Transcript Changing Views

Changing Views
External Influences for Healthcare
Dr R Hangartner
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?
Trends
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Social
Technological
Political
Economic
Legal
Environmental.
Global
Regional
UK
Technology
Knowledge
Travel
Data Protection
Political
Supply of
Labour
Human Rights
Economic
Training
Climate Change
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.
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?)
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
– Global (Virtual) Medical School -global
standards?
– Climate change
Insurers
• taxation - tax relief over 65s
• IPT
• Attitude to PMI, PHI etc.
• just another cover?
UK 2001
BMA News Review
UK 2001
• Typhoid
• Drug resistance
bacteria including TB
• Concordat between
NHS and Independent
Healthcare Providers
• New regulator - NCSC
• PFI
The Long View
What trends in social behaviour might we
expect to experience?
Social Behaviour
• Individual and Employer - funding
• Voluntary Organisations/Private Providers
– Provision of services
• Multiple Careers
• Taxation on Consumption
• Consumer expectations…..
Consumer
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Comprehensive - meets needs (?)
Fair
Responsive
Effective
Efficient
Privacy.
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
The Long View
What medical developments could impact on
health care needs?
Medical Developments
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Genetics - diagnosis, therapeutics
Imaging - remote imaging
Surgery - remote operations
Pharmaceuticals - new drugs and new concepts
of treatment
– Devices - monitoring and treatment in home
environment
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?
Devices
• Technology -devices
– Monitoring and treatment at home - Japan
– Imaging - earlier diagnosis, remote imaging,
operator skills
– Robotic surgery - shore to ship, intercontinental
Survival
Survival
Survival
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0
1
2
Year Dx
3
4
Earlier Diagnosis
Earlier Diagnosis
Shift
Survival
-1
0
1
2
Year
3
4
Improved Treatment
Rx
Shift
Survival
-1
0
1
2
Year
3
4
Predictive Testing
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Hereditary non Polyposis Colonic cancer
Familial Adenosis Polyposis
Prostate Cancer
Breast Cancer
• Have to modify behaviour.
The Long View
What are the implications for insurance
healthcare products?
Implications for insurance
healthcare products
– Expectation of
Consumer
– Affordability
– Necessity
– Education
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Relevance
Customer service
Efficiency
Expectation of
suppliers
The Long View
Are there anti-selection aspects that
providers need to address?
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
Detect
Prevent
Treat
Manifest Disease
Asymtomatic disease
Predisposing State
Genetic predisposition
Detect
Prevent
Treat
Manifest Disease
Asymtomatic disease
Predisposing State
Genetic predisposition
Global
Regional
UK
Technology
Knowledge
Travel
Data Protection
Political
Supply of
Labour
Human Rights
Economic
Training
Climate Change
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.
Dr R Hangartner
Brett Cook Consulting
[email protected]
Dr R Hangartner
[email protected]