Transcript A Health Care Perspective

Jamaica Diaspora Conference
Creating National Wealth:
A Health Care Perspective
Presented by Gary Rhule, MD, MPH, MBA
Presented on June 11, 2016
SANKOFA
• Akan (Ghana) word and symbol meaning, “it is not taboo to fetch what is at
risk of being left behind”
• Mythical bird with its feet firmly planted forward with its head turned
backwards
WHAT IS DRIVING GLOBAL HEALTH CARE
TRENDS?
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Massive shifts in healthcare; fragmentation
Global innovation: move from chronic disease medications to specific, personalized
biologics and care
An aging health care workforce and aging population
Before 2020, about 2 million engineering and life science jobs will become open, mostly due
to retirement (STEM programs are not keeping up with the projected demand)
Regulation and Taxation: many argue this drives down innovation, and, claim it keeps
companies from having investments in the US
GLOBAL HEALTH CARE MARKET
• US$9.59 trillion global healthcare market for consumers, providers, payers,
and investors in both developed and developing nations
• Providers strive to improve the cost, quality, and availability of affordable
healthcare
• Reimbursement rates based on patient outcomes
• Virtualization of care with telecom and technology (telemedicine)
• Customer expectations are higher, personalization of care
Jobs
Productivity
Innovation
National Wealth
JOBS
• The health care sector usually is a major employer; the sector employs
scientists, physicians, nurses, dentists, other health care providers and
clerical and administrative staff
• Indirectly, the sector also supports thousands of additional jobs through its
supply chain: medical supplies, clinical equipment, and professional services
PRODUCTIVITY
• Second, the health care sector contributes to a productive and engaged
workforce
• Productivity, how efficiently goods and services are produced, is the single
most important determinant of a country’s per capita income over the
longer term
INNOVATION
• Third, the sector drives science and technology research; puts the result to
work
• Advancements in life sciences adds economic benefits that exceeds health
research and health-care costs over the same period by orders of magnitude
• For example, at the turn of the 20th century, life expectancy was 50 years;
now the estimated average life expectancy in in many countries exceeds 80
years
HEALTH CARE ECONOMIC DEVELOPMENT
Direct
services
Export of health
related products
and businesses
Industrial
Diversification of
health care
business
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Integrated care
Hospitals
Clinics
Surgery
Centers
Dental
PT/OT/Rehab
Long-term
care
Mental Health
Research and
Development
Access, quality, cost control
Logistics
Transport
Packaging
Pharma
Biotech
Devices
Infrastructure
Logistics hub
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• Medical
Tourism
• Centers of
excellence
• Rehabilitation
• Vacation
HEALTH CARE SERVICES VS HEALTH CARE
INNOVATION
• Services are provided to the community
• Innovation refers to the goods and services used in the industry: machinery,
medicines, bandages, gloves, imaging, data management, research, etc.
• Biotechnology, pharmaceuticals, biosimilars
HEALTH CARE EXPORTS
• Provide a flow of income or revenue from external sources
• Goods and services
• Health related research
MEDICAL TOURISM
MEDICAL TOURISM
• Travel of people to another country for the purpose of obtaining medical
treatment
• The recent trend is for people to travel from developed countries to
developing countries for medical treatments because of cost consideration
• Some treatments may not be legal in the home country, e.g. some fertility
procedures
MEDICAL TOURISM
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Market size estimate US$ 45.5 to 72 billion based on approximately twelve million
cross-border patients worldwide
Average spend US$3,800 to 6,000 per visit
Includes medically-related costs, cross-border and local transport, inpatient stay
and accommodations
Estimate some 1.4M Americans will travel outside the US for medical care in 2016
(WHO report estimated 15M, Medical Tourism, Kelley, E., Oct 2013)
Cost savings estimate vary from 20% to 60%
MEDICAL TOURISM SERVICES
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Cosmetic surgery
Dentistry (general, restorative, cosmetic)
Cardiovascular (angioplasty, CABG, transplants)
Orthopedics (joint and spine; sports medicine)
Cancer (often high-acuity or last resort)
Reproductive (fertility, IVF, women's health)
Weight loss (LAP-BAND, gastric bypass)
Scans, tests, health screenings and second opinions.
DESTINATIONS
Mexico
Cuba
Argentina
Bolivia
Costa
Rica
India
Colombia
Brazil
Singapore
Ecuador
FACTORS INFLUENCING INCREASE
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High cost of health care
Long wait times for certain procedures
The ease and affordability of international travel
Improvements in both technology and standards of care in many countries
The avoidance of waiting times is the leading factor for medical tourism from the UK,
whereas in the US, the main reason is cheaper prices abroad
Choice: insurance may not cover orthopedic surgery (such as knee or hip replacement) or
limits the choice of the facility, surgeon, or prosthetics to be used
Convenience and speed
MEDICAL TOURISM: WHY TRAVEL?
• United States, a liver transplant may cost US$300K USD; in Taiwan US$91K
• Public health-care systems often have long wait times for certain
operations: for example, an estimated 782,936 Canadian patients spent an
average waiting time of 9.4 weeks on medical waiting lists in 2005
• Canada has also set waiting time benchmarks for non urgent medical
procedures, including a 26-week waiting period for a hip replacement and a
16-week wait for cataract surgery
LOGISTICS HUB
LOGISTICS HUB
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Global demand for sophisticated, affordable health care options: booming biomedical
industry
Pharmaceutical and medical technology companies handle delicate medical materials
Growing base of complex biomedical manufacturing, research and clinical trial activities in
Asia
Life-sciences logistics hubs: GDP-certified temperature, humidity-controlled
Warehousing, distribution, inventory management and control
Express lane for urgent bio-medical products
WHY IS THERE AN OPPORTUNITY?
• Manufacturers of drug, devices, and diagnostics are under unprecedented
margin pressures
• Biosimiliars are following the path of generic drugs and establishing a
foothold in the market
• Regulatory agencies across the globe are decreasing approvals of new
products while increasing storage and handling requirements for certain
product classes
TRACKING AND VISIBILITY
• Supply chain visibility is crucial in the biotech industry
• Advanced tracking technologies to ensure that the customer receive
frequent updates regarding products
HEALTHCARE LOGISTICS: SERVICES
• Supply chain management improves infrastructures and efficiencies
• Connects business to business
• Connects patients to services
• Many processes that have to be designed, implemented, and meticulously
executed to ensure no patient’s care is impacted by non-conforming
activities
HEALTHCARE LOGISTICS: SERVICES
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A shifting landscape shaped by innovation, efficiency and cost savings
Ordering devices and medications
Tracking changes to surgery schedules and treatment regimens
Ensuring that critical supplies and devices are delivered at the prescribed time and
readily available for surgeries
having all the technology systems in synchronization to ensure real-time visibility
to outbound orders, available inventory, reverse logistics moves, and procedure
schedules
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DELIVERING RESULTS
• Access, Quality, Cost Control
• In the healthcare industry, the outcomes of patient care can be influenced
by logistics decisions
• Product life cycles are shortening with the advent of diagnostics and
biological based treatment regimens
• Products are moving more quickly to market, and in smaller batches with
shorter expiration dating and more stringent handling requirements
VALUE TO THE CONSUMER
• Trends toward consumer health treatments
• Manufacturers must have visibility to demand and data to drive products
and services through multiple channels simultaneously
• The supply chain must become more responsive
• Entities not adapting to this trend must be evaluated for their long-term
value
INFRASTRUCTURE DEVELOPMENT
CASE STUDY: SINGAPORE BIOPOLIS
Country Stats **Data taken from Index Mundi
JAMAICA
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Population: 2.72 million (2014)
Area: 4,244 square miles (10,991 km²)
GDP: $14.36 billion USD (2013)
GNI per capita 2012, US$5140
GNI per capita 1962, US$316
Urbanization: 52% of total population (2010)
SINGAPORE
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Population: 5.47 million (2014)
Area: 269.11 square miles (697 km²)
GDP: $307.87 billion USD (2014)
GNI per capita 2013, US$54,040
GNI per capita 1962, US$490
Urbanization: 100% of population
SINGAPORE BMS: BIOPOLIS
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The Singapore Biomedical Sciences (BMS), June 2000, one of the key pillars of the
economy, with Electronics, Engineering and Chemicals
International research and development center for the biomedical sciences
Private and public scientific partnerships
The development is situated adjacent to the National University of Singapore, the Institute
of Technical Education, Singapore Polytechnic, National University Hospital, Singapore
Science Park, Ministry of Education and Fusionopolis (an R&D center dedicated to
electronics and technology)
Phase 1 opened in 2003, 7 buildings
SINGAPORE BIOPOLIS
• Phase 2 in 2006; 2 additional buildings
• Biomedical sciences (BMS) accounts for six percent of Singapore's GDP and
BMS manufacturing output is more than S$23B
• 2000 personnel
• Phase 3 2011; extends basic research, translational work from bench to
bedside
• Phase 4 and 5; improvements to lab design for clinical trial supports
CREATING A WORLD-CLASS HEALTHCARE
HUB
• Healthcare infrastructure: multiple layers of care
• High standard of medical practice (measured by standardization and
accreditation)
• Complete spectrum of services
• Operational efficiencies: networked, electronic medical records, procedure
scheduling
INTELLECTUAL CAPITAL
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Knowledge and innovation-intensive economy
Enhancing and strengthening Singapore’s knowledge-creation and innovative
capability by directing and undertaking research and development in SET through
the research institutes
Research, innovation and test-bedding
Private-sector research labs co-located with public-sector research institutes,
tertiary hospitals and universities
Shared facilities reduce ramp-up time and promote collaboration between
researchers in both private and public sectors
HUMAN CAPITAL
• Developing human capital by promoting manpower training and
development in the areas of science, engineering and technology (SET)
• Promotion of SET to increase public awareness and understanding of the
importance of science and technology in Singapore
• Professional healthcare education
• Nursing, physicians, dentists, allied health professionals, etc.
• Clinical governance, healthcare management
INDUSTRIAL CAPITAL
• Commercial application of scientific knowledge, technology through
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industry engagement and collaboration
R&D investment promotion: active commercialization of intellectual
property
Integrated research infrastructure; venture capital support; strengthening
manpower capabilities
Cross-sectoral work: IT systems, medical equipment, pharmaceuticals,
nutrition and consumer lifestyle co-develop and test new products,
solutions and business models
Companies leverage the strong foundation in basic biomedical sciences
research and translational clinical research as well as track record in
scientific and clinical excellence for that purpose
GLOBAL WELLNESS AND FITNESS
GLOBAL WELLNESS AND FITNESS
• Market $1.49 trillion
• Growing wellness and fitness offers more flexibility for new entrants
GLOBAL WELLNESS AND FITNESS
Wearable devices $3.1B
• Medical Tourism $ 48B
• Alternative Medicine $112B
Mobile health apps $8.02B
• Weight loss industry $595B
• Sporting goods and apparel $236B
Global Nutrition Market $391B
• Global fitness $78.4B
• Telemedicine $19.4B
Sankofa: There must be movement and new
learning as time passes; as this forward march
proceeds, the knowledge of the past must never be
forgotten
THANK YOU
QUESTIONS?
Gary Rhule MD, MPH, MBA
June 11, 2016
www.garyrhule.com
[email protected]