AFG Venture Group Dispatches

Corporate advisory and consultancy in Australia, South East Asia and India.

International Trends In Healthcare – The Consumer View of Healthcare In 2040

Dr Liz Paslawsky (formerley Gale), Phd, M.H.A, H1, BSc
Company CEO, Dr Liz Paslawsky & Associates

Extracts from a conference paper given in Brussels at the International Design and Health Conference – October 2010. The conference paper was in two parts. The first was the patient’s view of health care in 2040. The second was the implications for health professionals, planners and policy makers and the multi-discipline’s involved in capital work’s. This extract is Part 1, the patient’s view of health care. The paper was adapted to be relevant to the Australian Health Reform agenda.

Drivers of change

We always discuss the drivers of change in Healthcare as: Increasing costs, aging population, rapid advances in medical technology, skills shortage. We ignore the most fundamental driver of change that is in human attitude and behaviour.

In every aspect of life and business the trend is towards consumers doing more for themselves whether through the internet, (buying, paying, booking, transferring, dating). Self service processing in retail (purchasing groceries, photography) or sorting your problem over the telephone (global outsourcing of call centres – India, Asia).

Health is also moving to self care.

Why Self care?

Simply, because we cannot afford to do anything else. The Australian Federal Government’s reform agenda key driver was to manage the growth in the burden of Chronic Disease. In Australia Chronic conditions now consume 70% of the Health sector’s spending. Diabetes expenditure alone is projected to increase 436% to $8.6 billion from 2002/ 03 to 2032/ 33. For each older person in 2007, there were 5 working-age people. In 2050 there will be less than 3 working-age people.  Implications:

  • Constraining the supply of informal carers,
  • Decrease health workforce,
  • Reduce the taxation base to fund expenditure on health care.

The two key principles behind the National health reform agenda.

  • Shared responsibility: “The health system has a particularly important role in helping people of all ages become more self reliant and better able to manage their own health care needs.” (NHRC, 2009)
  • Strengthening prevention and wellness:  “Our health system also needs greater emphasis on helping people stay healthy through stronger investment in wellness, prevention and early detection and appropriate intervention to maintain people in as optimal health as possible”. (NHRC, 2009)

Legislation moving funding towards home care

Federal legislative changes including:

The Broader Health Cover. Encouraging General Practitioners towards providing improved coordination of patient care for those with chronic conditions and the ability to refer patients free of charge to allied health services. Private Health Funds can develop Chronic Disease Management Programs (CDMP) and share the burden of cost through the “risk equalisation pool”.

Aged care legislation over the last 10 years has been towards supporting the aged in their own home. “Aging in Place’ and the growth in diversity of community care packages.

Legislation whose outcome is for the consumer to be paying an upfront payment or more directly of their health care costs is moving consumers towards more affordable home care services.

Trends in home based service delivery

Services are being developed across the “chronic disease care continuum”. The fastest growth in Australia is telephone coaching disease management companies. For example, Mckesson, Healthways, Bupa Health Dialog, COACH. They are expanding their product capabilities to provide an integrated service across the continuum of care.

The care continuum commences with web-based information for those whom are motivated towards self care. These websites are often portals, which are integrated with a nurse telephone coaching service. Telephone coaching chronic disease management programs, provide coaching services of varying intensity, based on client health risk. The telephone coaches are backed by sophisticated technology providing resource tools to send to the client during the coaching session. The telephone technology generates an electronic medical record that can easily be integrated to other EHR systems.

Hospital service delivery trends and models of care are towards home-based care. Hospital Substitution services moving towards home-based programs. eg home orthopaedic and cardiac rehabilitation programs. They are supported by technological growth in home care products especially Diagnostic tools:

  • Remote monitoring-blood pressure, heart rate, skin temperature,
  • Diagnostic toilets;
  • Microscopy added to cell phone
  • Telemedicine

Consumers are moving toward self care

Consumers are gathering sufficient information to be able to make an informed decision. The type of information being obtained allows the consumer not only to take greater control but also to make choices.

1. Seeking and accessing health information

Increasingly health information available is becoming more personalised at the individual level. Generalised information on disease groupings and stereotype treatment responses over the internet are becoming irrelevant to the consumer. Diversity of individual specific sources include:

  • Personalised medicine

Genomics, individuals know their genetic sequence and can predict their own health risk of acquiring many diseases.

  • Social media backing the traditional Internet- blogs, twitter, my space.

The breadth and depth of conversations are boundariless. Quality of life, emotions, feelings, are as relevant as what treatment should I be seeking that will suit me.

  • Access to Electronic Health Record.

Today the question is who owns your medical record? Soon the question is how well are you managing your own EHR?

  • Self help groups, disease specific associations, advocacy groups,

The hope is that they all work collaboratively or align their information

  • Health providers-coordinated patient care and consumer directed services,

Coordination of patient care provides opportunity to better identify the needs of the consumer. Consumer directed care will expand the type of information requested by consumers.

2. Changes in Generational attitudes

The baby boomers do think differently from their children:

Generation X

Born 1965-1979Resourceful, self reliant, individualistic, Lifestyle is important. Increased expectations. More computer/information literate than the baby boomers.

Generation Y

Born 1980Sense of civil duty, buy locally, confident, comfortable with considering new concepts, communicate informally, electronically and hallway conversations. Assesses the most up to date technology

3. Consumers demand more Information Transparency

Information transparency in Healthcare is becoming an ethical obligation:

  • Transparency on patient access, costs, waiting lists
  • Patient satisfaction measures
  • Patient safety measures – hospital error rates, infection rates.

Consumers are redefining their definition of healthcare

4.         Growth of Complementary and Alternative Medicine (CAM)

Escalating demand for Complementary and Alternative Medicine (CAM) is occurring with high out of pocket expenditure. The National Institute of Complementary Medicine (NICM) estimates that in 2007 out of pocket funding for CAM was estimated to be AU $4.13 billion per year.

CAM is a self care market. It is estimated that 80% of cancer patients use CAM however less than 20% tell their doctor. The first survey of cancer patient satisfaction in NSW, 2008 revealed:

the need for greater emotional support, help with fear and anxiety, information and education and the need to feel comfortable when talking with staff about Complementary, Alternative or Non-traditional therapies”.

5.         “New age”/wellness paradigm and the belief in the need to balance your mind/ body /spirit

The notion of preventive health is taking a wider meaning with the new age movement to include:

  • Physical body – lifestyle, nutrition, exercise
  • Emotions (expressed as feelings) – importance of self esteem, ability to laugh
  • Mental – your thoughts, self image
  • Spiritual – your relationship with yourself, calmness, creativity, your inner knowing and your higher power.

Outcome: 2040 The emergence of the new consumerism in health care.

Consumer Empowerment

Feeling empowered the western disease model of care and treatment paradigm, no longer dominates. Reaction to ill health as passive recipients changes to a belief that the consumer is an equal partner in decision making in their own care.

In 2040 the consumer view will be:

I am the CEO of my own body the doctors are my consultants. I will decide what treatment I want, how I will receive it, and who provides the treatment”.

2040: Characteristics of an empowered health care consumer.

  • Knowledgeable and wants to embrace the most reliable health information, has an ability to access knowledge when required,
  • Paying for a service and looking for value for money
  • Concerned with their health and wants to simply feel their best
  • Quality of life/ symptom relief is important in addition to disease management
  • Searching: western medicine cannot provide absolutely everything
  • Seeking treatments that are congruent with their values and beliefs.
  • With an open mind have a pragmatic pursuit of better outcomes
  • Expedience – need for immediacy – “what will help me right now”.
  • High in expectation – demand to be treated with respect and dignity
  • Seeking a doctor to interpret information and personalize for the individual. Not to know all the answers but to know where to look.
  • Has a choice, discerning.
  • Seeking a welcoming engaging environment and expecting more convenience and personal comfort.

Conclusion

Society is forcing health to move towards self care. Consumers are able to gather information sufficiently to be able to make an informed decision and therefore are empowered to make choices. How the consumer defines what health means to them as individuals, will influence the choices they choose. The empowered consumer will have a diverse range of influences and impacts on the health system. Organisations applying strategic thinking using the traditional trend analysis approach will misread the market opportunities.

About the Author

Dr Liz Paslawsky, Phd, M.H.A, H1, BSc is an experienced health sector CEO who has succeeded in the private, public and not for profit sectors. Liz has been the CEO of two Area Health Services in NSW, an institutional banker with Westpac for 8 years targeting the health sector across Australia and New Zealand, led the successful commercialisation of biotechnology, developed centres of excellence and led transformational change in the not for profit sectors.

Integrating the skills gained from the three sectors Liz has established her own highly successful international consultancy company targeting the Health sector both in Australia and overseas. Clients are from the USA, England, China and Australia.

Winner: NSW and ACT Telstra Business Woman of the Year Corporate/Government Sector 1997

Contact details: lizpaslawsky@gmail.com