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.

rh@brettcookconsulting.com

Dr R Hangartner

rh@brettcookconsulting.com