HEALTHCARE & MANAGEMENT:HEALTHCARE & MANAGEMENT:

Challenges & OpportunitiesChallenges & Opportunities

Chung-Fu LanNational 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 Changesin Healthcare Environment

1. Changes in medicine itself

2. Ever-expanding role of government: Through financing and regulation

3. Involvement of financial & industrial capital: The business of medicine

4. 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 dominance3. Buyer’s market/ Market competition4. Strategic thinking & planning/

Focused or specialized/ Innovation

COMPONENTSSociety & 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

Focus on disease

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

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 forTaiwan’s Healthcare System

Rethinking of:– values in health & medicine– philosophy & objectives of medical & allied

health professional education– rights & responsibility for clinical decision-

makers– 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 !!Many Thanks !!