frost & sullivan: innovation & opportunities-chronic diseases & community care-trends in...
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Innovations & opportunities:
Chronic diseases & community care: Trends in Asia & Singapore
21st Singapore Pharmacy Congress: Industry Workshop
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Chronic diseases & community care: Trends in Asia & Singapore
July 2011
Dr. Milind Sabnis
Agenda
• Introduction
• Key Global and Asian trends
• Singapore in context
• Chronic diseases in Singapore
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• Chronic diseases in Singapore
• Future outlook of healthcare
• Question & answer session
ECONOMIC GROWTH
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ECONOMIC GROWTH
Growing middle class is changing the mix in demand for healthcare services
• Creation of “healthcare elite”: those that can, will spend money out of pocket for elective procedures, executive and personalized levels of care.
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AGING POPULATION
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AGING POPULATION
Aging population will account for around 20% of the world population in 2050
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2.0%
4.0%
6.0%
8.0%
10.0%
12.0%
50.0
100.0
150.0
200.0
250.0
300.0
350.0
400.0
Pe
rce
nta
ge
of
Ag
ed
65
an
d A
bo
ve
to
Tota
l Po
pu
lati
on
(%
)
Po
pu
lati
on
(M
illi
on
)By 2020, two-third of the Asia-pacific population over 65 years will have at least one chronic disease
Healthcare Industry: Population Aged 65 and Above, (Asia Pacific), 2009-2020
The Burden of Disease in elderly, Asia Pacific
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0.0%
2.0%
-
50.0
2010 2015 2020
Pe
rce
nta
ge
of
Ag
ed
65
an
d A
bo
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to
Tota
l Po
pu
lati
on
(%
)
Year
Aged 65 and Above (Million)
Percentage of Aged 65 and Above to Total Population (%)
� In 2010, 7.6% (241.7 million) of the Asia Pacific population was aged 65 and above.
� By 2020, this will be more than 9.7% (333.95)
� 65.2% of those aged 65+ have one chronic condition
Source: WHO, Frost & Sullivan
SINGAPORE
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SINGAPORE
Singapore’s rich and middle class is expected to growY
ea
rs
Distribution of population by income groups: 2006-2014(f)
558
560
550
553
563
567
293
314
336
2012e
2013e
2014e
No. of households ('000)
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Ye
ars
Sources: Frost & Sullivan Analysis., EIU, Singapore Department of Statisticse- estimate
587
566
558
501
533
553
254
273
293
0% 20% 40% 60% 80% 100%
2010
2011e
2012e
Annual earnings between US$10,000 and US$ 50,000
Annual earnings between US$50,000 and US$ 1 m
Net wealth over US$1m
0.81.0
1.0
0.8 1.1 1.4
60%
70%
80%
90%
100%
0.81.0
1.0
0.8 1.1 1.4
60%
70%
80%
90%
100%
Singapore has the fastest aging population in south-east Asia
Singapore Population (in Mn) by Age Groups, 2006, 2010, 2014e
• Singapore had the fastest ageing population (above 65 years) in South east Asia in 2010• By 2030, one in five residents will be 65 and above, as compared to one in 12 (2009)• By 2050, Singapore is projected to world’s 4th oldest population
In anticipation of 800,000 elderly
Singaporeans by 2030, government
policies encourage family and home-
based care and provide access to
community based services instead of
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0.7 0.8 0.7
0.6 0.70.7
0.80.8
0.8
0.80.9 1.1
0%
10%
20%
30%
40%
50%
60%
2006(a) 2010(a) 2014 (f)
0-14 yrs 15-24 yrs 25-34 yrs 35-44 yrs 45-54 yrs 55+ yrs
0.7 0.8 0.7
0.6 0.70.7
0.80.8
0.8
0.80.9 1.1
0%
10%
20%
30%
40%
50%
60%
2006(a) 2010(a) 2014 (f)
0-14 yrs 15-24 yrs 25-34 yrs 35-44 yrs 45-54 yrs 55+ yrs
2006 2010 2014e
4.4m 5.1m 5.7m
Sources: Frost & Sullivan Analysis., WHO, Singapore Department of Statistics e- estimate
Total Population
community based services instead of
institutionalized care
The aging population and associated diseases, together with smaller families could potentially lead to a similar situation that Japan is facing, with a need then to have healthcare services that enable the elderly population to live independently and receive care in and out of the hospital setting.
Chronic diseases account for two-third of total deaths in Singapore
Rank % of Total Deaths 2007 2008 2009
1 Cancer 27.7 29.3 29.3
2 Ischaemic Heart Disease 19.8 20.1 19.2
3 Pneumonia 13.9 13.9 15.3
4 Cerebrovascular Disease (including stroke) 8.7 8.3 8
5 Accidents, Poisoning & Violence 6 5.8 5.7
6 Other Heart Diseases 4.3 4 4.4
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Chronic diseases are likely to continue becoming the predominant disease burden in
SingaporeSource: MOH
6 Other Heart Diseases 4.3 4 4.4
7 Urinary Tract Infections 2.2 2.1 2.5
8 Chronic Obstructive Lung Disease 2.6 2.5 2.4
9 Nephritis, Nephrotic Syndrome & Nephrosis 2 2.1 2.3
10 Diabetes Mellitus 3.6 2.7 1.7
All Others 9.2 9.2 9.2
Total 100 100 100
Total number of Deaths 17140 17222 17101
9004 9037 9359 9863 10316 10673 11042 11424 11819 12228 12651 13089
8000
10000
12000
14000
Number of Cancer Notifications by Year, 2004-2015
Cancer incidence is expected to continue to grow
5,124
5,249
5,375
5,501
5,633
5,200
5,300
5,400
5,500
5,600
5,700
New cases of cancer in a year (’000) in the Asia-pacific
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0
2000
4000
6000
8000
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
At its present growth rate, the Ministry of Health estimates there will be 13,000 new cancer
cases a year by 2015
In 2010, around 72,500 individuals were seeking treatment for cancer
Source: Health Promotion Board
4,800
4,900
5,000
5,100
2010 2011 2012 2013 2014
HEALTHCARE PARADIGM SHIFT
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HEALTHCARE PARADIGM SHIFT
From...
Provider Centric Focus Patient Centric
Centralized – Hospital Monitor De-Centralized – Shift to Community
...To
A modern healthcare system is on the horizon, demanding a paradigm shift
Healthcare Paradigm Shift
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Invasive in general hospitals Treatment Less invasive in specialized hospitals
Treating Sickness Objective Preventing Sickness – “Wellness”
Source: Frost & Sullivan
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Consumer-centric care delivery model
Home as the Hub:
� The home and other local settings will grow significantly as a locale of
choice for care delivery
� Delivery system will expand to include community and family resources
Integration:
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O
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Integration:
� Medical services are integrated with
wellness activities to provide overall
care delivery
Customization:
� At multiple levels (health plans, interaction with caregivers,
individual care pathways, communications, etc.)
� Driven by patients
Hospital based careHospital based care Community based careCommunity based care
Innovation in hospital business models: Hospitals go virtual; development of community based care
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Centralized model
Patient overload
Increased costs
Strain on health care resources
Decentralized model
Reduced patient load
Reduced cost
Optimum utilization of health care resources
Virtual Hospitals: Shifting the Financial Gravity of the System
Healthy, Independent Living
Chronic Disease Management
Community Clinic
Doctor’s Office
100%
Assisted Living
HOME CARE
RESIDENTIAL
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Healthy, Independent Living
Chronic Disease Management
Community Clinic
Doctor’s Office
Assisted Living
Specialty Clinic
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Cost of care per day
$1 $10 $100 $1,000 $10,000
0%
Skilled Nursing Facility
Specialty Clinic
Community Hospital
ICU
RESIDENTIAL CARE
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ali
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f li
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Skilled Nursing Facility
Specialty Clinic
Community Hospital
ICU
ACUTE CARE
Connected Health Driving New Access Solutions
Remote Patient Monitoring
•Overall (Global) annual compound growth rate of 56% from year 2008 to 2009
• About 75 market players
•Fragmented and divers
Hospital-based Systems
• Vertically integrated and diverse market led by healthcare planning systems
• Patients are connected through Total Hospital Information System
Consumer Health
• Market in the growth stage
• Globally, consumer health sees 4% growth in 2009 to reach US $169 million expected rapid growth in the next three years
Telehealth
•Total global market to reach $ 9 billion by 2012, with projected 9.9% compound growth rate
•Emerging market with potentially more efficient delivery of care
Connected Health
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•Fragmented and divers market nature makes it difficult to place a market value
•E.g.. TeleStation by PHILIPS
Information System
• Monitoring and diagnosis system are connected
• Apple (though iPhone,iPAD)and Blackberry are moving in this direction to provide consumer wellness care through their healthcare Applications.
delivery of care
Source: Frost & Sullivan
Consumer health – health services come home…F
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The future of healthcare cross industry fertilizationF
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General HospitalGeneral Hospital Focused Focused Specialized HospitalSpecialized Hospital
Innovation in Hospital Business Models: Trends towards specialized care delivery around specific therapeutic areas
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Value Proposition:
Don’t know what’s wrong?
– We can address any problem you bring
Value Proposition:
Need care for a specific condition?
– Specialists, experience, world-class facilities
Traditional operations
Long post operative length of stay
Specialized hospitals offering minimal invasive
surgeries/ day surgeries
Reduces or eliminates length of stay
The 3 Cornerstones - The Body, Mind and Soul - Contribute ToHumans Definition of Health, Wellness and Well Being
Mind
Mood
Stress levels
Mental health
Sense of optimism
Attitude
Security
Safety
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Body SoulPersonal values
Personal fulfilment
Self image / self actualization
Sight / vision
Touch & feel
Smell / breathing
Sound
Temperature
Wellness
Health and Wellness: Shift in Healthcare Trends From Treatment to Prevention
Healthcare Spending Per Capita (2007, 2050)
In most countries worldwide, per capita In most countries worldwide, per capita
healthcare spending is rising faster than per healthcare spending is rising faster than per
capita income which is unsustainable capita income which is unsustainable
If current trends hold If current trends hold -- by 2050, healthcare by 2050, healthcare
spending will double, claiming 20spending will double, claiming 20--30% of 30% of
GDP for some economies GDP for some economies
Prevention trends result in greater demand for areas such as weight management and functional foods and beverages
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Due to rising costs of healthcare, future Due to rising costs of healthcare, future
spending will move away from spending will move away from
treatment treatment
Healthcare Spending by Type of Activity
Why Wellness?
50% Percent of all diseases can be avoided and prevented by lifestyle changes
Only 31% of healthcare expenditure in organization is spent on direct medical costs
Medical Costs
Direct = 31%
Medical Costs
Workers
Indirect = 69%
Lost Productivity:- Absenteeism - Presenteeism
Employee & Customer Dissatisfaction:
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69% of medical costs are due to productivity loss
50% of all medical costs can be saved with integrated and comprehensive health management.
Workers Compensation
Salary Continuation
Dissatisfaction:- Turnover + Temporary Staffing- Poor Quality
Replacement Workers:- Training Interim Employee- Administrative re-work
Source: An Unhealthy America: The Economic Burden of Chronic Disease, The Milken Institute Center for Health Economics
75% caused by Chronic Diseases that are preventable
Prevention/Wellness
Disease/Care Management
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Goal:
Keep People Healthy Longer
Goal:
Keep People Healthy Longer Goal:
Manage
Goal:
Manage
� Early identification and prevention
� Access to new forms of care delivery to improve patient knowledge, self-help and health
� Connection to benefits design to increase coverage for those services which prevent disease and improve health over long term
� Reducing administrative and clinical waste
Shifting the Health Focus of the SystemF
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Management
Healthy/“Worried Well”
“At Risk” Undiagnosed Chronically IllManaged
Chronically IllUnmanaged
Endof Life
Continuum of Care
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f Im
pacte
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opula
tion
Manage or Mitigate Risk
Manage or Mitigate Risk Goal:
Diagnose and Reduce Treatment Delay
Goal:
Diagnose and Reduce Treatment Delay
Goal:
Manage
Goal:
Manage
Goal:
Move to Self-Managed
Goal:
Move to Self-Managed Goal:
Informed Decisions
Goal:
Informed Decisions
For Additional Information
Donna Jeremiah
Director
Corporate Communications
Asia Pacific
+603 6204 5832
Carrie Low
Executive
Corporate Communications
Asia Pacific
+603 6204 5910
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Jessie Loh
Manager
Corporate Communications
Asia Pacific
+65 6890 0942