Preventive healthcare technologies are poised to revolutionize patient outcomes and reduce healthcare costs, but widespread adoption depends on overcoming regulatory, economic, and psychological barriers.

An ounce of prevention is worth a pound of cure, according to a time-honored idiom attributed to Benjamin Franklin. While he used the phrase figuratively in reference to fire safety, the American Founding Father was expressing a universal truth: a reactive approach presupposes that the damage may already have been done.

For healthcare systems, the harm is not just represented through poor outcomes but an economic burden that experts say could be dramatically alleviated by investment in preventive solutions.

Data from Australia’s Department of Health and Aged Care in 2023, for example, suggests that every Australian dollar (roughly NT$21) invested in preventive health could save an estimated AU$14.30 (roughly NT$298) in healthcare and associated costs.

While up-to-date figures on potential cost-effectiveness are lacking for the United States, the Division for Heart Disease and Stroke Prevention under the U.S. Centers for Disease Control and Prevention (CDC) estimates that cardiovascular disease and stroke cost the healthcare system US$254 billion every year, with a further US$168 billion in lost productivity. Combined, these two diseases kill over 944,800 people annually as of 2022 – representing approximately one in three deaths in the country. With the American Stroke Association estimating that 80% of strokes are preventable, clinical preventive services (CPS) can prevent deaths while conferring significant value to healthcare systems.

Unfortunately, the number of people using CPS in the United States has been declining for years, according to data from the Office of Disease Prevention and Health Promotion (ODPHP), which like the CDC is a federal U.S. agency under the Department of Health and Human Services. The number of adults aged 35 years old and over who received all recommended high-priority CPS fell from an already dismal 8.5% in 2015 to just 5.3% in 2020.

Major obstacles continue to be costs and a lack of awareness as to what services are available under regulations introduced in 2010 under the Affordable Care Act, commonly known as Obamacare. The act mandated that insurers cover recommended preventive services at no extra cost to patients. In a recent development, President Donald Trump’s administration has announced its intention to defend the Affordable Care Act’s mandate for no-cost preventive services against a legal challenge currently under review by the Supreme Court.

A crucial component of preventive services is screening for various diseases. Worldwide, rates of preventive screenings plummeted during the Covid-19 pandemic, with lockdowns, social distancing, and resource reallocation all cited as factors. In Taiwan, reticence to engage primary healthcare services saw a slump in screenings for major cancers of 23.4%, amounting to 1.19 million missed checkups, despite the absence of a hard lockdown.

Taiwan’s biggest decrease was seen in screenings for oral cancer, which were down 39% compared with pre-pandemic levels. This was particularly concerning as, thanks in part to betel nut chewing, Taiwan has one of the world’s highest incidences of the disease. Meanwhile, even screening procedures that did not require person-to-person contact saw a marked decline, with fecal immunochemical tests – noninvasive checks for colorectal cancer – being one prominent example, according to the Journal of the Formosan Medical Association.

A proactive approach

In response to these declines, telemedicine usage surged as authorities relaxed restrictions on video consultations, remote monitoring, and medication management to encourage patients to seek care. While obstacles to a widespread embrace of telemedical alternatives include legal concerns and a preference for in-person consultations, such changes could be part of a move toward innovative tech-based preventive solutions. Amendments to the Ministry of Health and Welfare’s (MOHW) Rules of Medical Diagnosis and Treatment by Telecommunications, effective from July 1, 2024, have extended the scope of telemedicine to include a wider range of chronic disease circumstances.

“People are starting to understand the importance of technology for monitoring health, especially after Covid,” says Syed-Abdul Shabbir, a professor of artificial intelligence and digital health at the Graduate Institute of Biomedical Informatics at Taipei Medical University. “And this technology is maturing, so things are changing for the better.”

Collaborating with domestic companies like Leadtek, a manufacturer of smart medical devices such as wearable ECG recorders and oximetry monitors for noninvasive blood oxygen measurement, Shabbir researches telemonitoring strategies with an emphasis on “4P medicine.” This approach represents a shift from the traditional reactive, curative model to one that is proactive, personalized, preventive, and participatory.

The key to driving a paradigm shift and fostering widespread adoption of this technology lies in providing clear, compelling evidence of its efficacy and value to healthcare administrators.

“We need to provide more and more evidence to the National Health Insurance [Administration] and convince them that, if you monitor, you can predict – if you predict, you spend less,” he says.

An important consideration, says Shabbir, is the issue of data sharing. In societies with a high number of competing private insurers, this problem is particularly pronounced, but even for countries where public healthcare predominates, it is a factor. “If nobody wants to share their data, it becomes siloed, and we just don’t know what is happening,” he says. “Therefore, no matter whether it’s a public or private insurance system [or a mixture of both], the data should be unique.”

Academic experts agree that the economic benefits must be emphasized for healthcare authorities to get on board. “Preventive healthcare is just emerging and has a long way to go,” says Herbert Hsiao, a professor at National Taiwan University’s Department of Mechanical Engineering and CTO of Pulxion, an early detection technology for stroke prevention. “But the bottom line is that, in general, preventing disease is much cheaper than treating it after it has developed.”

To effect wholesale change, “all parties,” including the general public, policymakers, medical associations, and industry, must “be on the same page,” says Hsiao. The challenge, however, is that most governments, constrained by limited budgets, often seek quick, visible solutions to satisfy immediate public expectations. He notes that “without a sustainable approach and long-term investment in preventive technologies, healthcare systems will come under increasing strain” – a reality already evident in nations with well-established socialized healthcare systems, such as the United Kingdom.

Pulxion’s flagship product, PulStroke, leverages AI-powered, non-contact imaging technology to screen for carotid artery stenosis (CAS), a leading predictor of ischemic stroke – the most common type, responsible for approximately 87% of all strokes, according to American Stroke Association data. Ischemic strokes occur when a blood clot or other obstruction blocks blood flow to the brain, depriving it of oxygen and nutrients. Using an LED light, the compact, portable device captures high-resolution footage of the skin around the anterior triangle of the neck, enabling early detection and intervention.

When CAS occurs, turbulent blood flow creates subtle pulsations on the skin’s surface that are imperceptible to the human eye. PulStroke makes these variations visible and analyzes them using cloud-based algorithms, distinguishing between normal patterns in healthy individuals and irregular pulsations in those with CAS. After quantifying these differences, the device’s software generates a risk assessment report, all within five minutes.

With accuracy exceeding the 90% reliability of Doppler ultrasonography – a standard CAS screening method – PulStroke eliminates the need for specialized technicians and fixed testing sites. “There are no operating barriers,” says Hsiao and his team. The device significantly reduces waiting times and costs, addressing clinical gaps that remain unfilled in current screening practices.

The goal, says Hsiao, is to extend the technology beyond hospitals to communities to create “personalized mobile hospitals.” He adds that the device could also be adapted to screen for conditions such as heart valve abnormalities and blockages in dialysis fistulas – surgically created connections between arteries and veins that enable blood filtration in patients with kidney failure.

Referring to Pulxion as an “NTU spinoff,” Hsiao explains that funding came through the A+ Startup Technology Enhancement Program (A+STEP), an initiative of the Department of Industrial Technology under the Ministry of Economic Affairs, which aimed to support innovation in academia with a view to creating commercially viable businesses. Some universities developed advanced technologies but hesitated to pursue commercialization due to legal restrictions and a lack of government appetite for cooperation. This, he says, has changed over the past 10 years, with various departments now offering sizeable sums for promising projects.

Breaking barriers

While recent books, such as Honghong Tinn’s Island Tinkerers, have challenged the view of Taiwan’s tech revolution as solely a top-down process driven by the Chinese Nationalist Party state, innovation in 1960s and 1970s Taiwan was certainly more goal-oriented. In this regard, Hsiao praises the emergence of a more hands-off approach.

“They don’t lay out any rigid framework for you,” he says. “They just let you go for your creativity, which allows professors to work on things they really enjoy.” Regarding business strategy, the PulStroke hardware is available for both purchase and lease. The software will follow a usage fee model, with each assessment report incurring a small charge.

Another Taiwanese health tech company exploring such a service model is Singular Wings Medical, which offers a range of products, applications, and services under its BeatInfo brand. Through a lightweight sensor, which is adhered to or strapped across the chest, the BeatInfo wearable device can monitor digital biomarkers such as a user’s heartbeat, respiratory rate, and core temperature.

A series of toggle switches on the interface of the app allow users to turn features such as the alert and GPS location functions on and off. Should any serious instances of arrhythmia or other physiological irregularities occur, medical professionals, family members, or – in the case of private sector healthcare providers – call center operatives will receive notifications via a web-based console and take appropriate actions.

“It’s perfect for rescue purposes,” says Singular Wings Medical founder and CEO David Lee. “For example, if people go hiking alone and [experience] a body situation, the system gets an alert ahead of time.” This is particularly useful in cases of severe atrial arrhythmia, which are directly linked to ischemic stroke. “We can send resources to the spot, saving time,” says Lee. “Maybe we can even save a life.”

For long-term prevention, data is stored on a cloud server, accessible to all relevant parties, and displayed as interactive graphs that allow analysis from a broad, months-long perspective down to individual minutes. As an example, Lee pulls up the data of an anonymous elderly patient, which, at a macro level, appears unremarkable. However, zooming in reveals a different picture.

“You don’t need to be a trained doctor or expert to see something is simply not right,” Lee says. “It’s very irregular and showing signs of atrial fibrillation, which for a man of this age makes the chances of ischemic stroke 20 times higher.”

While the BeatInfo device and its companion apps are available for purchase, Lee says another technology – a continuous glucose monitoring (CGM) system – will be introduced as a subscription-based service. By analyzing the continuous ECG signal from the BeatInfo sensor, the software employs a patented AI-based algorithm to generate data on blood glucose fluctuations.

“We use one vital sign and, after our calculation, output another vital sign,” says Lee. “We’ve achieved some very convincing results – 87%, which is comparable to the accuracy of Abbott’s Freestyle,” he says, referring to the current gold standard in CGM wearables.

Most importantly, unlike competitors’ devices, BeatInfo’s technology does not require an applicator with a needle to insert a filament under the skin for continuous glucose monitoring via Bluetooth. This noninvasive approach helps overcome the psychological barriers to adoption, Lee says. Unlike traditional CGM solutions, which leave a filament device under the skin for two weeks before disposal, the BeatInfo sensor generates no medical waste, he notes. By contrast, other companies’ CGM devices need to be discarded every two weeks.

“Our method is a game-changer,” Lee says. “It’s just like your smartphone, and you wouldn’t throw that away every couple of weeks, right?”