slides [ppt, 3.6 mb]
TRANSCRIPT
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Changing Views
External Influences for Healthcare
Dr R Hangartner
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The Long View
• What trends are we observing that impact on Healthcare insurance provision?
• What trends in social behaviour might we expect to experience?
• What medical developments could impact on health care needs?
• What are the implications for insurance healthcare products?
• Are there anti-selection aspects that providers need to address?
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Trends
• Social• Technological• Political• Economic• Legal• Environmental.
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Global
Regional
UK
Technology
Knowledge
Economic
Travel
Climate Change
Political
Training
Supply of LabourHuman Rights
Data Protection
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NHS
• labour shortages • waiting lists and waiting time• self-pay - increasing proportion of independent
hospitals income• concordat between NHS and independent sector
hospitals• staff attitudes - many doctors have PMI cover,
more NHS nurses are buying PMI cover.
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NHS Reorganisation
• Primary/Secondary care boundaries
• more care at home less care in hospitals.
• Joint planning • health and social care
systems converge?
• More funding (local taxation?)
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Finance
– Financial Markets - instability and recession - market size, relevance of products
– Monetary Union - will care systems converge? – Demography - balance between economically
active and dependants• Pensions
• Elder care
• Healthcare
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– Global (Virtual) Medical School -global standards?
– Climate change
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Insurers
• taxation - tax relief over 65s• IPT• Attitude to PMI, PHI etc.
• just another cover?
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UK 2001
BMA News Review
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UK 2001
• Concordat between NHS and Independent Healthcare Providers
• New regulator - NCSC
• PFI
• Typhoid
• Drug resistance bacteria including TB
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The Long View
What trends in social behaviour might we expect to experience?
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Social Behaviour
• Individual and Employer - funding
• Voluntary Organisations/Private Providers– Provision of services
• Multiple Careers
• Taxation on Consumption
• Consumer expectations…..
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Consumer
• Comprehensive - meets needs (?)
• Fair
• Responsive
• Effective
• Efficient
• Privacy.
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Is this the same overseas?
• Culture - concepts of social and health care, urban and rural societies
• Population Structure• Technology• Fraud - healthcare fraud is the fastest growing area
for insurance fraud in the US• Healthcare infrastructure• GDP per capita and Healthcare spend and payment
systems - WHO Reports
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The Long View
What medical developments could impact on health care needs?
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Medical Developments
– Genetics - diagnosis, therapeutics– Imaging - remote imaging– Surgery - remote operations– Pharmaceuticals - new drugs and new concepts
of treatment– Devices - monitoring and treatment in home
environment
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Genetics
• Genetics– Rarely one gene cause one disease– Phenotype (expression) - the gene, modifier
genes and the environment
• New pharmaceuticals– Designed -->expression of genes– Immune system regulators– Anti receptors - life style vaccines?
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Devices
• Technology -devices– Monitoring and treatment at home - Japan– Imaging - earlier diagnosis, remote imaging,
operator skills– Robotic surgery - shore to ship, intercontinental
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-1 0 1 2 3 4
Survival
Year Dx
Survival
Survival
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-1 0 1 2 3 4
Survival
Shift
Year
Earlier Diagnosis
Earlier Diagnosis
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-1 0 1 2 3 4
Survival
Shift
Rx
Year
Improved Treatment
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Predictive Testing
– Hereditary non Polyposis Colonic cancer– Familial Adenosis Polyposis– Prostate Cancer– Breast Cancer
• Have to modify behaviour.
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The Long View
What are the implications for insurance healthcare products?
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Implications for insurance healthcare products
– Expectation of Consumer
– Affordability– Necessity– Education
– Relevance – Customer service– Efficiency– Expectation of
suppliers
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The Long View
Are there anti-selection aspects that providers need to address?
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Anti-selection aspects
• Insurance Industry - risk pool
• Individual Insurers - Data protection
• GP records • Location of
treatment
• Early diagnosis - screening -
• When is a diagnosis a diagnosis not a test result?
– Pre-disease
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Genetic predispositionPredisposing State
Asymtomatic disease
Manifest Disease
Detect
Prevent
Treat
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Genetic predispositionPredisposing State
Asymtomatic disease
Manifest Disease
Detect
Prevent
Treat
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Global
Regional
UK
Technology
Knowledge
Economic
Travel
Climate Change
Political
Training
Supply of LabourHuman Rights
Data Protection
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Dr R Hangartner Brett Cook Consulting
Information Age
• Tom Ferguson “Industrial Age Medicine is dead….” www.fergusonreport.com
• Informed and proactive consumer
• Global aspiration and expectation…..
• Uniformity of provision (essential need) and systems of training and care delivery.