British American Chamber of Commerce October 2009 Alison Platt – Group Development Director The three things I will cover today…… • A little bit about Bupa. • Some perspectives on healthcare from “across the pond”. • The changing face of the Foreign and Commonwealth Office. About Bupa… We commenced operations in 1947 and our founding principles 60 years of remain core to our success and growth over 60 years and into the heritage… future. Bupa’s core purpose is to prevent, relieve and cure sickness and ill …only in health health of every kind, across all of Bupa’s businesses and geographies. and care… Our aim is to provide our customers with high quality health and care products and services. We are a private company with no shareholders – Our primary concern is for our customers. All our profits are reinvested in the … no company to provide more and better health and care to our increasing shareholders… number of customers around the world. In all cases, we aim to treat and care for our customers as individuals. Our size and geographical focus has shifted, allowing us to exercise … scale… the benefits of scale and geographical diversity… we take care of lives in more countries than any one of our competitors. Our vision ‘to take care of the lives in our hands’ reflects what we do, and represents our guiding principles. We recently gave more focus … vision to this by articulating our mission ‘to help people live longer, healthier and happier lives’. Our values are reflected in everything we do…. … to benefit our customers around the world United Kingdom Spain Bupa UK Membership India Sanitas Bupa Health Assurance Max Bupa Sanitas Hospitals Bupa Wellness Sanitas Bupa Care Services UK Residencial Bupa Home Healthcare Bupa Cromwell Hospital Bupa Health Dialog China Representative US Office Beijing Health Dialog Hong Kong Bupa Hong Kong Thailand Bupa Thailand Bupa International: Offices in Brighton, England; New Zealand Copenhagen, Denmark; Bupa Care Services Miami, US; Dubai, UAE; Saudi Arabia New Zealand Cairo, Egypt; and Hong Kong Bupa Arabia Australia Bupa Australia/ MBF Bupa Care Services Australia Bupa has unique knowledge across healthcare Private Medical PMI businesses in the UK, Spain, Australia, Thailand, Hong Kong, Saudi Arabia, Insurance (PMI) India*, China* and internationally. Wellness and occupational health services in the UK, delivered through 50 Wellness & Wellness Centres Workplace Health Protection Products, UK Health Chronic Disease Management through Health Dialog, United States Hospitals and Primary Care Centres in Spain Hospitals Bupa Cromwell Hospital, Central London 301 Care homes in the UK 40 Care Homes in Spain Aged Care 48 Care homes in Australia 46 Care homes and Retirement villages in New Zealand Public/ private More on this later… partnerships *yet to commence operations Growth in Revenue and Customers A further 20 Revenue (£bn) Lives Covered million lives Rest of World covered by Health Dialog CAGR 13% 5.9 CAGR 12% Australia Spain 10.3m Bupa Intl (UK) 2.4 UK 4.7m 2001 2008 2008 2001 2008 Post M&A Post M&A There has been a significant shift towards a more international set of businesses: In 2001, 26% of revenue originated from BUPA’s non-UK businesses In 2008, 51% of revenue originated from BUPA’s non-UK businesses Source: Management Accounts 2001 , 2008 (excluding Hospitals and Bupa Ireland); AOP 2008 NHS v US health reforms: Debate obscured the real issue My perspective on the debate • Heated rhetoric and selective use of statistics is unhelpful • UK and US citizens value different things in healthcare: • US: Value choice – you have the most advanced treatments in the world • UK: Value equality and universality – healthcare “free at the point of use” But overall, US health outcomes are no better than in the UK • Obama is not proposing a British-style NHS – he is principally focused on broadening health insurance • The NHS improved over the last 7 years, but: • 230,000 people are still waiting 18 weeks or more for treatment • Productivity has fallen 4% over the last decade • The gap in life expectancy between rich and poor is widening The real issue: Funding the escalating costs of healthcare US – „A Crisis of Costs‟ NHS – „A Crisis of Provision‟ • US spends 16% of its GDP on • State forced to take decisions healthcare - twice that of Britain over which drugs and – but not everyone is covered. treatments to fund on financial • The rising price of new drugs grounds. and treatments has seen health • Funding gap will be £15bn by insurance premiums double in 2010, according to The King‟s the last decade. Fund. • Significant bureaucracy – for • Banking crisis and government every two doctors, there is one rescue packages have increased administrator. the state‟s debt position and • Healthcare costs are crippling are squeezing public spending US companies – 60 percent of even further. bankruptcies are related to healthcare costs. Finding a solution The most successful health systems – the ones that deliver the best outcomes for patients – are those that have a strong core public health provision supplemented and enhanced by a dynamic and competitive private market. The private health sector can partner with public health systems in a number of ways: UK: Working with the NHS to offer health coaching services to improve health outcomes, patient satisfaction and provide support for time-pressured GPs. UK: Providing out of hospital care to 12,000 NHS patients – freeing up bed space, reducing waiting times and improving patient satisfaction. France: Providing health coaching services to 138,000 diabetics and looking to roll this service out to entire diabetic population in France (c. 1.4 million). Spain: Operating a new 300 bed hospital in a 15 year partnership to provide for the healthcare needs of 140,000 people in the Manises region of Valencia. Australia: Bupa Australia‟s Chief Medical Officer is chairing the National Health and Hospitals Review for the Government The way forward The US or the UK could learn lessons from the health systems of other countries: Switzerland and the Netherlands: Every person must have health insurance, but the state will step in for those who can‟t afford it. France: Compulsory health insurance. Ranked as the most efficient health service in the world by WHO. Spends 11% GDP on health, but better life expectancy than US & UK. A European-style combination of private insurance backed by a core government safety net may be the best outcome. The private sector‟s expertise can be leveraged on both sides of the Atlantic to address the funding crises. The changing face of the FCO • The change journey in the last five years. • The challenges currently in play. • Potential for radical reform 2010 and beyond.