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Accenture Asia-Pacific Healthcare Innovation and Transformation Survey

Innovation-Powered HealthcareHow unique challenges are driving innovation and transformation in Asia-Pacific’s most advanced healthcare systems

2

Introduction

3

Asia-Pacific is home to some of the most advanced healthcare systems in the world. Singapore, Japan and Australia are the most prominent examples, with overall standards and outcomes that rival or lead any other developed nation.

Each country faces a major challenge in sustaining and improving healthcare for the years ahead. Aging populations, skills shortages, rising costs, overstretched infrastructure, inefficiency and budgetary pressures have made features of their current models unsustainable.

At the same time, advancements in thinking and technology are driving a fundamental shift in healthcare delivery – a shift that could tackle several of the longest-standing problems in today’s healthcare systems.

In short, the healthcare model of the future is emerging: a decentralized, self-directed system, orchestrated by new participants, facilitated by technology, and optimized through advances in behavioral science and service design.

Healthcare policy-makers, administrators, practitioners and industry participants need to drive transformation and innovation efforts in line with this model to build more effective and sustainable healthcare systems for future generations.

The 2016 Accenture Asia-Pacific Healthcare Innovation and Transformation Survey investigated how willing and ready patients are for the future of healthcare. The results are promising for change-makers and suggest that the time is right for bolder initiatives. In general, this survey finds that:

• Most patients want more self-directed care

• There is an openness to technology-driven healthcare and remote interaction/monitoring

• Technology confidence is high enough to drive change

• There is a willingness to pay for devices to support more independent healthcare

• Patients are open to the efforts of payers and providers to take an active role in influencing citizens toward healthy choices.

4

SECTION 1

What Do Patients Want?

5

There are clear areas where citizens want improvements. The top two are shorter waiting-room times (55 percent) and lower out-of-pocket expenses (50 percent). Third is the time it takes to get an appointment (32 percent), but this is largely due to demand in Australia (37 percent) and Singapore (44 percent).

Processing of insurance claims

Access to my doctor via email or other electronic means

The explanation of problems and side-e�ects

Convenience of opening hours

The time it takes to get an appointment

Costs, out of pocket expenses

The time I spend in waiting rooms

Convenience of locations

Convenience of prescription renewal

Understanding the cost of healthcare before treatment

Australia Singapore Japan

19%

7%

17%

22%24%

58%59%

20%

46%

34%

63%

11%

14%6%

21%19%

31%13%

10%

57%

37%44%

34%19%

15%

28%

16%22%

29%

7%

Aspects of current healthcare systems needing the most improvement

In Japan, only 15 percent feel that the time it takes to get an appointment needs improving, but 57 percent say they are not happy with the long time they spend in waiting rooms – this reflects both the high accessibility of the system and the considerable strain it is under.

6

In our survey, Australian patients are the most satisfied with their health system: 50 percent indicated that they are very satisfied with the overall quality of care, while 46 percent said the same about the convenience of healthcare services. Singapore, with corresponding numbers of 19 and 14 percent, and Japan, with 15 and 13 percent, show signs of a sizable gulf between patient expectations and the healthcare services they receive.

Survey DetailsCountries in scope: Singapore, Japan and Australia

Sample size: 2,250 (750 per country)

Sample profile: Evenly distributed across age groups, gender and income brackets; all respondents were citizens or permanent residents of their country.

Special conditions: Each respondent must have been treated at a doctor, hospital or other medical center at least once per year over the past three years. In the final sample, 81 percent had been treated three or more times a year.

Conducted: January/February 2016

81%

67%

57%

10%

19%

26%

9%14%

17%

Convenience of the healthcare

85%

75%

65%

9%

17%

23%

6% 8%12%

Overall quality of healthcare

85%

71%

55%

8%

22%

36%

7% 7% 9%

GP satisfaction

83%

71%

60%

10%

21%

31%

7% 8% 9%

Specialist satisfaction

Dissatisfied

Neutral

Satisfied

Australia Singapore Japan Australia Singapore Japan Australia Singapore Japan Australia Singapore Japan

Satisfaction levels by country

8

SECTION 2

Three Unique Systems

9

While Singapore, Japan and Australia all have healthcare systems that provide universal health care coverage - supporting similar, world-leading average life expectancies - there are many major differences in healthcare delivery.

For example, unlike in Singapore and Japan, primary care in Australia serves as a gatekeeper to the wider health system. By contrast, Japan has no strong distinction between primary and specialist care systems.

There are also significant differences in healthcare funding. Australia and Japan have quite different public medical insurance programs, while instead, Singapore uses mandatory medical savings accounts (with workers contributing a stipulated percentage of their salaries, matched in turn by their employer).

Australia, Japan and Singapore also have their own unique demographic, economic, cultural, political, geographic and social factors that impact the healthcare system. These sometimes extreme differences make it fascinating to compare them in the survey findings that follow.

For example, Japan has five times the population of Australia and over 20 times that of Singapore. While Australia’s healthcare may not have to reach as many people, it has extraordinary distances to cover – delivering healthcare to an area as large as the contiguous United States.1

Japan also has the oldest population of any country in the world, with a quarter over the age of 65. But Singapore’s population is set to grow older more rapidly than Japan’s in the decades ahead: the proportion over 65 in the city-state will leap from 11 percent today to 28.6 percent by 2050 (by which time Japan’s over-65 population will have climbed to 36.4 percent).

COUNTRY PROFILES AUSTRALIA SINGAPORE JAPAN

Population1 24.0 million 5.5 million 126.8 million

Population growth rate (2010–15)1 1.57% 1.97% -0.12%

Population over age 65 (2014)2 15% 11% 26%

Projected population over age 65 (2050)1 22.4% 28.6% 36.4%

Total healthcare spending (2013)3 US$142 billion US$14 billion US$505 billion

Healthcare spending per capita3 US$6,110 US$2,507 US$3,966

Healthcare spending percentage of GDP2 9.4% 4.6% 10.3%

Citizen share of spending3 19% 57% 14%

GDP per capita2 US$61,925 US$56,285 US$36,194

Life expectancy3 82 years 82 years 83 years

Total geographic area (land only)4 7,633,565 km2 687 km2 364,485 km2

Sources: 1United Nations Department of Economic and Social Affairs, 2World Bank World Development Indicators, 3WHO Global Health Observatory, 4United Nations Statistics Division

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As we will see below, Singapore, Japan and Australia have many of the same challenges, but their differences give each a distinct key priority with respect to innovation and transformation in healthcare.

Key question for Singapore: how to make the most of the country’s willingness (evidenced below) to embrace consumer-directed healthcare innovations

Keeping pace with Singapore’s fast-growing and fast-aging population will require significant investment. Already, Singapore is planning to increase its number of hospital beds by 30 percent between 2015 and 2020.2 Its challenges are compounded by high population density, which contributes to proportionally higher urban healthcare risk factors (such as sedentary lifestyles).

But Singapore has low healthcare spending per capita, reflecting its world-leading level of healthcare efficiency.3 Its respondents are also the most open to change, technology, self-service and innovation in healthcare. If Singapore can find ways to use these twin strengths to drive greater transformation, it could lead the world to the healthcare model of the future.

Key question for Japan: how to influence the population to draw less on the healthcare system and manage their health more independently

In our survey, half of Japanese respondents (50 percent) visit a doctor, hospital or treatment center at least once a month, compared with 20 percent in both Australia and Singapore. Japan also has three times as many receiving weekly treatment: 6 percent compared with 2 percent in Australia and Singapore.

To support this level of healthcare usage, Japan has a staggering number of hospital beds: 7.9 per 1,000 people – over two and a half times the OECD average of 2.9. And they are being used: the average length of hospital stays (31.2 days) is close to four times the OECD average.4 Japan’s model is increasingly unsustainable – particularly given the high average age of the population. The key to reform will be to harness more technological substitutes and drive citizen behavior toward greater self-management. As we will see below, the former will be easier than the latter.

Key question for Australia: how to bring healthcare costs down without sending outcomes and satisfaction ratings the same way

At over US$6,100 per person, Australia spends considerably more on healthcare per capita compared with both Singapore (US$2,507) and Japan (US$3,966). Spending has been rising faster than GDP for decades. For instance, in the decade to 2012/13, healthcare spending grew by 4.7 percent per year5 – far higher than GDP growth, which has averaged just under 3 percent for the past decade.6 Furthermore, private health insurance premiums have seen steep year on year rises (over 5%), reflecting the rising costs of hospitalization.

The cycle of rising costs and spending is not showing any signs of stopping, driven on by increasing chronic disease rates, an aging population and high consumer expectations. Australia’s urgent challenge is to bring healthcare costs down while maintaining patient satisfaction rates.

THREE UNIQUE QUESTIONS

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Agree

Disagree

Neutral


12%

27%

60%

4%

22%

74%

17%

32%

51%

Singaporean consumers want more self-service options

Twice a year


8% 8%7%

13%14%

30%

15%

6%

8%

13%

22%24%

13% 12%

6%

2%

7%

13%

22% 23%

14% 13%

4%

2%

Once a year Three times a year Every three months Every two months Every weekOnce a month Twice a month

How frequently have you visited a doctor, hospital or treatment center over the past three years?

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SECTION 3

Consumer-Directed Care

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Developments in self-monitoring devices, smart sensors and communications are allowing consumers to take charge of their own health.

Not only can consumer-directed care relieve the burden on healthcare systems, it can also improve health outcomes by empowering individuals to take charge of their health.

The potential for savings and efficiencies is enormous – especially in the management of chronic diseases such as diabetes. Accenture estimates that the US, for example, could save almost US$2 billion annually by adopting a model where physicians treat adults with diabetes more “by exception,” relying instead on technology-enabled self-monitoring.7

The technology to implement such a model already exists. For example, GlucoWise, set for launch in late 2016 by UK medical technology firm MediWise, takes non-invasive blood glucose readings using low-power radio waves. It then links the data to a cloud-based mobile app that provides advice and alerts driven by an advanced analytics engine. It helps patients to manage their condition independently, even forecasting real-time trends in a patient’s blood glucose levels to help them adjust food or medication intake.8

CONSUMER-DIRECTED CARE IS THE FUTURE

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Technology will be the key enabler for self-directed care, so the population’s ability and confidence with new technology will be critical to success.

Encouragingly, this survey finds that 57 percent overall are confident or very confident about using new technology, with only 3 percent not at all confident. This is a significant result, because those with higher technology confidence were also:

• More confident in their ability to manage their own healthcare

• More likely to want more self-service options

• More open to health coaches

• More open to virtual assistants

• More prepared to complete procedures using devices at home that would monitor their health

• More positive about technology replacing traditional healthcare services

• More satisfied with their healthcare system across the board (i.e. overall quality, convenience, primary and specialist treatment)

• More willing to pay for self-monitoring devices.

TECHNOLOGY IS THE KEY ENABLER

Proportion reporting higher confidence with using new technology


75%

60%

36%

Technology confidence by country

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A relatively high proportion of patients (62 percent overall) want more self-directed services. Demand is greatest in Singapore (74 percent), followed by Japan (60 percent), with Australia (51 percent) further back.

Australia was also the least positive about the prospect of technology replacing traditional healthcare services. This is perhaps not surprising given that it is a primary care focused health delivery model with high levels of satisfaction – patients may perceive that they have more to lose than to gain from innovation and transformation.

Singapore’s consumers, meanwhile, want changes that can address their main concerns: the time spent in waiting rooms and the time it takes to get an appointment. Self-service options would clearly be a welcome step in the right direction – saving considerable time and effort.

Demand for self-service technology is helping Singapore to become a breeding ground for innovative health technology start-ups. The Singapore government recently invested SG$500,000 in one of these, RingMD, which uses an online platform to instantly connect patients to doctors for non-emergency issues.9

Prime Minister Lee Hsien Loong has also led calls for more international entrepreneurs and investors to use Singapore as a test-bed for urban healthcare innovations.10 By fostering innovation, Singapore could make significant market-driven, progress towards a more consumer-directed healthcare model.

But government-funded initiatives are also evident. HealthHub, launched by the Singapore Ministry of Health in October 2015, could ultimately link with, complement or evolve into an intelligent virtual assistant.11 It provides personalized health service information, access to health records, appointment tools and a localized service directory.12 As many as four out of five (80 percent) of those in Singapore would use a virtual assistant, compared with 65 percent in Australia and 59 percent in Japan.

START-UPS DRIVE NEW POSSIBILITIES

Don’t know

Negative, I don't like it

Indi�erent, it's equally good and bad

Positive, I like it41%

54%49%

34%34%

17%10%

9%

5%3%

7%

37%


How do you feel about technology replacing traditional healthcare services?

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Consumer-directed healthcare needs the right funding model. For example, Australia is shifting both aged and disability care models toward directly funding individuals rather than service providers.

From February 2017, all Home Care Packages (services that help older citizens to stay in their own homes) will be allocated directly to the elderly, who will be free to choose any approved provider.13

Similarly, the National Disability Insurance Scheme (NDIS), which rolls out progressively in 2016, allows people with a disability to select their own services and supports.14 Both systems are designed to empower citizens and encourage providers to innovate and offer higher-quality services. If successful, similar reforms will likely spread to mainstream healthcare, particularly in chronic disease management which lends itself better to personalized budgeting and payments.

NEW FUNDING MODELS ARE NEEDED

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Singaporeans are already used to making many of their own healthcare spending choices, given high levels of consumer-funded health services. Australians also appear to be ready for the shift.

Our survey shows that a high proportion of those from Singapore (78 percent) and Australia (75 percent) trust themselves to take charge of their own health.

But Japanese respondents (46 percent) are not so sure, perhaps reflecting a greater reliance on doctors and the healthcare system. Japanese respondents are similarly less comfortable deciding for themselves when they need to access medical treatment and deciding what treatment they need.

JAPAN: HOOKED ON TRADITIONAL HEALTHCARE

"I trust myself to take charge of my own health"75%78%

46%

"I feel comfortable deciding when I need to access medical treatment"91%

81%51%

"I feel comfortable deciding on the types of treatment I need"66%

41%72%


Japanese consumers show greater dependence on healthcare services to manage their health

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SECTION 4

Decentralized Delivery

19

Consumer-directed care allows for greater decentralization of healthcare infrastructure. This will liberate many aspects of healthcare from bricks-and-mortar facilities and siloed services.

But are patients prepared to remain at home, use alternative facilities and embrace remote services? This study suggests that they are.

Home health self-monitoring is the archetype for where patient-directed and decentralized healthcare models are leading. Our survey suggests that the vast majority of patients (69 percent) are prepared to complete procedures using devices at home to monitor their health (or the health of someone they care for), with the results automatically sent to treating practitioners.

More specifically, a strong proportion of patients are willing to monitor their own blood pressure (73 percent), urine (69 percent) and blood (63 percent). Many (56 percent) would also wear a comfortable health-monitoring device for most of the day and night, automatically sending data to treating practitioners and intelligent systems.

But patients are far less enthusiastic about more invasive and unfamiliar ideas: only 37 percent would be prepared to have an implanted device that automatically collects health data. Not many more (42 percent) would swallow a pill that does the same.

HOME HEALTH SELF-MONITORING

Australia and Singapore have already demonstrated the health benefits and cost savings possible through hospital-at-home and other home-based services. In Singapore, Alexandra Health System, which manages Khoo Teck Puat Hospital, won a United Nations Public Service Award for its “Aging-In-Place” program, which resulted in a 67 percent improvement in readmission rates.15

In Australia, meanwhile, a study by Western Sydney University found that home care services led to 20 percent lower mortality rates, and 25 percent lower readmission rates, compared with traditional hospital-based care. In one example, a patient receiving home-based peritoneal dialysis would save AU$36,826 per year, compared with outpatient services at a local facility.16 These findings fly in the face of the conventional wisdom that people with poor health have the least ability to manage their own condition back to good health.

HOME SWEET HOME

20

Extending quality healthcare into rural and remote areas is a major challenge in Australia.

Parts of Australia’s existing system are already decentralized by necessity, could be transformed by technology-driven innovations.

One leading example has been pioneered by Silver Chain, one of Australia’s largest community health and care services, which has developed virtual hospital services to reach far-flung areas of Western Australia. Videophones in patients’ homes link directly to a client care center in Perth staffed with qualified nurses, 24 hours a day, 7 days a week.

Findings from a series of government-funded studies of this model showed that video-assisted medication prompts could save over AU$15,000 per client per year, realized through reduced travel costs and improved workforce productivity. Telehealth nurses were also highly effective at identifying and addressing problems: of the 1,577 clinical alerts in the study, only 160 needed referral to doctors, with the balance managed by the virtual hospital.17

LONG-DISTANCE CARE

Overall, patients in our survey clearly indicate a strong willingness to remotely interact with doctors and other medical practitioners.

Over three-quarters would do so by phone (77 percent) or email (76 percent) if it saved them time.

In Singapore, online messenger chat (70 percent) and text message (73 percent) are also welcome channels, but there is less enthusiasm in Japan (51 percent and 62 percent respectively) and Australia (52 percent in both cases).

Only 37 percent of Japanese respondents would be happy to interact via videoconference from their homes – a far lower proportion than Australia (58 percent) and Singapore (53 percent). However, few patients from any country (16 percent) are willing to use videoconferencing facilities at a library or community center for health appointments. This suggests that decentralized solutions that move services into homes are likely to be more successful than shared public facilities.

ENTHUSIASM FOR REMOTE INTERACTION

21

Just as personal computers did in the early 1980s, personal diagnostics technology is getting smaller, cheaper and, increasingly, entering our homes. For example, in 2001, DNA sequencing cost US$100 million per genome. In 2007 it was down to US$10 million. Today? Just US$1,000 per genome and falling.18

Companies such as Genalyte and NOWDiagnostics are making strong progress in fingertip-prick blood-testing kits for consumers. These affordable devices, often supported by the smartphones, will help consumers to understand and manage their own health like never before.

The technology is there, patients want to use it, and it would help to take pressure off strained health services. The question is, who pays for the shift to wider home health monitoring?

Encouragingly for healthcare systems under pressure to cut costs, many patients would be prepared to fund their own independence. Particularly if governments set up systems that allow their investments to deliver the right mix of benefits.

Our research finds that half of consumers would pay for a home health monitoring kit if it means faster access to treatment (47 percent). Some 44 percent would pay for a kit that allows doctors to better manage

THE ETERNAL QUESTION: WHO PAYS?


...allows you faster access to treatment, i.e. shorter waiting times for appointments.

44%

39%57%

...allows you to accumulate 'reward points' for healthy lifestyle choices and sticking to treatments.

31%48%

30%

...entitles you to discounts on gym memberships, health coaching and healthy food.

34%42%

22%

...allows you to do more by yourself, be involved in your own healthcare plan and direct yourself through the healthcare system.

37%44%

22%

...allows doctors to better manage your health potentially leading to better treatment of your condition.

46%50%

37%

Would you be willing to pay for a home health-monitoring kit that...

health issues. These are the top two choices in all three regions. In line with other findings in this research, Japan showed the least willingness to pay for home health monitoring kits. Singapore shows the most willingness, perhaps because citizens are already less reliant on government funding.

A kit that includes these and other benefits (including reward points and discounts) is most popular, with a high proportion (43 percent) willing to pay more than SG$250/AU$200/¥15,000 for it. Almost one in five (18 percent) would pay SG$500/AU$400/¥30,000 or more.

22

SECTION 5

New Agents in the Healthcare Workforce

23

A future healthcare model that is heavily reliant on technology and patient self-service demands a shift in the healthcare workforce. With physician-patient ratios under pressure, doctors and other health professionals need to practice at the top of their licenses, with new roles created to take over existing tasks and support new features of healthcare service delivery.

New, non-clinical actors – health coaches, navigators and ambassadors – will be key, alongside an evolution of existing roles. Australia’s Productivity Commission has put forward formal suggestions for this, including:

• Paramedics treating patients in their homes rather than in emergency departments

• Pharmacists instead of GPs administering vaccines, monitoring blood pressure, testing for diabetes and providing repeat prescriptions19

• Physician assistants examining, diagnosing, referring and prescribing to patients, taking the pressure off GPs

• Nurse practitioners performing endoscopy and sedation procedures instead of doctors

• Physiotherapists diagnosing and treating some patients in emergency departments

• Shifting more patient personal care from nurses to assistants.20

Health coaches could be set to play a key role in improving consumer health through educational and motivational techniques. They have proven effective in helping patients to make healthier lifestyle choices. In a review of 109 randomized trials investigating the benefits of health coaching, 75 percent concluded that health coaching could have a positive effect on behavior (e.g. alcohol and tobacco use), motivation and confidence to self-manage their health.21

Some 46 percent of respondents in our survey would be happy to have a health coach; 28 percent would not like one. But one-quarter (26 percent) are not sure, which suggests that work needs to be done to both explain and sell the benefits of health coaching to consumers.

I would use a virtual assistant

I would like a health coach41%

65%

59%80%

56%41%


COACHING BETTER HEALTH

Singapore shows greater openness to health coaches and virtual assistants

24

SECTION 6

Shifting Behavior

25

Building the healthcare system of the future demands changes in patient behavior. Similarly, improving health outcomes – especially for chronic and lifestyle diseases – requires behavior changes from consumers. Put simply, governments have two big reasons to get better at influencing consumers.

Our research suggests that public health awareness campaigns are not going to be enough on their own. That’s because people are not entirely rational about health decisions. For example, we overvalue short-term costs and benefits, meaning that we often fail to appreciate the long-term impact of unhealthy choices, such as smoking or alcohol consumption.

As a result, some governments are now aiming to positively influence citizen behavior by accounting for – and sometimes exploiting – our deeper behavioral biases. These strategies, often called “nudges” after an influential book on the topic,22 exploit aspects of our sometimes illogical innate psychology.

For example, our survey found that two-thirds of respondents have made changes to their lifestyles to improve their health after doing their own research (66 percent). A warning from a doctor (58 percent) was the second most common factor. Advertising (35 percent) and friends and family (44 percent) were much less influential.

The top two results are linked to two behavioral biases. One: we are more likely to do things that we have decided to do ourselves.23 And two: the person delivering the message matters – those in positions of authority and those with specialist knowledge are more likely to change behaviors.24

THE MESSENGER MATTERS

...being warned about health risks by a doctor or other medical practitioner?

...a friend or family member informed you of the associated health risks or benefits?

...doing your own research into healthier living?

...reading or watching an advertisement with a healthawareness message?

35%

44%

58%

66%

Have you ever changed your lifestyle or habits to improve your health after...

26

Several other biases need to be front of mind during the design of future healthcare services. For example:

We like to feel specialThe City of New Orleans and the UK’s Behavioral Insights Team tested different text messages designed to encourage low-income adults (who had not seen a doctor in two years or more) to attend a medical appointment. The message that read “You have been selected for a FREE doctor’s appointment” won out over a message that appealed to a sense of responsibility, as well as one designed to be quick and simple.25

Collective thinkingPeer pressure is notorious for influencing negative behavior, but it can be an equally powerful force for good. DebMed’s “Group Monitoring System (GMS)” tracks hospital hand hygiene based on sensors at hand cleaning stations, and the results are communicated at a group level so that no individual is ever singled out. The system has helped staff to become more comfortable with policing each other (as it affects their collective scores). At a hospital in New York, DebMed GMS led to a 40 percent increase in hand hygiene compliance in just four months.26

We don’t like making changesThis makes default options critically important. Organ donation is a case in point: research shows that the proportion willing to donate organs is often far greater than the proportion on donor lists. This is because the default is often to opt out, and people never change it. But 25 countries now make donation the default option (including Singapore, but not Australia or Japan), which increases organ transplant availability.27

Safety in numbersPeople are strongly influenced by “herd mentality” – more formally known as social proof. For example, a study on towel reuse among hotel guests found that messages in bathrooms that appeal to environmental impact proved less effective than those that simply said: “95 percent of guests in this hotel reuse their towels.”28 This strategy could drive significant lifestyle changes in society by highlighting how citizens or employees compare to one another based on exercise, calorie intake and other factors.

Behavioral science approaches are most effective when campaigns are clearly defined, measured and tested. In this sense, they rely on good data. Health data is expanding exponentially (including via new connected sensors and remote monitors), is becoming more integrated across healthcare systems, insurers and consumers, and is increasingly powerful thanks to advances in intelligent analytics. These trends will help to make behavioral science more important and more effective in the future, providing governments with even greater scope to give society a healthy nudge.

SAFER IN THE HERD

27

At the outset, we posed a key question for each of the countries in this report. We asked how Singapore could make the most of its willingness to embrace consumer-directed healthcare. This opportunity should not be underestimated as it may be harder to drive change from within Singapore’s largely market-driven healthcare institutions. Considerable private sector profits are generated in open markets for patient care, and this could disincentivise prevention and use-reduction initiatives. Building models that give consumers the options, incentives and power to shift to innovative healthcare will be key in Singapore.

We also asked how Japan could influence society to draw less on the system and manage its health more independently. The need to do this is increasingly urgent. While Japan has the highest annual physician visits per capita in the OECD,29, 30 it also has the lowest number of practicing physicians per capita - just 2.4, well short of the OECD average of 3.2.31 However, as we have seen above, Japanese citizens are not yet willing to adopt consumer-directed healthcare. The government needs to find new ways to shift expectations around service availability and provide incentives to use alternative options, especially technology-enabled solutions.

Out of necessity, Japan is likely to lead the world in technology to support elderly populations. The stereotype of younger people being more confident with technology holds true in this study. What is encouraging is that the differences between the age groups are not large – and only significant between the oldest and youngest cohorts.

Finally, we asked how Australia could cut healthcare costs without reducing outcome and satisfaction ratings. The government might start by reducing waste, having already identified significant wasteful spending, including interventions (tests, scans, procedures, medicines, etc) that are “irrelevant, duplicative or excessive.”32

Australia’s impressive satisfaction rates increase the cost-cutting challenge. Future expectations are high and there is little incentive for citizens to change. Unlike Singapore, there is weaker interest in self-directed services, and Australia is also the least positive about technology replacing traditional healthcare services. But citizens need to be ready for change, because Australia’s ability to pay is falling.

Additional resistance to change could come from the medical profession. Australia’s health policy is strongly influenced by outspoken views from medical and practitioner industry groups which have repeatedly quashed government-sponsored changes to the health system.

Like Singapore and Japan, Australia will need to shift to this new model by starting small and smart. Populations that cost the most, will benefit most or are the most willing to change should be priorities. In the coming years, efforts toward this new paradigm will reach a tipping point, precipitating major change. At that point, each of the countries in this study will no doubt have met many of today’s challenges, and be ever closer to leaving a truly sustainable, effective and efficient healthcare system for future generations.

Lower confidence Neutral/unsure Higher confidence

29 or younger

30 - 69 years

70 or older

18%

21%

22%

20%

21%

33%

62%

58%

45%

Conclusion

Technology confidence by age

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REFERENCES1. The US states excluding Alaska and Hawaii. This covers 7,663,941 km2 (land only) – almost identical to Australia

2. “Healthcare 2020: A vision for Singapore’s future,” Healthcare Innovation, 9 Sep 2015

3. Singapore was ranked the world’s most efficient healthcare system by Bloomberg in 2014. These rankings were based on a weighted efficiency score comprising life expectancy, relative per-capita cost of healthcare and absolute per capita cost of healthcare. Singapore scored top with 78.6, Japan was fourth (68.1), and Australia was sixth (65.9) – impressive results compared with the UK (63.1) in 10th, Germany (51.6) 23rd and the US in (34.3) 44th. See “Singapore Beats Hong Kong in Health Efficiency: Southeast Asia,” Bloomberg Business, 18 Sep 2014

4. “OECD Economic Surveys: Japan,” April 2015

5. “Improving Australia’s health system: what we can do now,” Australian Government Productivity Commission, May 2015

6. Australian Trade Commission, Benchmark Report 2016

7. “Virtual Health: The Untapped Opportunity to Get the Most out of Healthcare,” Accenture, 2015

8. www.gluco-wise.com

9. “Ten innovative healthcare startups ramping up in Singapore,” PulseIT, 16 June 2015

10. “Singapore offers to be test bed for urban solutions,” The Straits Times, 21 Apr 2015

11. Virtual assistants draw on advances in machine learning and other intelligent technologies to help consumers navigate the healthcare system without drawing on its resources

12. “One-stop health information and services portal provides access to key medical records and health content,” Ministry of Health Singapore, 18 October 2015

13. “More choice and better care for older Australians,” Department of Social Services, 12 May 2015

14. “Integrated Market, Sector and Workforce Strategy,” NDIS, June 2015

15. “Alexandra Health System’s Aging-In-Place program,” Alexandra Health System media release, 26 June 2014

16. “Taking Healthcare Home,” University of Western Sydney, 23 Feb 2016

17. “Transforming aged care in Australia,” Accenture, 2015

18. “The start-ups turning healthcare on its head,” Financial Times, November 5, 2015

19. This is likely to be well received in Australia, where significantly more respondents in our survey want to see improvements in the convenience of prescription renewal (31 percent) compared with those from Japan (10 percent) and Singapore (13 percent)


21. “Does health coaching work?” The Evidence Centre, April 2014

22. “Nudge: Improving Decisions about Health, Wealth, and Happiness,” Richard Thaler, 2008

23. “Does Changing Behavioral Intentions Engender Behavior Change? A Meta-Analysis of the Experimental Evidence,” Psychological Bulletin, 2006, Vol. 132, No. 2, 249–268

24. “Obedience to Authority: An Experimental View,” Stanley Milgram, 1974

25. “How can text messages encourage people to see a doctor?” Behavioral Insights Team, 22 Feb 2016

26. “Champlain Valley Physicians Hospital Increases Hand Hygiene Compliance by 40 percent in Four Months With DebMed® GMS™,” PRNewswire, 17 November 2015

27. “An international comparison of deceased and living organ donation/transplant rates in opt-in and opt-out systems: a panel study,” Lee Shepherd, Ronan E O’Carroll and Eamonn Ferguson, BMC Medicine, 2014 12:131

28. “A Room with a Viewpoint: Using Social Norms to Motivate Environmental Conservation in Hotels,” N. Goldstein, R. Cialdini, V. Griskevicius, Journal Of Consumer Research, 2008 Vol. 35

29. At 12.9 this is far higher than second ranked Germany (9.9), nearly double the OECD average (6.5) and four times the rate of Sweden (2.9)

30. OECD Health Data 2015

31. OECD Health Data 2015


CONTACTPenny O’HaraManaging Director - Head of Healthcare, Accenture APAC

[email protected]

SURVEY METHODOLOGYAccenture commissioned a three-country survey of 2,250 consumers (aged 18+) to understand their attitudes toward their health system and healthcare technologies. The survey was completed online and included respondents from Australia (750), Japan (750) and Singapore (750). It was fielded by Longitude Research, on behalf of Accenture, between January and February 2016, with the sample evenly distributed across age groups, gender and income brackets. Each respondent self-reported having been treated by a health provider at least once per year over the past three years.

ABOUT ACCENTUREAccenture is a leading global professional services company, providing a broad range of services and solutions in strategy, consulting, digital, technology and operations. Combining unmatched experience and specialized skills across more than 40 industries and all business functions — underpinned by the world’s largest delivery network — Accenture works at the intersection of business and technology to help clients improve their performance and create sustainable value for their stakeholders. With approximately 375,000 people serving clients in more than 120 countries, Accenture drives innovation to improve the way the world works and lives. Visit us at www.accenture.com.

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