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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 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 • • • • • • 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 Survival Survival Survival -1 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 – – – – 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 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]