Changing Views External Influences for Healthcare Dr R Hangartner.
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Transcript of Changing Views External Influences for Healthcare Dr R Hangartner.
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
• Social• Technological• Political• Economic• Legal• Environmental.
Global
Regional
UK
Technology
Knowledge
Economic
Travel
Climate Change
Political
Training
Supply of LabourHuman Rights
Data Protection
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
• Concordat between NHS and Independent Healthcare Providers
• New regulator - NCSC
• PFI
• Typhoid
• Drug resistance bacteria including TB
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
• 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
– 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
-1 0 1 2 3 4
Survival
Year Dx
Survival
Survival
-1 0 1 2 3 4
Survival
Shift
Year
Earlier Diagnosis
Earlier Diagnosis
-1 0 1 2 3 4
Survival
Shift
Rx
Year
Improved Treatment
Predictive Testing
– 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
– 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
Genetic predispositionPredisposing State
Asymtomatic disease
Manifest Disease
Detect
Prevent
Treat
Genetic predispositionPredisposing State
Asymtomatic disease
Manifest Disease
Detect
Prevent
Treat
Global
Regional
UK
Technology
Knowledge
Economic
Travel
Climate Change
Political
Training
Supply of LabourHuman Rights
Data Protection
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.
