Professor Nick Bosanquet Professor of Health Policy Imperial College London Building Blocks for Heal

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Professor Nick BosanquetProfessor of Health
PolicyImperial College LondonBuilding Blocks
for Healthcare 21st Century.
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What is the global shift in healthcare policies?

• New Model of care
• More active insurance funders
• Rise of generics. International pharma
  nationalized hospitals.
• Gains in more pluralistic systems
• Different Challenges in Asia

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New Model of Care

• Prevention
• Risk management in local populations
• Screening/Early diagnosis
• Ambulatory/MI treatment
• Care programmes

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New High benefit Programmes

• CHD
• Diabetes
• Challenge of Long term Conditions
• 18 m in UK
• 70 per cent of spending
• Blockbuster drugs improve survival
• But less quality of life of survivors
• Niche diseases

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Health expenditure as share of GDP

• UK 8.3
• NZ 9.0
• Spain. 8.2
• Australia 9.5
• Netherlands.
• 9.2
• Finland 7.5
• Denmark 9.1
• France 11.1
• Germany 10.7
• Switzerland 11.3
• U.S 15.3

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The Newhouse Effect No More?

• Sure link between GDP growth and faster growth of
  health
• Spending
• Now clustering around 3000 PPP
• Scandinavia. 2,500
• US? 6,000
• Gains to middle income countries

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Ischemic heart Disease Mortality per 100,000

• 1980 2004
• US 237.1 127.6
• UK 2471
  108.7
• France 73.5
  42.5
• Netherlands 167.2
  61.5

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Shortage of Experienced Staff

• Health teams
• Increased role of specialist nurses
• Communication with patients
• Detailed programmes
• Coming of medium ticket technology

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Global Concerns

• Quality
• Communication with patients
• More use of pluralism/competition

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Changed Role of Hospitals

• Fewer beds
• Reduced Admissions
• More focus on specialization
• Darzi review in UK
• Move to polyclinics

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Competing Models

• A. medical Authority
• High/Rising Cost
• Hospital factories
• Short treatment episodes
• Big Ticket technology
• B. Informatics/Evidence base
• Quality
• Communication with patients
• Use of medium ticket technology

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Technologies

• Big Ticket
• Scanners
• Academic medical centre
• Medium Ticket
• IVD
• Diagnostics in primary care
• Communication through PACSlt

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National Strategies

• US cancer
• UK Coronary heart Disease
• Finland
• XCHD
• Diabetes

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The Key Contributors to Model B

• Donabedian
• Cochrane
• Doll
• Nashville. MIS
• New Jersey Pharma

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The Building Blocks for Improved
Outcomes/Services.

• National strategies on key disease areas.
• Developing Leadership/ key contributors.
• Independent information on outcomes/quality of
  process.
• Partnership for innovation.

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Key National Strategies.

• Coronary Heart Disease.
• Cancer.
• Stroke.
• Diabetes.
• Mental health/Suicide prevention.
• Demo-group.
• Children.
• Older people.

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CHD Strategy

• Prevention
• Smoking/diet
• Identification of high risk groups
• Diagnostics/rapid access to angioplasty
• Rehabilitation
• Gains in reduced mortality Europe 40 per cent
  since 1990. Avoidable deaths

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Diabetes Strategy

• Diagnostic testing
• Eye examinations
• Foot-care
• Access to insulin
• Proven preventive policies for reducing sight
  loss, avoiding foot damage

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Cancer Strategy

• Healthcare paradigm
• Prevention
• Screening
• Rapid diagnosis and treatment
• Care programmes
• Support for carers
• Cancer Reform Strategy..
• Bosanquet and Sikora. The Economics of Cancer
  Care. CUP 2006.

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Success in local programmes

• CHD
• Runcorn/Gravesend
• Identify high risk patients
• 3000 from 60,000
• Use of statins
• Prevent 27 deaths a year
• New diabetes programmes
• Programmes in eyecare

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Coming of medium ticket technology

• Technology depends on power forces not just on
  science. NHS tied to big ticket technology? The
  Holy Trinitybig government, monopoly profession
  and big contractors
• Diagnostics
• Early detection in cancer
• Angioplasty
• Orthopaedics
• Eyecare

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Strategies in mental health services

• Heavy Disease burdens from disability/premature
  mortality
• The malignant disease of depression
• Help lines
• Primary care prescribing
• Success in Europe in reducing suicide rates 20-30
  per cent

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Improving palliative end of Life Care

• Effective use of opiates
• Privacy ,dignity and control in the last phase
  of life.(Bosanquet and Salisbury Oxford
  University Press 1999
• Important role of hospices/specialist nurses
• Can there be compassion for patients/carers in
  healthcare?

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Informatics for Health service quality

• Shortage of experienced staff - now and in the
  future
• Greater pressure for quality/clinical governance
• Process comparisons. Outcome information
• UK success in comparisons for cardiac surgery/
  quality of care for renal patients
• Information on access/waiting times/service
  quality

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Tracking new partners

• Changes in key partner industries
• Pharma industry. Generic drugs for most patients
  plus targeting of new innovative drugs
• Main generics. Slovenia/India/Japan
• Diagnostics. Greater availability at local level
• Informatics. The industry that IT forgotnow
  waking up
• Medical devices. Move towards day treatment/
  short stay. Stents
• Range of new partners for China

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Integrating services. The New Opportunity

• Team work
• Technology
• Early access
• Conflict between professional paradigms and
  incentives
• Big ticket v medium ticket technology
• Use of local informaticsbuilding the potential
  both for primary care and for new units

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New policy directions to promote redesign and
more effective use of resources

• Encourage partnerships with international high
  achievers.
• Develop local patient/consumer groups.
• Independent information on service quality.
• Encourage range of insurance providers.

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New partners

• Pharmacies
• Opticians
• Patient testing/diagnostics
• Telemedicine
• The expert patient

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Case studies in private/public partnership

• Pharmacies
• Increased activity in testing
• Chlamydia testing
• Opticians
• Extended eye care
• Direct referral for cataract/low vision problems

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New informatics.Making it happen

• Catch up with supermarkets
• Health carer as a communication programme
• Different versions of telemedicine from mobile
  phones through remote monitors to PACS
• Health systems develop distinctive
  strategies/policy mix.