación verbal y no verbal

Countries have difficulties in balancing the economics of their health-care systems

and being able to maintain basic medical services to all segments of the society. Is-sues such as the definition of an optimal retirement age and the development of liberal, public, or mixed health-care societal models are constantly being debated.

Experts argue that already by the 2020s the health-care delivery system in Western countries will be fully digitized [13]. What sort of challenges lie ahead?

One of the most influential factors affecting the long-term sustainability of health-care systems concerns the dramatic change of the demographic pyramid [14]. During the last century, developed countries have experienced progressive change on how the working-age population has postponed or completely aban-doned the creation of families due to changes in living habits as well as the effect of industrialization. To make matters more complicated, life expectancy has in-creased steadily over the years as well. Long-term care and welfare systems need to respond to these concerns as effectively as possible [15].

Fig. 3. Life expectancy comparison between Finland, China, and the Democratic Republic of the Congo (http://www.gapminder.org).

Trends in life expectancy and the fertility rate in Finland, China, and the Democratic Republic of the Congo are depicted in Figure 3 and Figure 4 re-spectively. As a representative example of the historical evolution of these two trends, in 1900 the average life expectancy in Finland was 43 years and the total fertility rate was 4.8 children per woman. The 2015 life expectancy in Finland was 81 years, and families had an average of 1.8 children per woman. The trend is similar in China. In 1900 the life expectancy was 33 years and the fertility rate was 5.5 children per woman. Today life expectancy in China is 77 years, almost at the level of Western societies, and fertility rates are at a similar level of 1.6

children per woman. Conversely, some of the African countries, for example, the Democratic Republic of the Congo, show cases of extreme poverty. In the Congo, life expectancy in 1900 was 31.6 years, and the fertility rate was 5.99 children per woman. Currently, life expectancy in the Congo has increased to 58.3 years, with fertility rates of 5.72 children per woman.

Fig. 4. Children per woman comparison, Finland, China, and the Democratic Republic of the Congo (http://www.gapminder.org).

Although trends differ among countries, the reality is that nearly all devel-oped countries are aging as a result of low fertility, existing immigration policies, and longer lives. Historically, society’s progressive industrialization has had a positive impact on the creation of basic sanitation and health-care services. The development and implementation of human rights go hand in hand with urbani-zation. Scientific and technological developments have also helped create what we today understand as basic health-care delivery.

Future trends in morbidity (i.e., the incidence or prevalence rate of injuries and chronic diseases, such as cancer, fractured hips, strokes, dementia) and disability rates will be crucial determinants of societies’ abilities to meet the challenges of population aging [4]. The long-term projections of the Economic Policy Commit-tee and the European Commission show that the pension, health, and long-term care costs linked to the aging population will lead to increases in public spending.

Public spending on long-term care is also expected to increase substantially; it is projected to increase from 1.2% to 2.3% of gross domestic product (GDP) in the European countries between 2007 and 2060 [15]. As a consequence, the impact of this demographic prediction on the welfare state is a high-priority topic on the European policy agenda [14].

During the coming decades the profound changes in the population structure will force all countries to prepare and execute new ways of operating their health-care systems. In addition, the financial-crisis-induced austerity measures, such as restrictions on increases in health-care spending have had negative effects, especially for certain population groups [16]. What is even less encouraging is the equity gap among wealthy and less wealthy countries as well as the stratifi-cation of the society, dividing it into groups of wealthy people who have access to high-quality health-care services and into middle- and lower-class working groups that have difficulties in accessing the same services [17]. Figure 5 shows the effect of the GDP per capita on child mortality with a comparison of Finland, China, and the Democratic Republic of the Congo, which has the lowest GDP per capita on a global scale. To portray the difference between developed and under-developed countries, the x-axis in Figure 5 is in logarithmic scale.

Fig. 5. Child mortality as a function of the GDP per capita, purchasing power parity adjusted (PPP$)—a comparison between Finland, China, and the Democratic Republic of the Congo (http://www.gapminder.org)

The reason for such polarization in developed versus developing countries is grounded in the demographic challenge of an aging society, which is dramatically stressing the economic sustainability of existing health-care systems. The level of industrialization of different countries has an impact on the GDP per capita,

and therefore on the quality of healthcare provided to the population. A dramatic example of this is the Democratic Republic of the Congo, a country lacking in in-dustrial infrastructure but extremely rich in natural resources, which have been exploited and corrupted for centuries due to commercial and colonial extraction.

EU countries have difficulties in balancing the economics of the health-care system, being able to maintain a welfare state at the same time, and providing basic medical services to all segments of the society. The truth is that national policies have not been able to develop an optimal system, and there are practical differences in terms of services provided to low- and middle-class groups and those that just a selected group of the population can access.

In this scenario, experts discuss the enormous potential for a new wave of digital technologies (e.g., electronic health records, remote patient monitoring, wearable sensing technologies, Big Data analytics, artificial intelligence, activity trackers, etc.) to improve many aspects of health-care systems in terms of pro-ductivity and patient health as well as economics of social care provision [18].