2011Health Indus & Mana Holistic Care & Valuation

8/13/2019 2011Health Indus & Mana Holistic Care & Valuation

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A Framework of Holistic Care

[email protected] 3366-8069


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Health Negative View (more medical care)

Minimization/Absence of some variables Societies take this view might only intervene

life-threatening traumas and illness

Positive View (more holistic) A state/condition of complete physical, mental,

and social well-being (not merely the absence ofdisease or infirmity, WHO)

Pursue a variety of significant interventions toenhance the health of its member


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Right to Health The enjoyment of the highest attainable

standard of health is one of the fundamentalrights of every human being without distinction ofrace, religion, political belief, economic or social

condition. (2nd preamble of WHOs constitution) The objective of the World Health Organization

(hereinafter called the Organization) shall be the

attainment by all peoples of the highest possiblelevel of health. (Article 1 of WHOs constitution)


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ICESCR (International Covenant on Economic, Social and Cultural Rights)


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Health care: the total societal effort, undertaken in the

private and public sectors, focused on pursuing health

Healthneed

Hea

lthoutcome

National health system: components,

function & interdependence

ManpowerFacilities

Commodities (drugs, etc)

Knowledge

RESOURCEPRODUCTION

General Tax

Social Security

Voluntary Insurance

Charitable Donation

Individual & Family

ECONOMIC SUPPORT

Preventive CarePrimary Care

Secondary Medical Care

Tertiary Medical Care

Care of Special Disorders

DELIVERY OFSERVICES

Public Agencies: Ministry

of HealthPrivate Market

Voluntary Agencies

Enterprises

ORGANIZATION OFPROGRAMS

Planning

Administration

Regulation

Legislation

Planning

Administration

Regulation

Legislation

MANAGEMENT

Source: M. Roemer: Types of Health System andDeterminants, National Health System of the world

Health services: specific activit ies undertaken to maintain

or improve health or to prevent decrements of health


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Carry out the Right to Health

Systems

Transformation/Production

Policies

Public/Private (FP/ NP)Organizations

Health/Illness

Preventing

Early detecting/early treating

Curing & Rehabilitating

Disability requiring medical care

Inherent

Resulted from disease

Functionally decayed

Emergency, Inpatient,Ambulatory, Long-term


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Value Chain Entire production chain from the input of raw

materials to the output of final product consumedby the end user.(Porter,1980)

Each link in the chain adds some value to original

input.

Supplier

Value

Chain

The firmsValue

Chain

Channel

Value

Chain

End-user

Value

Chain

Value

Adds

Value

Adds

Value

Adds

Firm infrastructure (e.g.. finance, accounting, legal)

Health resource management

Technology development

Procurement

Inboundlogistics Productionoperation Outboundlogistics Marketingand sales service


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Health care Services value chain

Payer

Contributors

Government

Employers

IndividualsEmployer

Coalitions

Fiscal

intermediaries

Third party

Insurers

HMOs

PharmacyBenefit

Managers

Providers

Hospitals

Physicians

IDNsPharmacies

Purchasers

Wholesalers

Mail-Order

Distributor

Group

Purchasing

Organizations

Producers

Drug Mfgrs

Device Mfgrs

Medical-

Surgical Mfgrs

-Burns et al., 2002


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Characteristics of Health CareServices

Uncertainty Incidence

Curing

Third party payer

Information Asymmetry

Externality Government Intervention


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Health Care Services Market Pure free market

Users: able to pay Capitalism

$

services

$

Resources manpower facilities commodities

knowledge

UsersPatients

UsersPatients ProvidersProviders

SuppliersSuppliersEquity?

Solidarity?


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Government Intervention Equal access for equal need (financial barrier)

Health care financing

UsersUsers ProvidersProvidersService

GovernmentGovernment

Management

Equity

SuppliersSuppliers$

Resources

$

Who are paying?


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More Problems

Escalation of health care expenditure

Third partypayer



SuppliersSuppliers$

Resources

$

$Management

Utilization control, managed care Supply

-utilization review- Reasonable volume- Payment schemes (DRGs,

capitation)- Practicing patterns (CBA,CEA)

Demand

- copayment- deductible- availability of providers & careprovision

Responsiveness

Financial barrier

StintingQualityEfficiency

Creamskimming


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A regulated, agent-principal,

inefficient market Problems Everywhere!

Resource production & allocation

Manpower production (Edu.) Technology dissemination (CEA) Plans & providers productive

efficiency Budget cap Care rationing

Quality/Safety Manpower qualification Drugs, devices permissionOrganization accreditationAdequate, appropriate care

Equity

Financial contribution Financial barrier

Selection incentive

Third partypayer



Management

SuppliersSuppliers$Resources

$Expenditure, quality, access

Informationasymmetry(deficientsupervision &

knowledge ofchoice)

Agent-principal(provider, agent)

CompetitionEquity

Balance ofprovision,

Efficiency

Technologicalintroduction

Incentives


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Consumption Decision Government Regulations

Health Plan Management

Agent (provider) Principal (patient)

Who can decide what, which, and whenWho can decide what, which, and when

services/commodities/facilities to be used?services/commodities/facilities to be used?


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Market and Players

Systems

Transformation/

Production

Policies

Distributors Producers

Fiscal

intermediaries

Third party

Payer

Contributors

ManagementRegulation



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Provision of Medical Care

Illness DisabilitySub-acute

Primary Secondar Tertiary Chronic Mental Function lost

Setting

Home

Community

Institution

Acute Disable


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Life style

Heredity

Health

(well-being)

SomaticSo

cial

Psychic

Life Expectancy

Reserve

Internal

Satisfaction

Interpersonal

Behavior

Social

Behavior

Disability

Impairment

Participation in

Health Care

Discomfort

Health Behavior

Ecologic Behavior

External

Satisfaction

Medical care services

Environment

Population

CultureSystemNatu

ralRe

source

s

EcologicalBalance Huma

nSatis

faction

s

(Size, Distribution, Growth Rate ,Gene Pool)

Attitude,

behavior

Prevention, Cure, Care,

Rehabilitation

Physical (natural and

man made),

Sociocultural(economics ,

education,

employment, etc.)

The force-field and well-being paradigms

Source: Blum(1983)

The maximization of the biological and cl inical indicators of organ function andthe maximization of physical, mental, and role functioning in every day li fe

Absence of

disease


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Ageing Population Functional decay, chronic diseases, may

need partial or full support/health care The need for support/health care is

gradually increasing

No easy way to break up support andhealth care

A belief of the continuum of care

Welfare steps in and plays a major role forcaring ageing population


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Provision of Wellbeing

Health Health Sub-acute Old Age

Promotio Screening Primary Secondar Tertiary Chronic Mental Function lost Self Support Care

Setting

Home

Community

Institution

Acute Disable

:

:

:

:

NHI LCI

LCISP

NHISP


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A Framework of Holistic Care


Promotio Screening Primary Secondar Tertiary Chronic Mental Function lost Self Support CareSetting

Home

Community

Institution

Acute Disable

Systems


Policies


Fiscal

intermediaries

Third party

Payer

Contributors



Consumers


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Organization Forms and Funding

Systems


Policies


Fiscal

intermediaries

Third party

Payer

Contributors



Consumers

Public Private FPPrivate NPVolunteer

Producer Platform

Public funding

Personal funding

Charity funding


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Composition of Funding The proportion of personal and charity funding

required by the system depends on theproportion of public funding put in .

Public funding depends on how much publictaxes/insurance premiums the public willing topay.

Charity/donation funding can alleviate personalfunding burden.

Whos burden need to be alleviate?

Priority setting?


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More Opportunities

Systems


Policies


Fiscal

intermediaries

Third party

Payer

Contributors



Consumers

Private FP

Producer Platform

In addition to traditional drugs, devices,medical/surgical supplies R&D, Mfgrs,distributors, many potential opportunitiescan be imagined, some are on-going,and some enjoy fruitful payback.


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Extensions


Promotio Screening Primary Secondar Tertiary Chronic Mental Function lost Self Support CareSetting

Home

Community

Institution

Acute Disable

Systems


Domestic Mkt

Policies


Fiscal

intermediaries

Third party

Payer

Contributors



Consumers

Foreign Mkt

Policies

Beauty

Policies

Care

Policies


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Where is the market? Who are your customers?

Users, providers, fiscal intermediaries,downstream parties

Who are potential competitors?

Why is it the right product for customers?

How to approach customers?

How much does it cost?


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Value Chain of Biomedical

technology

Products / sales

Post-market

surveillance

Phase 3 Phase 2

Safety &

Efficacy

Lead

Optimization

Lead

Discovery

Validate

Target

Molecular

Target

Identification

Clinical Research

Phase 1

Pre-clinical Research

CROCMOCSO

R & DR & DTestingTestingCommercialCommercial

Venture

Capital

Pharmaceutical

ProducerPharmaceutical Mfg.

Medical devices

Med-surg supplies


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Industry trends Structural changes to the value chain

Used to be integrated pharmaceutical companiescompeting across the value chain as a whole.

New industry segments Biotech and drug delivery technologies created many

specialized companies. Genomics required R&D companies significant investments

in risky technology and information platforms.

Intensive M&A activity changed the structure of thecompetitive environment.

Globalization has led to heightened competition across allpharmaceutical markets.


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Partnership and collaboration An industry-wide R&D productivity decline has bed to a

widening gap b/w shareholder expectations and

productivity levels in the pharma industry. Biotech, drug delivery and genomics technologies all

provide specialist capabilities through which industry-wide productivity gains can be driven. M&A activity

provides distinct tiers of competition along with criticalmass through which economies of scale and scope canbe generated. Globalization ensures the returns frominvestment are maximized through global marketing.

The key market devices used to connect disparatetechnology, functional, therapeutic and geographicalexpertise and capabilities are partnerships andcollaborations.


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A Deal Involving

Two parties, buy and seller Two expertise, negotiation and valuation


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The Deal-Making Process Once potential partnering firms have concluded that

individual strategic goals can be satisfied through an

agreement, the structure, terms and value of theagreement must be negotiated and agreed upon.

Reaching agreement is more difficult and timeconsuming than initiating it.

Both parties enter the negotiation with differentexpectations (e.g., deals value, provisions).

The parties would not share all of their information and

expectations (estimate the uncertain variablesindividually).


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Valuation Supporting Negotiation Enabling negotiators to estimate and

quantify potential outcomes More convincing arguments for a

technology value

Improving the pace of reaching consensus(the fair, equilibrium price)

Better valuation technique improvesnegotiating position.

2011Health Indus & Mana Holistic Care & Valuation

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