Time Trends in Health for the Next Decade

7th July 2016 – Athens, Greece Divani Caravel Hotel

Ricardo Baptista Leite, MP, MD, PhD(c) Medical Doctor and Member of the Portuguese Parliament Member of the Parliamentary Health Committee | Foreign Affairs Committee Head of Public Health | Catholic University of Portugal Guest Lecturer | NOVA Medical School and NOVA Information Management School City Councillor of Cascais ricardo.baptistaleite@gmail.com | @RBaptistaLeite

Time Trends in Health for the Next Decade

Portugal: Cascais – Sintra – Estoril Coast

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The Evolution of Healthcare in Portugal

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Infant Mortality Rate (per 1000 live births) Life Expectancy at Birth

Incidence of HIV and AIDS

Time Trends in Health for the Next Decade

Portuguese NHS

Universal coverage

Global

Tendency to be free of charge

Quality

Access

Citizen centered

The Future of the Portuguese NHS

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Time Trends in Health for the Next Decade

The Evolution of Healthcare in Portugal

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Health expenditure per capita below the average of OECD countries (OECD, 2011)

Time Trends in Health for the Next Decade

2011 | Portugal: TROIKA

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Time Trends in Health for the Next Decade

Annual health spending growth below the average of OECD countries (OECD, 2010-2013)

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The Evolution of Healthcare in Portugal Time Trends in Health for the Next Decade

The Evolution of Healthcare in Portugal

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Despite spending less per capita, Portugal has better health indicators in comparison with the average OECD countries (OECD, 2011)

USA

Time Trends in Health for the Next Decade

The Evolution of Healthcare in Portugal

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Economist Intelligence Unit | Top Tier by Outcomes (EIU, 2014)

USA

Time Trends in Health for the Next Decade

Financial Situation of the Portuguese NHS: What to Expect?

Innovation: costs in healthcare (projection)

Expenses in healthcare (in % of GDP) 2010-2060

Scenario

Source:

OEDC Average

OEDC Average

OEDC Average

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Time Trends in Health for the Next Decade

Portuguese National Health Service: Future Challenges

Life Expectancy at birth Slightly above EU average

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PT EU

Time Trends in Health for the Next Decade

Health Life Years at Birth, Women 5 years behind from EU average

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PT

EU

Time Trends in Health for the Next Decade

Portuguese National Health Service: Future Challenges

Demographic Evolution Year 2000 and Prospect for 2050

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PT

EU

In 2050, over 2/3 of the Portuguese population will be ≥ 65yo

Time Trends in Health for the Next Decade

Portuguese National Health Service: Future Challenges

High Prevalence of NCD’s Example | Type 2 Diabetes Mellitus

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PT

OECD

Time Trends in Health for the Next Decade

Portuguese National Health Service: Future Challenges

Lack of Human Resources

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Troika years: + 6.000 MD’s + 4.500 Nurses 2011: 2.1 Million without a GP 2015: 770K without a GP However…

Time Trends in Health for the Next Decade

Portuguese National Health Service: Future Challenges

Healthcare in the European Social Model

Core Values: an European Picture

Universal coverage

Equity in the access

Offer of high quality healthcare

Solidarity in funding

1.

2.

3.

4.

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Time Trends in Health for the Next Decade

The Evolution of Medicine

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Time Trends in Health for the Next Decade

• Promote health • Preserve health • Restore health, when compromised • Minimize suffering and malaise

Goals of Medicine

Nutbeam D. Health Promotion Glossary. Health Promotion International, 13(4): 349-364. 1999 http://ww2.ecclesbourne.derbyshire.sch.uk/

The Evolution of Medicine

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Time Trends in Health for the Next Decade

Industrialization of Healthcare

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Time Trends in Health for the Next Decade

Health Factory, Norway, 2010

Cost reduction in health management

Reduce low added value healthcare

Time Trends in Health for the Next Decade

Cost reduction in health management

Reduce low added value healthcare

Failure to reduce the burden of disease

Time Trends in Health for the Next Decade

Reduce low added value healthcare

Reduce excessive margins without

reducing healthcare

Efficiency

Structural reforms

Health promotion and prevention

Starting point

Adapted from WHO

National Health Services: The Future

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Time Trends in Health for the Next Decade

Social Determinants of Health

@RBaptistaLeite Dahlgren and Whitehead, 1991

Time Trends in Health for the Next Decade

The Future of the National Health Services

What is the future of Health Care?

“In health care, the days of business as usual are over.”

Michael Porter

Porter ME, Lee TH, The Strategy That Will Fix Health Care, Harvard Business Review, October 2013 @RBaptistaLeite

Time Trends in Health for the Next Decade

Supply-driven health care system organized around

what physicians do

Patient-centered system organized around what

patients need

Focus on the volume and profitability of services

provided – physician visits, hospitalizations,

procedures, and tests

System based of patient outcomes achieved

Fragmented system, in which every local provider

offers a full range of services (silos)

System organized in which services for particular medical conditions are concentrated in health-

delivery organizations and in the right locations to deliver high-value care

The Future of the National Health Services

@RBaptistaLeite Porter ME, Lee TH, The Strategy That Will Fix Health Care, Harvard Business Review, October 2013

Time Trends in Health for the Next Decade

Supply-driven health care system organized around

what physicians do

Patient-centered system organized around what

patients need

Focus on the volume and profitability of services

provided – physician visits, hospitalizations,

procedures, and tests

System based of patient outcomes achieved

Fragmented system, in which every local provider

offers a full range of services (silos)

System organized in which services for particular medical conditions are concentrated in health-

delivery organizations and in the right locations to deliver high-value care

The Future of the National Health Services

@RBaptistaLeite Porter ME, Lee TH, The Strategy That Will Fix Health Care, Harvard Business Review, October 2013

Time Trends in Health for the Next Decade

@RBaptistaLeite Porter ME, Lee TH, The Strategy That Will Fix Health Care, Harvard Business Review, October 2013

Time Trends in Health for the Next Decade

The Future of the National Health Services

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Time Trends in Health for the Next Decade

The Future of the National Health Services

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Time Trends in Health for the Next Decade

Community Value-based Healthcare

The Future of the National Health Services

Definition of Value

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Time Trends in Health for the Next Decade

Porter M. N Engl J Med 2010;363:2477‐81

Outcomes Matter

Time Trends in Health for the Next Decade

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ICHOM

Time Trends in Health for the Next Decade

@RBaptistaLeite ICHOM – Internation Consortium for Health Outcomes Measurement

@RBaptistaLeite Porter ME, Lee TH, The Strategy That Will Fix Health Care, Harvard Business Review, October 2013

Time Trends in Health for the Next Decade

The Future of the National Health Services

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ICT Challenges in Healthcare Time Trends in Health for the Next Decade

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ICT Challenges in Healthcare Time Trends in Health for the Next Decade

• “20% of medical advice we give is probably wrong just because we are different from each other.”

Dr. Mehmet Oz @ WEF

• Failure rates! Number of patients who fail first time use of drugs: – 70% Alzheimer’s and Cancer drugs

– 50% Arthritis drugs

– 40% Depression drugs

• Currently, in a way we are using a trail and error approach in real time – with the human body!

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Precision and Personalised Medicine

ICT Challenges in Healthcare Time Trends in Health for the Next Decade

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Precision and Personalised Medicine

ICT Challenges in Healthcare Time Trends in Health for the Next Decade

• Ten years after sequencing the human genome we do not have the knowledge, education or informatics tools to implement clinical genetics, genomics, proteomics, meta bolomics or epigenetics into practical personalised medicine.

• Predictive and personalised medicine informatics needs to be a research and education theme in its own right.

• The healthcare related scientific community has too few informaticians and unfortunately many of those that we do have are without the breadth of understanding of the field to make the kind of advances that are needed.

Golubnitschaja O, et al: General Report & Recommendations in Predictive, Preventive and Personalised Medicine 2012: White Paper of the European Association for Predictive, Preventive and Personalised Medicine. The EPMA Journal 2012, 3:14. @RBaptistaLeite

ICT Challenges in Healthcare Time Trends in Health for the Next Decade

Source : IBM Center for Applied Insights

How to get here?

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ICT Challenges in Healthcare Time Trends in Health for the Next Decade

Cognitive Computing| Artificial Intelligence

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Cognitive Computing Cognitive Computing is the simulation of human thought processes in a computerized model

ICT Challenges in Healthcare Time Trends in Health for the Next Decade

In 2006 the IBM “WATSON” project was born

WATSON is based on “knowledge management” Instead of

EMR’s that are based on “registry management”

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ICT Challenges in Healthcare Time Trends in Health for the Next Decade

WATSON for Healthcare Integration of knowledge with data towards generating better

decisions and outcomes

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ICT Challenges in Healthcare Time Trends in Health for the Next Decade

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ICT Challenges in Healthcare Time Trends in Health for the Next Decade

Em resumo… Saúde Sustentável

In a nutshell… Time Trends in Health for the Next Decade

Time Trends in Health for the Next Decade 7th July 2016 – Athens, Greece

Divani Caravel Hotel

Ricardo Baptista Leite, MP, MD, PhD(c) Medical Doctor and Member of the Portuguese Parliament Member of the Parliamentary Health Committee | Foreign Affairs Committee Head of Public Health | Catholic University of Portugal Guest Lecturer | NOVA Medical School and NOVA Information Management School City Councillor of Cascais ricardo.baptistaleite@gmail.com | @RBaptistaLeite