HEALTHCARE & MANAGEMENT:
Challenges & Opportunities
Chung-Fu Lan National Yang-Ming University
October 16, 2003, Kaohsiung
Challenges
The Health of the Nation
The improvement in the citizen’s health (as shown in most of health indicators). The universal health insurance program has essentially achieved equitable access for all & improved cost efficiency. But the performance between quality of healthcare & quality of life, personal medical care & public health care, healthcare delivery & finance, national health account & household economic burden, as well as the response to the special need of aging & vulnerable populations, to the new & shifting burden of disease, & to the progress of technology & information advancement are still major concerns.
Drastic Changes in Taiwan’s Healthcare Environment
Dominance of the NHI on healthcare expenditures, resources development & their ecologies. Massive expansions of large medical centers/chains (hospital beds) & health-related schools, & skewing of some small & medium-size hospitals, clinics & medical specialties. Demands for health professionals to meet the need of the market-driven healthcare system & pressures in clinical practices to catch up with the progress of new technology & information development. Public expectation on higher quality services at lower contribution.
Reasons for Changes in Healthcare Environment
1. 2.
3.
4.
Changes in medicine itself Ever-expanding role of government: Through financing and regulation Involvement of financial & industrial capital: The business of medicine More knowledge & questioning public: Challenging traditional medicine interests
Health Policy Challenges Encountered by the Decision Makers
Dealing
with scarcity Funding systems equitably & sustainably Allocating resources effectively Delivering care efficiently Implementing change
Scenarios for Healthcare Industry
SCENARIOS 1. Business as “usual” 2. Hard times/ Government dominance 3. Buyer’s market/ Market competition 4. Strategic thinking & planning/ Focused or specialized/ Innovation COMPONENTS Society & economy, National health (insurance) policy, Population structures & demands, Health system needs, Health outcomes & % of GNP
Structural Shifts in Healthcare
New incentives & disincentives The transformed system with hybrid healthcare An increase in consumer sovereignty Growth of new products & market segmentation Growth of managed care Salaried physicians up, autonomy down Hospital admissions down but shift to ambulatory & community environment Increase in intensity of inpatient care Shift of healthcare manpower & resources into more profitable services Financial pressure means political pressure
Opportunities
Demographics & Burden of Disease
Growing
older & living longer Increasing diversity Widening household income gap Shifting burden of disease – lifestyle behaviors, mental illness, & chronic diseases Increasing healthcare costs Increasing tiering of health insurance
Healthcare Delivery System
Reassessment
of healthcare workforce’s supply & demand Evolution of healthcare delivery organization (vertical, horizontal & virtual integration, IDS or networks, center of excellence,…) New activity of medical management (from managed care to managing care)
Medical Technologies on Care
Genetic mapping & testing Rational drug design (the use of computer to design drugs that target a particular molecular receptor or enzyme, then turning them on or off) Minimally invasive surgery Advances in imaging Gene therapy Vaccines Artificial blood Xenotransplantation (the transplantation of cells, tissues & whole organs from one species to another) Stem cell technologies
Information Technologies in Healthcare
Basic
business process-management systems (go electronic & automation) Clinical information interfaces (electronic medical records, EMR) Data analysis Telehealth (combining case management & patient information systems) & remote monitoring
Reconciling Public Health & Personal Medicine
Expanded
perspective on health Children’s health Women’s health Health & healthcare of the seniors Disease management Disability, chronic care & quality of life Health behaviors
Healthcare Paradigm Shifts from Biomedical to Expanded View
Rigid adherence to the biomedical model Attention solely to acute episodic illness Focus on individuals Cure as uncompromised goal
Expansion to incorporate a multifactorial view of health Chronic illness management Focus on communities & other defined populations Adjustment & adaptation to disease for which there is no cure Focus on disease person & the disease
Focus on disease
Forecasting Future Scenarios in Healthcare
Population-based
healthcare Horizontally & vertically integrated healthcare Organized & managed healthcare Evidence-based healthcare & reimbursement Genomic/molecular medicine e-healthcare (B2B, B2C & C2B, C2C)
Basic Strategies for Healthcare Reform in State Controlled System
Privatization Pre-funding Diversification/ Selectivity Raising incentives or benefits/ Lowering entry criteria Competition/ Integration Teamwork/ Alliance Private Finance Initiative/ Public Format Initiative; PFI
Possible Options for Taiwan’s Healthcare System
Both demand- & supply-side cost controls Enforcing quality management Decreasing reimbursement by government & insurers Capping healthcare budgets Encouraging managed competition, declining use of inpatient care, resulting in closures & mergers More outpatient care & diversification Growth of alternative institutions & service models
Industry
consolidation Concentration of services in large healthcare chains Financial security & competition Increasing amount of extra-billing Using more intermediate manpower Non-price competition between hospitals Disintegration of bargaining power More experiments, more reinventions
The Challenge for Taiwan’s Healthcare System
Rethinking
of:
– values in health & medicine – philosophy & objectives of medical & allied health professional education – rights & responsibility for clinical decisionmakers – duty to the patient & to the society
Rebuilding
of:
– – – –
morality in medicine & healthcare healthcare delivery structure healthcare financing mechanism trust among the consumer, the provider & the insurer in healthcare
Rebalancing
at:
– – – – – –
public expectations & limited resources scientific advancement & clinical excellence quality & cost in healthcare health education & information development clinical & managerial decision-making medical ethics & new technological progress
Final Notes
Improving the nation’s health by planning a National Health Plan (NHP), rather than just the NHI, to reorient the goal & the content of health and healthcare services. Preparing to meet the shifting & emerging paradigms from the traditional biomedical model view to an expanded multifactorial view of health. Meeting healthcare and societal needs in accordance with socioeconomic resources development & affordability, making it happen with strategic thinking, target setting & prioritizing. Keeping paths with scientific advancement & value changes. Maintaining flexibility with diversity & changes.
Many Thanks !!