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Disclaimer: The views expressed in this paper/presentation are the views of the author and do no necessarily reflect the views or policies of the Asian Development Bank (ADB), or its Board of Governors, or the governments they represent. ADB does not guarantee the accuracy of the data included in this paper/presentation and accepts no responsibility for any consequence of their use. Terminology used may not necessarily be consistent with ADB official terms.

Responding to 21st century

challenges and technological

innovations

Eduardo P. Banzon

Principal Health Specialist Asian Development Bank (ADB)

April 2018

and technological innovations Eduardo P. Banzon Principal Health Specialist Asian Development Bank (ADB) April 2018

Outline

Key 21 st Century Challenges which Hospitals must Face

Demographic and Epidemiologic Changes

Increasing Demand for UHC

The Need to Address Health Security

Opportunities to Improve Hospitals

Changes – Increasing Demand for UHC – The Need to Address Health Security • Opportunities to

KEY 21 ST CENTURY CHALLENGES WHICH HOSPITALS MUST FACE

KEY 21 S T CENTURY CHALLENGES WHICH HOSPITALS MUST FACE

I. Demographic Changes

Share of older population (65 years+) is expected to be 26% in 2050 (OECD average, 25%)

In 2012, those aged over 65 was 7% in Asian countries

Challenges of the speed of aging

Much shorter time to prepare for population aging

Brunei Darussalam, India and Mongolia: share of the population over 65 is expected to increase by 4 to 7 fold (from 2012 to 2050)

Greater demand for income security and health care of older people in the Asia/Pacific region in the coming decades

(OECD/WHO, 2014)

for income security and health care of older people in the Asia/Pacific region in the coming

% Population aged over 65 and

80, 2012 and 2050

% Population aged over 65 and 80, 2012 and 2050 Source: OECD/WHO, Health at a Glance:

Source: OECD/WHO, Health at a Glance: Asia/Pacific 2014 Original source: OECD Historical Population Data and Projections Database 2013; UNESCAP (2014).

Glance: Asia/Pacific 2014 Original source: OECD Historical Population Data and Projections Database 2013; UNESCAP (2014).

Old-Age Dependency (65+/(20-

64))

Old-Age Dependency (65+/(20- 64))

Percentage below Poverty Line by Age

(Per capita daily income < US$1.25, 2005 dollar PPP)

Age (Per capita daily income < US$1.25, 2005 dollar PPP) Poverty 2006 – 08 Poverty, 2009

Poverty 200608

income < US$1.25, 2005 dollar PPP) Poverty 2006 – 08 Poverty, 2009 – 12 Source: World

Poverty, 200912

Source: World Bank. 2016, Original sources: Giles and Huang 2015 based on data from CHNS 2006, 2011; ThaiSES 2011; World Bank East Asia and Pacific Standardized Household Surveys, various years; and VHLSS 2012.

2006, 2011; ThaiSES 2011; World Bank East Asia and Pacific Standardized Household Surveys, various years; and

2. Epidemiological Change: Leading causes and Risk factors of Disability-adjusted Life Years (DALYs)

(1990-2010)

Non-communicable diseases (NCD), e.g., ischemic heart disease, lung cancer, diabetes, chronic kidney disease, showed the highest growth (IHME,

2013).

3/4 of NCD deaths occur among persons +60 years (World Bank, 2016)

Dietary risks were the leading risk factors in most Southeast Asian countries, high BMI and high fasting plasma glucose ranked high in the Pacific; Smoking ranked second or third in Cambodia, Indonesia, Laos, Malaysia,

Myanmar, Papua New Guinea, Philippines, Thailand, Timor-Leste, Vietnam

(IHME, 2013)

Cambodia, Indonesia, Laos, Malaysia, Myanmar, Papua New Guinea, Philippines, Thailand, Timor-Leste, Vietnam (IHME, 2013)

Shifts in Leading Causes of DALYs in East Asia and Pacific, 1990-2010

Shifts in Leading Causes of DALYs in East Asia and Pacific, 1990-2010 Source: IHME, 2013

Source: IHME, 2013

Shifts in Leading Causes of DALYs in East Asia and Pacific, 1990-2010 Source: IHME, 2013

Shifts in Risk Factors of DALYs in East Asia and Pacific for Top 15 Risk Factors, 1990-2010

Shifts in Risk Factors of DALYs in East Asia and Pacific for Top 15 Risk Factors,

Source: IHME, 2013

Shifts in Risk Factors of DALYs in East Asia and Pacific for Top 15 Risk Factors,

Prevalence of ADL, IADL Limitation

(selected countries, by Survey Wave)

 

Beijing

Indonesia

Philippines

 

1994

1997

1993

1997

1996

2000

ADL limitation

4.9

4.7

4.2

6.5*

10.9

14.7

IADL limitation

13.4

17.7*

n.a.

n.a.

20.9

27.2*

*Difference in prevalence estimates across waves is statistically significant at p<0.05. Source: Ofstedal et al., 2007

*Difference in prevalence estimates across waves is statistically significant at p<0.05. Source: Ofstedal et al., 2007

3. Increased Demand to Meet

Universal Health Coverage

1) Growth in Health Expenditure

• Health spending was much lower in developing countries (e.g. Myanmar’s 25 USD PPP per capita) compared with developed countries (e.g. OECD

average 3,514 USD PPP per capita) (OECD, 2014)

Growth of health spending has exceeded economic growth in many Asia- Pacific countries (2000-2012) (OECD, 2014)

• “Aging” explains one-third of the health spending growth in developed

countries, but it may take greater share in low- and middle-income countries (by increase of health coverage, urbanization) (World Bank, 2016)

take greater share in low- and middle-income countries (by increase of health coverage, urbanization) (World Bank,

Growth in Health Spending and GDP per capita, 2000-12

Growth in Health Spending and GDP per capita, 2000-12 Source: OECD, WHO, Health at a Glance:

Source: OECD, WHO, Health at a Glance: Asia/Pacific 2014 Original source: WHO GHO 2014, OECD Health Statistics 2014.

Source: OECD, WHO, Health at a Glance: Asia/Pacific 2014 Original source: WHO GHO 2014, OECD Health

2) Access to Health Care with UHC

Need government commitment to universal access to health care for all people including older people

- Need sustainable financing mechanism or prepaid scheme funded by the (mandatory) public source (government tax or social health insurance): Thailand, China

- Without subsidy to the poor, pure contribution approach faces

barriers to UHC

- Extend the benefit package of existing schemes and essential medicines list to cover NCDs and services for older people

- Extend the benefit package of existing schemes and essential medicines list to cover NCDs and

Financing Mix and Health Expenditure as a % of GDP

Financing Mix and Health Expenditure as a % of GDP Source: WHO, 2011

Source: WHO, 2011

Financing Mix and Health Expenditure as a % of GDP Source: WHO, 2011

3) Aging and Health (and Expenditure)

Does health status of the elderly improve over the years (e.g.,

compare the health of 70 year-old man in 1990 and 2010)

Question: Are the increased life years healthy or unhealthy ones?

- Expansion of morbidity (Gruenberg, 1977; Manton, 1982; Yong et

al., 2010 (for Singapore)): People live longer with ill health, as longevity increases vulnerability

- Compression of morbidity (Fries, 1980, Jang and Kim, 2010; Liu,

Chen, et al., 2009; Woo, Zheng, et al., 2015): Life years with illness

and disability decreases as the onset of morbidity is delayed more than life is prolonged -> People with high socio-economic status (Jung, et al., 2007)

of morbidity is delayed more than life is prolonged -> People with high socio-economic status (Jung,

Health Cost towards the End of Life:

Role of Integrated Service Delivery

System

Proximity of death has bigger impact than demographic change

(medical cost does not rise uniformly with increasing patient age)

- Health expenditure at the end of life decreases with age

(Kuriyama, 2008; Seok, 2012; Shin, et al., 2012)

Hospitalization (vs. dying in hospice or LT care institutions) and clinical decision on treatment (intensity of care) at the end stage of life has a crucial impact on medical cost of the elderly: end-of-life care matters

Prevention and health promotion is important: People who were healthier when young consume fewer resources in later life (Gandjour and Lauterbach, 2005; Daviglus et al., 2005)

consume fewer resources in later life (Gandjour and Lauterbach, 2005; Daviglus et al., 2005) Kwon: Health

Kwon: Health Systems Asia

Health Expenditure at the Last Year of Life, Korea (2008)

18,000 16,496 17,027 15,818 15,919 16,000 14,455 14,966 14,420 14,000 12,954 12,879 11,134 12,000 10,000
18,000
16,496 17,027
15,818
15,919
16,000
14,455
14,966
14,420
14,000
12,954
12,879
11,134
12,000
10,000
8,861
7,143
8,000
5,485
6,000
4,274
4,000
2,000
-
1,000 KRW

~34

35~39 40~44 45~49 50~54 55~59 60~64 65~69 70~74 75~79 80~84 85~89 90~94

Source: HC Sin, MY Choi and BH Tchoe (2012)

95~

35~39 40~44 45~49 50~54 55~59 60~64 65~69 70~74 75~79 80~84 85~89 90~94 Source: HC Sin, MY
Determinants of Health Expenditure for Older People Source: OECD, 2013
Determinants of Health Expenditure for Older People
Source: OECD, 2013

Kwon: Health Systems Asia

Determinants of Health Expenditure for Older People Source: OECD, 2013 Kwon: Health Systems Asia

Per Capita Health Expenditure by Age Group, Japan (2010)

(Data Source) MHLW, Japan
(Data Source) MHLW, Japan

Kwon: Health Systems Asia

Per Capita Health Expenditure by Age Group, Japan (2010) (Data Source) MHLW, Japan Kwon: Health Systems

Climate Change

Climate Change Climate change has a direct threat to health – and it could potentially cause

Climate change has a direct threat to health and it could potentially cause health systems to collapse, should countries fail to mitigate risks.

Countries should build health infrastructure and systems that is resilient to climate

change.

fail to mitigate risks. Countries should build health infrastructure and systems that is resilient to climate

Regional Health Security

Emerging and Reemerging

infectious diseases recognized a

continuous threat in Asia

regardless of the country’s income status.

Regional Health Security measures should be strengthened to mitigate risks, improve response of countries and the international community.

measures should be strengthened to mitigate risks, improve response of countries and the international community.
measures should be strengthened to mitigate risks, improve response of countries and the international community.

Health Facility Aspects for Discussion

Safe and Resilient

Green and Sustainable

Accessible

People-

centered and

Integrated

Health

Security

for Discussion Safe and Resilient Green and Sustainable Accessible People- centered and Integrated Health Security

OPPORTUNITIES TO ADDRESS

THESE CHALLENGES

OPPORTUNITIES TO ADDRESS THESE CHALLENGES

1. New innovative hospitals whose design and construction can address these

Planning

Infrastructure for processes

Maintenance

Cost of ownership

challenges Design Space for machines Data room IT in patient rooms More mobile care deliv
challenges
Design
Space for machines
Data room
IT in patient rooms
More mobile care deliv
Construction
Building in cable
connections
Operationalization
Training staff
in patient rooms More mobile care deliv Construction Building in cable connections Operationalization Training staff

2. New technology supported health

care to improves efficiencies

$2bn

Cost of

adverse

events

$380m

Cost of preventable medication errors

Examples from Australia

17% of

$1.5bn

medication errors Examples from Australia 17% of $1.5bn Pathology tests are Cost of non- collaboration on

Pathology tests are

Cost of non- collaboration on Chronic Disease Management

duplicates ($306m)

18%

of errors due to

wrong medical Info

25%

of Physician’s time

errors due to wrong medical Info 25% of Physician’s time spent on getting medical info *

spent on getting medical info

* Peter Fleming, CEO NeHTA | Canberra, 12 April 2010

IT in service delivery has economic value

Positive socio-economic value after 7-9 years 2)

Source 1)

1) DesRoches CM et al. N Engl J Med 2008;359:50-60 2) The Socio-economic impact of interoperable EHR and e-prescribing systems in Europe and Beyond, Oct 2009

2008;359:50-60 2) The Socio-economic impact of interoperable EHR and e-prescribing systems in Europe and Beyond, Oct

Technology supported hospitals are

complex

Technology enabled processes are everywhere

are complex Technology enabled processes are everywhere Issues in health care • Difficult to automate human

Issues in health care

Difficult to automate human

decisions

Fragmented poorly- coordinated systems and processes

High volume of patients, little resources, little time

• Fragmented poorly- coordinated systems and processes • High volume of patients, little resources, little time

Focus needs to be on IT to improve

processes

2. Process Engineering Hospital construction
2. Process Engineering
Hospital
construction
processes 2. Process Engineering Hospital construction Patient care environment Management 3. Service Delivery
Patient care environment Management 3. Service Delivery
Patient care
environment
Management
3. Service Delivery

equipment

Hospital construction Patient care environment Management 3. Service Delivery equipment 1. Data Management

1. Data Management

From the current state of health facilities to 21 st century health facilities?

From the current state of health facilities to 21 s t century health facilities?

Thank You!

Thank You!