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 [email protected] | @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
@RBaptistaLeite
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
@RBaptistaLeite
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 [email protected] | @RBaptistaLeite
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