L O I S M A C K L I N , P H . D

2 0 A P R I L 2 0 1 3

INTERACTING WITH A GLOBAL HEALTH CARE SYSTEM

Images courtesy of the world wide web Context21 Inc.

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Today’s Presentation

• Characteristics of a Global Healthcare System

• Eight mega forces shaping the future of healthcare

Bio-break

• Emerging opportunities and challenges

• Conclusions

• Questions and discussion o What is demanded by a Global Healthcare

System?

• Networking

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Global Healthcare System Characteristics

• Providers actively market health related services, information or products to non-nationals.

• May involve international travel on behalf of the consumer or provider.

• Products, services or providers may or may not be regulated in the consumer’s “home” jurisdiction.

• First point of entry is the usually the internet.

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There is a shift in the role of the patient from passive recipient

to active global consumer of health related products, information, and

services

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“When we want your opinion we

will ask you”

Digital

technologies have

severed the

geographic link

between the

healthcare

consumer and the

healthcare

provider.

Early signals of a paradigm shift

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(1) WEB 3.0-Semantic Web

The integration of machines, the web and human beings Tim Berners-Lee

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World Wide Web-Hyper Connectivity

Everything is linked and interacting in real-time

• Human to human • Machine to machine • Human to machine

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World Wide Web-Big Data

• Seamless interfaces • Powerful data analytics

Averages 21,500 daily

chats and responds to

41,000 questions each day

As of 2012, 2.5 quintillion (2.5×1018) bytes of data were created every day

patientslikeme.com

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(2) Medical Advances

• 3-D Bio-printing (4-D Printing) • Human cloning • Trans-humanism

Mechanically augmented humans Biologically enhanced machines

• Digital consciousness • Genetic enhancement

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(2) Technological Advances-Robotics and Nanotechnology

• Microbots • Intelligent • Anywhere • Everywhere

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Technological Advances-Sensor Technology

Networks of ubiquitous Sensors (optical, acoustic, biological,

mechanical, chemical, magnetic)

• Linked by the Web

• Will make the immediate environment known, sensitive and responsive

• Change behavior by closing feedback loops

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Technological Advances-Imaging Technology

• Nano scale • Graphics software • Real time 3 D videos • Molecular and gene

imagining • Multi-subject data sets

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(3) Healthcare Consumerism

Drivers:

• High cost of local healthcare.

• Long wait times.

• Convenience/Choice.

• Increased household incomes.

• Ease and affordability of international travel.

• Foreign investment in quality offshore healthcare infrastructure.

• International accreditation systems (i.e. Joint Commission International )

Cardiac

Bypass MRI Cataract

Surgery

Breast

Cancer

(w MRI)

Hip

Replacement

Knee

Replacement Prostate

Cancer

All

Cancers

(avg.)

CT Scan

Number of Middleclass Consumers by 2030

(2011)

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International Accreditation

Joint Commission International (JCI) • A US based not-for-profit

• JCI has a presence in more than 90 countries today.

• JCI works with health care organizations, governments, and international advocates to promote rigorous standards of care and provide solutions for achieving peak performance.

QHA Trent • A private British-based healthcare company .

• QHA is able to offer a wide range of healthcare-orientated services, with a special emphasis on independent expert hospital and clinic surveying and accreditation around the world.

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Healthcare Consumerism

The choices are unlimited.

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Health Consumerism -Web-Based Health Information

35% of US adults have used the Internet to diagnose themselves in the past year. Source: Pew Research Center (2012)

65% of Britons choose to surf the net when they want to know the answer to a medical query Source: Porter Novelli EuroPNStyles survey (2010)

WebMD.com

The New Second Opinion

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Healthcare Consumerism-BIG Business

Medical Tourism: • $20-35 billion annual market • Estimated 7 million patients worldwide • Spending an average of $3,000-$5000 per surgery • Market growing at a rate 25-35%

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(4) International Strategic Investment Hyderabad

Dec 16, 2011

Apollo's vision for the next phase of development is to

'Touch a Billion Lives'.

HYDERABAD: An international hospital is all

set to open up in the Health Port of the

Shamshabad airport (SEZ). The hospital will

be a joint venture between infrastructure

conglomerate GMR and health institutions

Apollo Hospitals and Mayo Clinic, which will

also mark that premier health clinic's foray

into India.

Earlier this year (2011), Mayo reportedly

made an entry into China collaborating with

a Chinese diagnostic service major,

Kindstar.

apollohospitals.com Context21 Inc. 19

(5) Healthcare Costs

Using US costs across a variety of benchmark specialties and procedures, the average range of savings for the top ten medical tourism destinations:

Brazil: 25-40% Costa Rica: 40-65% India: 65-90% Korea: 30-45% Malaysia: 65-80% Mexico: 40-65% Singapore: 30-45% Taiwan: 40-55% Thailand: 50-70% Turkey: 50-65%

Services are generally available on demand Source: Patients Beyond Borders (third ed.) by Josef Woodman (2013)

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Escalating Cost of Healthcare

UK Expenditure on Health (2010) – 9.6% of GDP

Source: Guardian (May 2012) US- 17.9% of GDP Canada- 11.3% 0f GDP

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(6) Demographics By 2050, for the first

time in human history, old people will

outnumber children on the planet.

Will the old become a

globalized commodity?

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Will increasing life expectancy mean

longer, healthy life expectancy or more

years spent in declining health and increasing

disability?

Projected Canadian Population 2050

5 Million

80 yrs +40% of the population will be

older than 65 yrs

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(7) Labour Availability

Who will take care of us?

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Projected Workforce by 2050 (millions)

2010 2050

China 973.3 870.1

India 780.6 1,008.0

United States 212.3 247.9

Indonesia 158.4 184.3

Brazil 132.2 137.2

Pakistan 109.6 224.1

Bangladesh 107.2 148.8

Russia 101.2 70.1

Japan 81.8 51.8

Mexico 72.5 79.5

Philippines 58.3 96.8

Germany 54.3 38.7

EU27 333.4 279.8

Canada 18.5 25.2

UK 63.0 45.1

Source: United Nations, World Population Prospects

227M

-17.9M

-30M

-53.6M

Labour Availability

25.9M

156M

-103M

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Labour Availability

What will take care of us?

Virtual Assistants

can be there for

every patient

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(8) Global Economy

Despite a global recession the need for healthcare remains the same

• Reduced budgets for public healthcare delivery are cut

• Fewer insured

Apollo Hospitals Enterprise, India’s largest

healthcare chain, has reported 24.73 %

growth in its net profit for the quarter ending

December 31, 2012

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Healthcare kiosks: Using digital technology and partnerships with

doctors and hospitals, Healthspot is bringing virtual doctors to patients

anytime, anywhere.

http://healthspot.net/

Let’s take a break

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INDIVIDUAL CONSUMER

• Access to large global healthcare markets

• Convenience

• Access to experimental or illegal goods and services

• Culture , religious or language preferences

• Anonymity

Opportunities of Global Healthcare

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Opportunities of Global Healthcare

Provider

• Access to large global consumer base • Less regulatory restrictions • Lower costs/increased profits • Access to labour • Less professional liability • Local government support and investment • More professional and/or business

opportunities

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Opportunities of Global Healthcare

Jurisdiction

PROVIDING

• Economic diversification (jobs, revenue, spin-off industries)

• Enhance domestic healthcare (infrastructure, skills, financing) • Higher standard of living

• International recognition

CONSUMING

• Access to lower cost, faster, and sometimes better products and services.

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Challenges of Global Healthcare

Individual Consumer

• Equality of care • Quality assurance • Pre and post procedural care • Medical records • Legal recourse • Who pays?

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Challenges of Global Healthcare

Provider

• Quality assurance/accreditation • Revenue collection and taxes • Regulatory environment • Access to skilled labour • Global competition/marketing • Ethical Standards • Professional and corporate liability

Published Wednesday, Oct. 03 2012, 8:14 PM EDT

Doctor’s arrest in Dubai underscores perils of working abroad

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Angeles Hospitals in Numbers:• 23 privately owned Hospitals across Mexico• 1,700 beds• 11,000 board certified specialists• 120,000 hospitalized patients a year•

More than 6, million outpatient visits a year

But the majority are not Mexican Citizens

Challenges of Global Healthcare

Jurisdiction

PROVIDING

• Attracting investors/Building Infrastructure

• Regulation

• Trade Agreements

• Skilled labour

• Equality

• Microbial movement

• Ethical /cultural considerations

CONSUMING

• Erosion of domestic health programs

• Brain drain

• Quality assurance

• Microbial movement

• Payment

• Product regulation

• Ethical/cultural considerations

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Conclusions

• A profound paradigm shift in healthcare delivery is already occurring.

• New healthcare options exist that demand: courage and wisdom from political leaders, a change in expectations, new delivery models.

• Consumer demands as will drive innovation in

healthcare delivery.

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THANK YOU

DR. LOIS MACKLIN

CONTEXT21 INC.

lois .macklin@context21.ca + (7 80) 97 4 -6450

Edmonton, Alberta, Canada

Discussions and Questions

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