Post on 30-Nov-2018
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Dr Stephen Child
Chief Medical Officer
Future of healthcare
Presenting symptoms Q1 2018 % of total
symptoms
Vomiting 3,218 4.1%
Rash 3,186 4.0%
Abdominal pain 3,303 4.2%
Fever (symptom) 3,827 4.8%
Cough 4,847 6.1%
Diarrhoea 1,761 2.2%
Medication query 2,134 2.7%
Chest pain 1,982 2.5%
Headache 1,743 2.2%
Diarrhoea and vomiting 864 1.1%
Head injury 929 1.2%
Sore Throat 1,250 1.6%
Immunisations 794 1.0%
Cold/Flu 1,900 2.4%
Unwell 884 1.1%
Vaginal bleeding 715 0.9%
Backpain 664 0.8%
Constipation 631 0.8%
Fall 401 0.5%
Dizziness 621 0.8%
What’s changed?
Growing patient expectations
Funder wants value
State suspicious of self-regulation
= reduced autonomy and wellbeing
Myth: only rich people have health insurance
Only 16% earn more than $100,000
*Statistics NZ – June 2017
Cancer therapy
Aromatherapy Ayurvedic RykeHerbalism Homeopathy
Shamanistic Naturopathy Urotherapy Diets +++ Macrobiotics
Probiotics Bioresonance Magnet Therapy Light Therapy Orgone
Polarity Therapeutic Touch Zoetron Aloe Cannabis Capsicum Castor Oil Ginseng Grapes Kombucha Milk Thistle
Mushrooms Acupuncture Chiropractic Craniosacral Colonics Cupping Ear Candling Reiki
Shiatsu Hypnosis Faith-based Meditation NLP Qigong
Bee Venom Caesium Salt Chelation Colloidal Silver Emu Oil
Hyperbaric OrthomolecularOxygen Shark Cartilage Vitamins
Condition X
30% placebo
always effective
20 people take
treatment A
20 people take
treatment B or
placebo
Evidence based or biased?
Background
Wang MT, Gamble G, Grey A. JAMA Internal Medicine. 2015;175(5):845-848.
Oestrogen and progestin replacement Prevention of cardiovascular disease in post menopausal women
Tympanostomy tube insertion Treatment of persistent otitis media
Vitamin D and calcium Prevention of fractures
Vitamin E Prevention of cardiovascular disease and cancer
Mammography screening Detection of breast cancer from 40 years
Percutaneous coronary intervention Treatment of stable coronary artery disease
Rosiglitazone Treatment of type 2 diabetes
Arthroscopic surgery Treatment of osteoarthritis of the knee
PSA screening Detection of prostate cancer
Vertebroplasty Treatment of osteoporotic vertebral fractures
Rosuvastatin Treatment of haemodialysis patients
Intensive glucose control Treatment of type 2 diabetes
Prednisolone Treatment of wheezing in preschool children
Darbepoetin alfa Treatment of type 2 diabetes and chronic kidney disease
Renal artery revascularisation Treatment of renal-artery stenosis
Calcium Prevention and treatment of osteoporosis
Intensive BP control Treatment of critically ill patients
Aspirin and heparin Women with recurrent miscarriage
Fish oils Prevention of cardiovascular disease
Type 2 diabetes screening Detection of type 2 diabetes
Established practices and indications
Medically Unexplained Diagnosis (MUD)
Germany n=620
consecutive
66% MUD
By 12 months:
Somatoform 22.9%
Affective 12.4%
Anxiety 11.4%
SouthernCross
nib Sovereign Unimed PartnersLife
Accuro Others
New Zealand’s private health insurance market
62%
15%
7% 5%
3%2%
6%
GPs interested in accessing patient feedback
Interested in feedback
about specialists
Interested in feedback about
other healthcare providers
(eg physiotherapists)
Need a plumber?
• Quality?
• Qualifications?
• Recommendations?
• Ability to understand the job?
• Invoice is visible
• Cost comparison
Outcomes and Experience Questionnaire (OEQ)
49,000 responses*
Patient Reported Outcome Measures Survey (PROMS)
5,300 responses*
*May 2018 figures
Patient outcomes and experience programme results
• highly likely to refer their friend or family member to see the provider who treated them
• Average of 94% for Experience and 88% for Outcomes
Patient outcomes and experience programme results: Detractors
Misogynist. Couldn’t talk
to me, or gave me
contradictory information.
So I took my husband
along, and he talked to my
husband instead of me,
that way I could find out
what was happening.
He is very blunt and
did upset me by the
manner in which he
assessed my low pain
threshold.
I could have
been better
informed.
Technically brilliant
but would be good
to know how to deal
with people at their
most vulnerable.
Likely future?
Self-regulation (and sanction) Super-specialisation
Corporatisation/competition
“Protocolisation” of
medicine
Self-regulation (and
sanction)Super-specialisation
Corporatisation/
competition
Will patients be better ?
• Vulnerable to exploitation
• Solutions without problems
• Increased “worried well “
• Who will they trust?
Will people trust Google?
Source: CB insights (morning consult + politico national tracking poll)
“How much do you trust Google to keep your personal
data private?”8%
Don’t know/ no opinion
53%Not at all/ Not very much
39%A great deal/ a fair amount
How ethical is the business model?
1. Define “value” offered
2. Transparency:
price, quality
3. Trustworthiness