2003 : Health Care Challenges, Systems and Leaders of the Future

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2003 Health Care Challenges, Systems and
Leaders of the Future
The Global Medical Forum II Making a Difference
in the Health Care Debate The Convergence of
Healthcare March 26, 2003, Zürich,
Switzerland Dr. Robert G. Geursen, M.D.,
Ph.D. robert.geursen_at_geursen-consulting.de
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2003 Health Care Challenges, Systems and
Leaders of the Future

• The Greying Society
• Emerging Diseases
• Access To Health Care
• Genomics and Proteomics
• Information and Knowledge

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The Greying SocietyIschaemic Heart Disease

• Over 1.8 million people in the EU have a heart
  attack in a given year and approximately 8.5
  million suffer from angina.
• In 1998, IHD is estimated to have caused at
  least 800.000 deaths in the EU.
• Angina and MI are uncommon below the age of 45,
  but thereafter, incidence rises with age.
• Some 8 per cent of men and 7 per cent of women
  in the age range 65-74 experience angina in a
  given year and for those aged 75, the figures
  are 11 and 10 per cent, respectively.
• Between 40 and 50 per cent of patients
  experiencing a heart attack die within 20 days.

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The Greying SocietyPre-senile Dementia /
Alzheimers Disease

• In Europe, dementia affects as many as 5 per cent
  of people over 65, rising to a third by the
  late 80s. In the United States,
• 4 million people are affected.
• The aging of the population means that the number
  of people affected by Alzheimers is likely to
  increase significantly.
• Alzheimers is, however, not merely a natural
  consequence of aging. Apart from genetic
  predisposition, long-term risk factors for
  acquiring cardiovascular diseases are also
  considered to be risk factors.

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Emerging Diseases Bacterial and Viral Pathogens

• A family of human retroviruses, of which HIV is
  one
• Helicobacter pylori, causing peptic ulcers
• Legionella pneumophilia, the cause for
  legionnaires disease
• Borrellia burgdorferi, causing Lyme disease
• Viral hemorrhagic fevers (Ebola, Lassa, Hantaan)
• Staphylococcuc aureus spec. causing toxic shock
  syndrome
• Vancomycin-resistent Enterococci
• Methicillin-resistent Staphylococcus aureus
• Hepatitis C, D and E
• Coronavirus spec. causing atypic respiratory
  syndrome SARS

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Access to Health CareCountry Categorization
The United Nations Classification of the
Countries of the World

• Developed Economies 23 countries The G7 group,
  other South and West European countries,
  Australia and New Zealand
• Economies in Transition 25 countriesCentral
  and East European countries, Russia, the
  Commonwealth of Independent States, the Baltic
  States
• Developing Countries 130 countriesSubdivided on
  a financial or geographical basis such as capital
  surplus countries (middle east oil states), net
  energy exporters (23), most indebted countries
  (15), least developed countries (50),
  sub-Saharan Africa countries (all south of
  Sahara, except South Africa and Nigeria)

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Access to Health CareHealth Care Profile of the
Developing World

• 1.3 billion people in developing countries live
  on less than US1 per day
• 30 million people die annually from preventable
  or curable causes(90 pneumonia, diarrhea,
  measles, TB, malaria, HIV/AIDS)
• 300 million cases of malaria in 1998, one million
  fatal cases every year
• 37 million people live with manifest HIV
  infection, nearly 26,5 million of them live in
  Africa, 20 million people are ill with TB, 90
  of these live in developing countries
• Because of limited diagnostic facilities, only
  10 of the seropositive Africans know that they
  are infected

Source WHO, SCRIP, MSF
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Access to Health CareSegmented Market and
Ramsey Pricing

• Where there is a need to recover fixed costs from
  sales in severalmarkets, all participants can be
  made better off by price discrimination of price
  elasticities different between the various
  markets.
• The mark up over marginal cost in each market
  should be inverselyproportional to the price
  sensitivity of demand, i.e. willingness to pay.
• Increased access to the product spreads the
  burden of fixed costs.
• Approach adopted by enterprises with high sunk
  costs, e.g. airlines,
• railways, utility providers

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Access to Health CareSingle Price Versus Price
Differentiation
Note A single price produces much smaller
profits (small rectangle) than does price
differentiation (large triangle).
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2003 Health Care Challenges, Systems and
Leaders of the Future
In all things human, close examination shows
that you can never eliminate an evil without it
giving rise to another..
Niccolò Machiavelli, 1469 -1527
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Information and KnowledgeSigns That You Live In
The 21st Century

• You just tried to enter your password on the
  microwave. 
• You have a list of 15 phone numbers to reach your
  family of 4. 
• Grandmother asked to send her a JPEG file of the
  newborn so she can create a screen saver. 
• Leaving the house without cell phone, which was
  not available the first 20/30 years of your life,
  is cause for panic, so you turn around to go get
  it.
• Your reason for not staying in touch with family
  is that they do not have e-mail addresses.
• You get an extra phone line so you can get phone
  calls.
• You wake up at 2 am to go to the bathroom and
  then check your e-mail.
• You start tilting your head sideways to smile.

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Information and KnowledgeThe Matter of Context /
Systems Thinking

• IT increases the efficiency of existing processes
• IT creates changes of paradigm
• IT enhances the connectivity between stakeholders
• IT encourages flexibility site becomes less
  relevant
• IT accelerates migration from in-patient care to
  home-therapy
• IT allows transforming information into knowledge
• Two questions remain, though
• Will knowledge be transformed into policy and
  policy into action?
• What are the incentives for the different
  stakeholders quality of care, financial outcome,
  loyalty / binding of patients, saving of time?  

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Genomics and ProteomicsMother Natures Blueprint

• There is a lot of commonality across the entire
  biological spectrum nature has created roughly
  1.500 gene types which are adapted / combined for
  many different purposes
• Plus ça change, plus cest la même chose whether
  it is the roundworm caenorhabditis elegans or a
  human being the genes are identical
• An individuals blueprint consists of some 30.000
  genes which encode for some 180.000 proteins that
  interact with cells
• These 30.000 genes make up 2 per cent of total
  human DNA
• 20 per cent of actual drugs have a biotech
  origin proteins, monoclonal antibodies, vaccines
  

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Genomics and ProteomicsMother Natures Principles

• Life of all species begins with a single cell
• Research goes on to harness the omni-potency of
  this first cell
• Stem cell biology and tissue engineering will
  lead to a new era of regenerative medicine
• Somatic gene therapy is already underway
• Understanding of disease states moves more and
  more from phenotype to genotype

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2003 Health Care Challenges, Systems and
Leaders of the Future

• The Greying Society
• Emerging Diseases
• Access To Health Care
• Genomics and Proteomics
• Information and Knowledge

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2003 Health Care Challenges, Systems and
Leaders of the Future
A crisis can be a very productive time period.
One just has to do away with this by-taste of
catastrophy.
Max Frisch, Swiss author of the last century