2. Changing Views External Influences for Healthcare Dr R Hangartner

3. The Long View What trends are we observing that impact on Healthcare insurance provision? What trends in social behaviour might we expect to experience? What medical developments could impact on health care needs? What are the implications for insurance healthcare products? Are there anti-selection aspects that providers need to address?

4. Trends Social Technological Political Economic Legal Environmental.

5. Global Regional UK Technology Knowledge Economic Travel Climate Change Political Training Supply of Labour Human Rights Data Protection

6. NHS labour shortages waiting lists and waiting time self-pay - increasing proportion of independent hospitals income concordat between NHS and independent sector hospitals staff attitudes - many doctors have PMI cover, more NHS nurses are buying PMI cover.

7. NHS Reorganisation Primary/Secondary care boundaries more care at home less care in hospitals. Joint planning health and social care systems converge? More funding (local taxation?)

8. Finance –Financial Markets - instability and recession - market size, relevance of products –Monetary Union - will care systems converge? –Demography - balance between economically active and dependants Pensions Elder care Healthcare

9. –Global (Virtual) Medical School -global standards? –Climate change

10. Insurers taxation - tax relief over 65s IPT Attitude to PMI, PHI etc. just another cover?

11. UK 2001 BMA News Review

12. UK 2001 Concordat between NHS and Independent Healthcare Providers New regulator - NCSC PFI Typhoid Drug resistance bacteria including TB

13. The Long View What trends in social behaviour might we expect to experience?

14. Social Behaviour Individual and Employer - funding Voluntary Organisations/Private Providers –Provision of services Multiple Careers Taxation on Consumption Consumer expectations…..

15. Consumer Comprehensive - meets needs (?) Fair Responsive Effective Efficient Privacy.

16. Is this the same overseas? Culture - concepts of social and health care, urban and rural societies Population Structure Technology Fraud - healthcare fraud is the fastest growing area for insurance fraud in the US Healthcare infrastructure GDP per capita and Healthcare spend and payment systems - WHO Reports

17. The Long View What medical developments could impact on health care needs?

18. Medical Developments –Genetics - diagnosis, therapeutics –Imaging - remote imaging –Surgery - remote operations –Pharmaceuticals - new drugs and new concepts of treatment –Devices - monitoring and treatment in home environment

19. Genetics –Rarely one gene cause one disease –Phenotype (expression) - the gene, modifier genes and the environment New pharmaceuticals –Designed -->expression of genes –Immune system regulators –Anti receptors - life style vaccines?

20. Devices Technology -devices –Monitoring and treatment at home - Japan –Imaging - earlier diagnosis, remote imaging, operator skills –Robotic surgery - shore to ship, intercontinental

21. Survival

22. Earlier Diagnosis

23. Improved Treatment

24. Predictive Testing –Hereditary non Polyposis Colonic cancer –Familial Adenosis Polyposis –Prostate Cancer –Breast Cancer Have to modify behaviour.

25. The Long View What are the implications for insurance healthcare products?

26. Implications for insurance healthcare products –Expectation of Consumer –Affordability –Necessity –Education –Relevance –Customer service –Efficiency –Expectation of suppliers

27. The Long View Are there anti-selection aspects that providers need to address?

28. Anti-selection aspects Insurance Industry - risk pool Individual Insurers - Data protection GP records Location of treatment Early diagnosis - screening - When is a diagnosis a diagnosis not a test result? –Pre-disease

29. Genetic predisposition Predisposing State Asymtomatic disease Manifest Disease Detect Prevent Treat

30. Genetic predisposition Predisposing State Asymtomatic disease Manifest Disease Detect Prevent Treat

31. Global Regional UK Technology Knowledge Economic Travel Climate Change Political Training Supply of Labour Human Rights Data Protection

32. Dr R HangartnerBrett Cook Consulting Information Age Tom Ferguson “Industrial Age Medicine is dead….” www.fergusonreport.com Informed and proactive consumer Global aspiration and expectation….. Uniformity of provision (essential need) and systems of training and care delivery. rh@brettcookconsulting.com

33. Dr R Hangartner rh@brettcookconsulting.com