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Dr Stephen Child

Chief Medical Officer

Future of healthcare

I was wrong(Partially)

191 conditions

Presenting symptoms Q1 2018 % of total

symptoms

Vomiting 3,218 4.1%

Rash 3,186 4.0%

Abdominal pain 3,303 4.2%

Fever (symptom) 3,827 4.8%

Cough 4,847 6.1%

Diarrhoea 1,761 2.2%

Medication query 2,134 2.7%

Chest pain 1,982 2.5%

Headache 1,743 2.2%

Diarrhoea and vomiting 864 1.1%

Head injury 929 1.2%

Sore Throat 1,250 1.6%

Immunisations 794 1.0%

Cold/Flu 1,900 2.4%

Unwell 884 1.1%

Vaginal bleeding 715 0.9%

Backpain 664 0.8%

Constipation 631 0.8%

Fall 401 0.5%

Dizziness 621 0.8%

Contract with society?1938-41

Erosion of doctor-patient relationship

What’s changed?

Growing patient expectations

Funder wants value

State suspicious of self-regulation

= reduced autonomy and wellbeing

Myth: only rich people have health insurance

Only 16% earn more than $100,000

*Statistics NZ – June 2017

Customer is always right

New Zealand find ‘game changer’ for bowel cancer (NZ Herald article)

Other therapy

Cancer therapy

Aromatherapy Ayurvedic RykeHerbalism Homeopathy

Shamanistic Naturopathy Urotherapy Diets +++ Macrobiotics

Probiotics Bioresonance Magnet Therapy Light Therapy Orgone

Polarity Therapeutic Touch Zoetron Aloe Cannabis Capsicum Castor Oil Ginseng Grapes Kombucha Milk Thistle

Mushrooms Acupuncture Chiropractic Craniosacral Colonics Cupping Ear Candling Reiki

Shiatsu Hypnosis Faith-based Meditation NLP Qigong

Bee Venom Caesium Salt Chelation Colloidal Silver Emu Oil

Hyperbaric OrthomolecularOxygen Shark Cartilage Vitamins

Google is tackling specific diseases

Source: CB Insights

1. Not informed

2. Ill informed

3. Imbalanced information

4. “At risk” – fear - pain

Vulnerable

Condition X

30% placebo

always effective

20 people take

treatment A

20 people take

treatment B or

placebo

Evidence based or biased?

Background

Wang MT, Gamble G, Grey A. JAMA Internal Medicine. 2015;175(5):845-848.

Oestrogen and progestin replacement Prevention of cardiovascular disease in post menopausal women

Tympanostomy tube insertion Treatment of persistent otitis media

Vitamin D and calcium Prevention of fractures

Vitamin E Prevention of cardiovascular disease and cancer

Mammography screening Detection of breast cancer from 40 years

Percutaneous coronary intervention Treatment of stable coronary artery disease

Rosiglitazone Treatment of type 2 diabetes

Arthroscopic surgery Treatment of osteoarthritis of the knee

PSA screening Detection of prostate cancer

Vertebroplasty Treatment of osteoporotic vertebral fractures

Rosuvastatin Treatment of haemodialysis patients

Intensive glucose control Treatment of type 2 diabetes

Prednisolone Treatment of wheezing in preschool children

Darbepoetin alfa Treatment of type 2 diabetes and chronic kidney disease

Renal artery revascularisation Treatment of renal-artery stenosis

Calcium Prevention and treatment of osteoporosis

Intensive BP control Treatment of critically ill patients

Aspirin and heparin Women with recurrent miscarriage

Fish oils Prevention of cardiovascular disease

Type 2 diabetes screening Detection of type 2 diabetes

Established practices and indications

Paternalistic

approachPatient-centric

approach

“The Patient Will

See You Now”

Medically Unexplained Diagnosis (MUD)

Germany n=620

consecutive

66% MUD

By 12 months:

Somatoform 22.9%

Affective 12.4%

Anxiety 11.4%

Achieving value in healthcare

OUTCOMES

COST

VALUE

What is “value”?

$

Gross hourly rate

Gross hourly rate

$

SouthernCross

nib Sovereign Unimed PartnersLife

Accuro Others

New Zealand’s private health insurance market

62%

15%

7% 5%

3%2%

6%

Source: HFANZ

Private health insurance in New Zealand and sustainability

GP research November 2017

Over 20 in-depth

interviews

140 GP survey

responses

GPs interested in accessing patient feedback

Interested in feedback

about specialists

Interested in feedback about

other healthcare providers

(eg physiotherapists)

Need a plumber?

• Quality?

• Qualifications?

• Recommendations?

• Ability to understand the job?

• Invoice is visible

• Cost comparison

Outcomes and Experience Questionnaire (OEQ)

49,000 responses*

Patient Reported Outcome Measures Survey (PROMS)

5,300 responses*

*May 2018 figures

Patient outcomes and experience programme results

• highly likely to refer their friend or family member to see the provider who treated them

• Average of 94% for Experience and 88% for Outcomes

Patient outcomes and experience programme: provider portal dashboard

PROMS: Shift in pain score, pre-op versus post-op

Pain is

static

Patient outcomes and experience programme results: Detractors

Misogynist. Couldn’t talk

to me, or gave me

contradictory information.

So I took my husband

along, and he talked to my

husband instead of me,

that way I could find out

what was happening.

He is very blunt and

did upset me by the

manner in which he

assessed my low pain

threshold.

I could have

been better

informed.

Technically brilliant

but would be good

to know how to deal

with people at their

most vulnerable.

Likely future?

Self-regulation (and sanction) Super-specialisation

Corporatisation/competition

“Protocolisation” of

medicine

Self-regulation (and

sanction)Super-specialisation

Corporatisation/

competition

Will patients be better ?

• Vulnerable to exploitation

• Solutions without problems

• Increased “worried well “

• Who will they trust?

Will people trust Google?

Source: CB insights (morning consult + politico national tracking poll)

“How much do you trust Google to keep your personal

data private?”8%

Don’t know/ no opinion

53%Not at all/ Not very much

39%A great deal/ a fair amount

How ethical is the business model?

1. Define “value” offered

2. Transparency:

price, quality

3. Trustworthiness

What do you think?

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Thank you

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