ACCESS Health China and L.E.K. Consulting recently launched a new report named Paying for the Cure: Transforming the Financing of Novel Therapies. The report focuses on innovative payment models for novel therapies in the Asia Pacific region. The report serves as a guideline for pharmaceuticals, hospitals, insurance companies, and policymakers to develop innovative services to benefit patients.
The report consists of three parts: context around the low affordability of novel therapies, analysis of current innovative cases, and instructions on the design of innovative payment models. The first part of the report reveals the current challenges for middle and low class patients to afford new and advanced treatments. For instance, a study in the report shows that more than seventy five percent of new cancer patients in Southeast Asia experience financial catastrophe or die within one year of diagnosis. The second part of the report categorizes four different models of health payment innovation in the region and analyzes the pros and cons. The last part of the report provides thorough instructions on designing an innovative healthcare financing solution. It highlights three key points of a successful model, which are patient centric, value added to both drug manufacturer and patient, and scalable.
Health Finance is a key focus area of ACCESS Health. We promote the development and implementation of innovative financial services by the government and the private sector to support affordable access to health services for all.
ACCESS Health has issued a call for proposals for its Safe Care, Saving Lives program in India. Safe Care, Saving Lives is currently focused on reducing newborn death in India through improvements to quality of care. The request for proposals is for the continuous development of a web based management information system that will compile and track progress toward quality improvement from a large number of health care facilities.
The call for proposals closes May 30, 2018. If you’re interested in submitting a bid, please click here for more information.
Cancer has both social and economic implications in India. The stigma associated with cancer is known to leave a psychosocial impact that alters the health seeking behavior of the patient. The prolonged treatment often impoverishes the household. The mortality rate due to cancer is high, at sixty eight percent of the annual incidence. Fewer than thirty percent of Indian patients with cancer survive five years or longer after diagnosis. This rate is much lower than many developed nations. Five year survival rates in South Korea and Japan are sixty eight percent and sixty percent, respectively. In a group of nations including U.S., Canada, Japan and sixteen European countries this rate is as high as eighty five percent. Leading factors for poor survival rate in India include delayed reporting due to lack of awareness, inadequate or incorrect diagnoses and suboptimum treatment often due to patients’ inability to access therapies. The absence of a convergent approach to address the multifactorial causality of cancer is also a concern for India (Mallath, et al., 2014). Public expenditure on cancer in India remains below ten dollars per person, compared with more than hundred dollars per person in high income countries (Pramesh, et al., 2014).
Psychological impact of cancer
Cancer therapy along with mere treatment also encompasses management of pain and psychological trauma. Hence it is often referred to as care beyond cure (Neron, 2009). A cancer patient is often undergoing extreme mental trauma and stress coupled with apprehension and uncertainty. The experience is worsened by the financial distress of the long term treatment and the disruption to normal life. Side effects of the radio and chemotherapy, and the associated physical pain, add to this already negative experience. In a study conducted by Public Health Foundation of India, Bhubaneswar on the patient satisfaction levels in cancer care elicits the trauma of the cancer patients in Indian public health. This study considers the long waiting times for diagnosis and followup. Most of the cancer hospitals are located in large cities and warrant long travel for patients. Lacking diagnostic skills among primary healthcare doctors often worsen the situation (Mahapatra, et al., 2016). Social stigmas associated with cancer are attributed to changes in the body, cancer fatalism and a false belief that cancer is contagious (Kaur, 2015).
Financial impact of cancer
As per the National Institute of Cancer Prevention and Research, about around 2.5 million of Indians are living with cancer with seven hundred thousand being added each year. Eighty seven percent of these are diagnosed with cancer at the final stages (Sharma, 2016). As per an article published in the Times of India, the cost of the five most common cancers in India has risen by three to four times between 2000 and 2015. Insurance companies claim that one among the five cancer claims is by those between 36 and forty five years of age. Cancer may hence leads to the loss or disruption of household income. As per the latest National Sample Survey Healthcare round average out of pocket spending on cancer care is around INR thirty thousand and is the highest among all the inpatient episodes. The out of pocket spending for cancer care in private facilities is about three times that of public facilities (National Sample Survey Office, 2014). About forty percent of cancer hospitalization cases are financed mainly through borrowings, sale of assets and contributions from friends and relatives (Rajpal, et al., 2018).
Literature referred in this blog suggests that primary care doctors need training for diagnosis as well as to provide counseling for patients in long term care. Nurses and community workers are well placed to act as focal points to fight cancer stigma. The government should give this serious consideration as they roll out the health and wellness clinics in India. The rates of cancer survivorship can be improved through “prevention, early detection, diagnosis and treatment.” The rate of early diagnosis in India is very low and about twenty or thirty percent of cases are diagnosed at stage one and two, respectively. Primary care centers can also work towards improving patient awareness on oral and cervical cancers which form the bulk of cancer cases in India (Rajpal, et al., 2018). The National Health Policy (2017) has emphasized stronger relation with the private sector to fill the strategic gaps in the public sector. This would enable quicker and financially practical last mile access of cancer care.
With the roll out of the National Health Protection Scheme, which aims to reduce financial catastrophe, it is all the more necessary to leverage the presence of the private sector and develop the capacity of the public sector to improve the quality of life and survival chances of those suffering from cancer. Cancer treatment needs empathy, patience and alleviation fear before alleviation of pain. India Against Cancer is one of the Ministry of Health’s serious attempts to provide information on the prevalent cancers in India with a major focus on awareness, prevention and treatment of these cancers. Few states have seriously taken the importance of early detection and treatment. A highly literate Kerala has forty percent of its cases are detected early, which ultimately leads to fewer deaths. Telangana is tying up with the Tata trusts to ensure that the medical colleges in the state act as hubs for detection and treatment of cancer. The Government of India has set up Revolving Funds in twenty seven Regional Cancer Centers with funds upto INR five million at their disposal. Treatment for upto INR two hundred thousand is being provided free of cost to ensure that the financial duress is reduced.
Yet the need of the hour would be to work on the awareness levels of the public as well the medical fraternity. With the 1300 Indians being diagnosed daily with the deadly disease, awareness on the tell tale signs, risk factors and treatment options need to be communicated better. This is important to ensure that the patient’s are well armed with the needed knowledge to fight their battle against cancer.
Kaur, R., 2015. Cultural Beliefs, Cancer and Stigma: Experiences of Patients from Punjab (India). Studies on Ethno Medicine, 9(2), pp. 247 254.
Mahapatra, S., Nayak, S. & Pati, S., 2016. Quality of care in cancer : An exploration of patient perspectives. Journal of Family Medicine and Primary Care, Volume 5, pp. 338 342.
Mallath, M., Taylor, D. & Badwe, R., 2014. The growing burden of cancer in India: Epidemiology and Social Context. Lancet, 7011(9), pp. 1470 2045.
National Sample Survey Office, 2014. NSSO Social Consumption Health 71st round 25th Schedule. Ministry of Statistics and Program Implementation.
Neron, A., 2009. Care Beyond Cure: Management of Pain and Other Symptoms. Canadian Journal Hospital Pharmacists, 62(2), p. 178.
Pramesh, C., Badwe, R. & Borthakur, B., 2014. Delivery of aff ordable and equitable cancer care in India. Lancet, 70117(2), pp. 1470 2045.
Rajpal, S., Kumar, A. & Joe, W., 2018. Economic burden of cancer in India: Evidence from cross sectional nationally representative household survey, 2014. Plos One, 13(2).
Sharma, D., 2016. Cancer data in India show new patterns. Lancet, 2045(16).
In previous articles in my series on health and aging, I talked about the importance of healthcare coordination and caring for elders in their homes and outside of traditional hospital environments. These efforts are an important factor to improve health outcomes for the elderly. Yet these initiatives will always fall short of achieving maximum impact when they are not tied together by integrated information technologies that allow for real time data sharing and analysis.
The best example of a government developing and implementing streamlined digital health services is found far from traditional centers of technological innovation. Estonia is a small country in northern Europe with a population of just over a million people. The government of Estonia has created one of the most successful eHealth systems in the world, offering streamlined, online access to healthcare services and closely linking health services to other government services, like driver’s licenses, citizenship cards, and child benefits.
At the root of the Estonian eHealth system is the Estonian national ID card. Much more than a photo identification card, the mandatory national card provides digital access to all of Estonia’s secure eServices. Each card has an encrypted chip that carries embedded files with the personal information of the card owner. The card can be used for a variety of services, including logging into personal bank accounts, voter registration, and traveling within the European Union.
The card is also the link to a person’s medical records. When a person goes to the doctor in Estonia, all their test results, prescriptions, and other relevant health files are automatically uploaded to the encrypted chip. Because a patient uses their card for all health transactions, doctors can closely track patient progress. For example, doctors can check whether patients have picked up their prescriptions or whether they have been prescribed new medications from other health providers. The doctor can also find out if an older person living alone has received a recent home visit from social services or if a home visit needs to be scheduled.
All information in the eHealth system is centralized and cannot be altered once the doctor digitally signs the patient record. Whenever a person visits a new healthcare provider, the new provider can easily review the patient’s full medical background simply by scanning the patient’s identification card. The eHealth system has also significantly improved emergency services across the country. Each emergency vehicle is now equipped with an iPad on which the eHealth program is run. Emergency personnel can obtain patient records while working on an injured person en route to the hospital. Police and firefighters use a similar system.
By linking medical records to other government services through the digital identification card, the government is able to streamline a wide array of other public services. For example, if a person needs to renew their driver’s license, they can present their digital identification card to the Department of Transportation to show that they have passed all necessary medical examinations. If a person requests medical leave from their job due to an injury, the identification card makes it easy for employers to verify the validity of the request.
The eHealth system also allows for real time collection and analysis of national health statistics. All data is coded and made completely anonymous before being made available for analysis. Once anonymized, researchers can extract any statistics they need, be it about medications, diagnoses, treatments, or specific health problems. This allows healthcare leaders to continually examine and improve healthcare systems and service offerings.
The digital overhaul of the Estonian health system is transformative for elders and all people in need of healthcare alike. While other countries with larger populations and weaker digital infrastructure may not be able to implement all these changes on such a grand scale, each of us can look to Estonia as a blueprint for what can be achieved with the right mix of government leadership, innovative technology, and widespread commitment to improving efficiencies in health.
ACCESS Health China recently held a special “Health Futures Industry Networking Reception” in collaboration with Yale University at the Yale Beijing Center. Yale University School of Public Health and ACCESS Health have been working together closely to create a healthcare innovation ecosystem with a specific focus on urban health. More than forty mentors and partners participated in the session.
We were honored to be joined by Dr. Sten H. Vermund, dean of School of Public Health, and Dr. Jeanette Ickovics, deputy dean of School of Public Health of Yale University as both keynote speakers. They each delivered a speech on urbanization and healthy cities based on their practical experience in both hospital care and community care. They highlighted the ways in which globalization and urbanization would create new challenges for health and life quality, such as a rise in pollution, increased chronic illnesses, and inefficient healthcare resource distribution.
Following the two speakers, Dr. Chang Liu, managing director of ACCESS Health Mainland China, Hong Kong, and Singapore, introduced the ACCESS Health China Health Futures Innovation Platform to the audience. Urban health is a new focus area of Health Futures in China. Innovations of health delivery system, health technology, and health finance are urgently needed to improve the quality and affordability of urban health services.
A follow up panel discussion featured four leaders from the investment, consulting, insurance, and property development worlds.
Shirley Yeung, founder and managing partner of Dragonrise Capital shared their investment strategy in urban health sector. She also shared successful examples and insights on the development of the urban health industry.
Dong Mei, KPMG partner in healthcare and aged care introduced the transformation and progress in the urban health sector. She explained the challenges and opportunities in the urban health industry in China.
Xin Li, vice president of Ping An Health Insurance, shared the innovative approaches of Ping An in health finance. She emphasized the significance of payment model innovation to realize the universal healthcare coverage under the trend of urbanization.
Andy Zhang, executive general manager of business development of Fosun-Sungin shared their practical achievements in combining urbanization and health services through real estate development. He illustrated some innovative concepts and technological applications in healthcare and aging in China.
At the end of the session, two Startup Alliance members, LinkAgingCare and Judong Tech, presented their projects and business development ideas for mentors and partners. LinkAgingCare is transforming a community based elder center into high quality education and event center with innovative online courses for the elderly. Judong Tech is building a regional emergency transport integration platform that grades emergencies and points people toward where they can go for help.
ACCESS Health China co organized the commencement ceremony of Bright Start with Non-Profit Incubator and J.P. Morgan on April 21, 2018. The commencement took place at Shanghai Polytechnic University. More than forty students and more than twenty guests from the program, corporations, and schools participated in the event.
ACCESS Health actively organized and participated in most of the sessions. Linguo Li, senior consultant of ACCESS Health China awarded students a certificate of graduation. Shu Shang, associate director of operations of ACCESS Health China was nominated to become one of five outstanding mentors. Shawn Gu, communications manager of ACCESS Health China delivered a speech on behalf of all mentors who have shared their time, knowledge, and experience to the Bright Start students.
We were also honored to have other distinguished guests join us, namely J.P. Morgan China human resource team, J.P. Morgan Foundation, Non-Profit Incubator team, four corporation representatives, and two university representatives. The event was also reported by many mainstream media groups in Shanghai.
Bright Start is a nonprofit joint project between ACCESS Health China and Non-Profit Incubator and funded by the J.P. Morgan Foundation. The goal of the project is to prepare students for jobs in the digital health sector.
ACCESS Health is the main partner and organizer of Bright Start. We connect schools and students to leading corporations in the digital health sector. To date, these corporations have provided more than eighty internship positions and participated in over twenty Bright Start events. We also provide corporations exclusive opportunities to communicate with young talents and student users among the universities.
ACCESS Health also participated in the internship recruitment and student training. We successfully recruited one intern from Bright Start students. The intern will officially join us this June after graduation with her excellent performance. Most staff members of ACCESS Health in Shanghai volunteered in the training sessions by sharing their insights in career development.
We have posted ten online study videos with support from our partners in the digital health industry. We also guided students toward critical and innovative thinking during design thinking workshops on their future careers in the health industry and on where health intersects with the internet.
This article was originally published on Forbes.com.
Coordinating social and healthcare for the elderly its a critical challenge. The goal of care coordination is to ensure that all those responsible for the health and wellness of an older person have a clear understanding of their roles and their shared responsibilities.
Even in a country like Sweden, which has a strong healthcare system and which dedicates significant money and time to improving the system, care coordination is a challenge. This is in large part because the responsibility for healthcare is divided between two levels of local government – the county and the municipality – and neither is fully informed about what the other is doing. Counties in Sweden are much like our states and municipalities like our cities. The counties deliver primary healthcare services and the municipalities manage social and long term care, including elder care.
In Sweden, it is not unheard of for a single person to have up to sixty different healthcare providers from different clinics and organizations, across both levels of government. In an ideal healthcare system, the primary healthcare provider would coordinate all care, keeping track of the person’s health information and keeping every provider up to date on respective roles and the patient’s health. Because of the healthcare division in Sweden, this rarely happens. A 2015 Commonwealth Fund survey of primary care physicians in Sweden and nine other countries found that fewer than half of primary care physicians in Sweden coordinate care with homecare and other social services.
A senior physician in Sweden who specializes in geriatric care puts it like this, “Imagine that the two sides start building a bridge to connect the two countries. Both sides do an amazing job. Both sides are competent. However, the two sides of the bridge don’t meet in the middle. You are left with two disconnected half bridges. This illustrates our healthcare system. We each work in silos. Each silo consists of competent healthcare providers working independently when what we need to do is work together.”
In Uppsala, a municipality of around 200,000 people near Stockholm, they have built a new structure to bridge the care coordination gap. The municipality created a central care coordination group for elder and long term care, which acts as a person’s surrogate primary care physician. The group includes doctors, nurses, occupational therapists, and support agents from the municipality. Instead of being directed by the primary care physician, this core team acts conducts all care planning meetings and updates the primary care physician on progress. This alleviates the burden on primary care physicians, who are employed by the county and rarely have time to attend, much less manage, care planning meetings for each of their patients in need of long term care or social services.
Primary care physicians are invited to participate to the maximum extent possible and are welcomed at all care planning meetings and into all care discussions. If they can’t attend the meetings, they are kept up to date on all developments by a member of the central care coordination team.
The Uppsala example is an important one. Every country has bureaucratic and administrative roadblocks that prevent efficient delivery of care for young and old alike. Uppsala care providers knew that policymakers wouldn’t be able to change the way care is divided between the municipality and the county. Any legislative change would move far too slowly for patients in need. Instead of accepting the status quo, local government leaders and healthcare providers worked together to restructure the way primary care physicians and specialized care providers communicate and interact. By doing so they transformed care coordination for the elderly and those in need of long term care. What Uppsala shows us is that local innovations can deliver remarkable results. Next in the series, we’ll talk about how technology can further improve care integration.
This article was originally published on Forbes.com.
Demographic change is a defining issue of our time. As the worldwide population ages, the healthcare systems of every country, including the United States, will face significant challenges to meet the needs of an aging population.
This article is the first in a series that will explore how nations are coping with demographic change. The series on aging will give you a close look at the future of long term care through the lens of a number of different healthcare systems. The articles will highlight people, communities, and companies that have found remarkable approaches to address problems associated with an aging population. My team at ACCESS Health and I helped identify these innovative approaches through years of research on elder care in Europe, Asia, and here in North America.
Elder and long term care is rapidly becoming one of the most daunting healthcare challenges of our day. Between 2015 and 2030, the number of people in the world aged 60 years or over is expected to grow by 56%, from just over 900 million to nearly 1.5 billion. By 2050, the global population of people older than 60 is expected to jump to two billion. In the United States, the number of Americans over the age of 65 is expected to doublefrom roughly 50 million today to nearly 100 million by 2060. While the United States is currently ranked among the top countries in the world for the elderly, there are significant variations across the country in access to healthcare and quality of life.
Central and South America are also rapidly aging. In every country in the region, the proportion of people over the age of 60 will increase significantly. The same demographic changes are happening in the Caribbean, where low and falling fertility rates compound the problem. In Europe, the aging population is also increasing. Europe faces its own unique challenges, in large part due to the global financial crisis of 2008. In Greece, Spain, Italy, and Portugal governments had to reform pension systems after the crisis, increasing the retirement age, limiting the number of benefits, and reducing resources allocated for healthcare and social care. In populous Asian countries like China and India, there are even greater challenges due to the sheer number of older people. In China, the population of people over 65 is expected to jump from 8% to 24% in just 30 years.
Neither low, nor middle, nor high income countries are immune to the implications of this change. As people age, they suffer from more and more illnesses. These chronic illnesses are placing an increasing burden on health systems. Governments need to recognize the effects of demographic change, not merely on public services, but on the social climate of each nation. Countries will have to reconsider all aspects of their communities, from healthcare systems and methods of delivering care to how whole cities are structured. An aging population can also create an unsustainable burden at the household level. The physical and emotional burden of providing care to an aging loved one is compounded by the fiscal burden as well.
Each country needs to find a way to avoid these scenarios. The benefit of changed population pyramids is that they force all of us to scrutinize our old ways of thinking and design new services and ways of delivering care. Governments must plan decades ahead, studying the economic and social implications of aging. As societies age, all those involved in the healthcare and social care systems must adapt their services, and continuously learn.
Many countries are finding new cost effective approaches to elder and long term care that meet the needs of their growing population of elders while containing costs. Some are building age friendly cities and housing. Others are adapting traditional services and products to meet new consumer needs. Many are revisiting their policy agendas and reviewing their healthcare financing systems as well. In the next article we will turn our focus to one country that has implemented some very low cost but high impact approaches to elder care, with great success: Sweden.
ACCESS Health was recently invited to share learnings from India on quality improvement as part of the 13th International Breastfeeding and Lactation Symposium in Paris. Ajitkumar Sudke, ACCESS Health India’s Director of Quality and Process Improvement and head of our Safe Care, Saving Lives program shared preliminary findings from a research study taking place in three Indian hospital neonatal intensive care units. The research identifies some of the bottlenecks and challenges that prevent mothers from feeding newborns breastmilk. It also describes strategies to overcome those challenges, including identifying culturally acceptable and easily adoptable quality indicators that can be measured to ensure adequate early initiation of breastmilk feeding and continued supply of breastmilk in babies admitted to neonatal intensive care units. Developing and using digital data collection tools to improve the collection of data related to current feeding practices was also discussed in detail. Download the ACCESS Health poster here and visit the conference website for more information.
Primary care is the first point of entry for most patients into a health system. This makes primary care an important platform for preventive and promotive efforts, such as nutrition counseling, mothers groups, and outreach for school health. Primary care can also be an important coordination point to address social determinants of health, including clean water and sanitation.
In India, primary care tends to be organized around short term interests. The consumer wants to feel better, quickly, and the provider wants to ensure that they see the most number of patients possible. This approach undermines long term health outcomes in favor of short term results, such as administering medicine for an immediate illness as opposed to determining the root cause of a current or potential illness and taking steps to prevent it.
Taking inspiration from existing health system frameworks, ACCESS Health created a market forces framework that offers a lens for responding to local market dynamics and taking a more strategic long term view of strengthening primary care. It includes a concrete four step process for applying the framework to India and other settings.
By going through this framework, policymakers and program designers can strategize potential solutions to increase access to, and the quality of, primary care, and create programs that shift incentives toward more robust, sustainable, and locally driven solutions. For existing programs, the framework can be used to map progress and make adjustments as required.
With the goal of universal health coverage as a priority, we think reforms to primary care in India are overdue. With this in mind, we developed this framework to facilitate such reforms. We invite you to download the framework here and share it widely within your networks.
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