Contenu connexe Similaire à Turkish health system forecast 2010 2050 for hacettepe Similaire à Turkish health system forecast 2010 2050 for hacettepe (20) 2. Health System Trends in G8 Countries: Perspectives for Turkey!
1. Forecasting!
2. Health Systems in Context!
3. Trends in G8 / Industrialized Countries!
4. Turkey 1995 – 2050!
5. Implications!
6. Perspectives: Value!
7. Questions!
Copyright
©
2012,
Prac3calignment
Incorporated
3. Health System Trends in G8 Countries: Perspectives for Turkey!
1. Forecasting: Three depths of field!
2. Health Systems in Context!
3. Trends in G8 / Industrialized Countries!
4. Turkey 1995 – 2050!
5. Implications!
6. Perspectives: Value!
7. Questions!
Copyright
©
2012,
Prac3calignment
Incorporated
4. Forecasting & Scenario Planning!
Hospital Admissions: Ankara 2020?
Prediction (Linear)! Forecasting (Scenarios)!
2011: 786,800! • Same system as today?!
2010: 752,350! • Increase primary care access?!
2009: 729,000! • Develop homecare infrastructure?!
2008: 731,600!
• Changes to national health system financing?!
2007: 624,050!
2006: 641,300! • Increase private facilities?!
2005: 607,000! • Working IT infrastructure?!
“Approximately 1,220,000 patients will be That depends on different scenarios…
admitted to hospitals in Ankara in 2020.” Maybe 600,000… maybe 2,000,000
Copyright
©
2012,
Prac3calignment
Incorporated
5. Health System Forecasting!
Question! Prediction! Forecasting!
1. How much will the Turkish • Growth in Tk.THE Life Expectancy!
health system cost in since 1990 = 3%! + Population Distribution!
2050?! + Epidemiological profile !
!
2. How many doctors, nurses, + Case-based costs!
• Tk.THE / GDP!
and pharmacists will we need + Cost trends (infl., &c.)!
in 2050?! + Disruptive trends (social,
3. Where should we build • Tk.THE/per cap * regulatory, economic, tech.)!
hospitals in Turkey?! growth rate * pop.! + Population needs !
4. What should the Ministry of ! + Service changes!
Health strategy be for ! + HHR pressures!
2015-2025?! ! + Clinical advances!
!
$ 570,000,000,000 ! $ 475,000,000,000 -
! $ 1,300,000,000,000!
6. 1. Forecasting!
2. Health Systems in Context!
3. Trends in G8 / Industrialized Countries!
4. Turkey 1995 – 2050!
5. Implications!
6. Perspectives!
7. Questions!
Copyright
©
2012,
Prac3calignment
Incorporated
7. Health Systems Context: Rank These Global Industries by “Value” (L–H)!
ANNUAL
GLOBAL
ALL
GOLD
MINED
ANNUAL
GLOBAL
ANNUAL
GLOBAL
ANNUAL
OIL
&
ARMS
SPENDING
TO
DATE
GLOBALLY
HEALTH
SYSTEMS
FOR-‐EX
ENERGY
SALES
A
B
C
D
E
Copyright
©
2012,
Prac3calignment
Incorporated
8. Health Systems in Context: Industry Rank by Global “Value” (L – H)!
9.1
ALL GOLD MINED GLOBALLY TO DATE, 2010!
TR
7.3
ANNUAL HEALTH SYSTEMS EXPENDITURES!
TR
6.1
ANNUAL GLOBAL FOREX TRADES (COMM & RETAIL)!
TR
2.7
ANNUAL MILITARY SALES!
TR
2.2
ANNUAL OIL SALES !
TR
Copyright
©
2012,
Prac3calignment
Incorporated
9. Health Systems in Context!
1. Complex Systems: Non-linear, value of whole > sum of values of parts, highly
interdependent variables!
2. High-reliability Industry: One mistake can be very serious (nuclear power = HRI)!
3. Everyone uses it, and needs it for different things !
a. High political value = prone to change structurally and financially!
b. Proportions and coverage of needs will change !
4. Highly Fragmented: Geographically, Politically, Professionally, Administratively !
5. Highly Regulated (Government influence) (Normally)!
Copyright
©
2012,
Prac3calignment
Incorporated
10. 1. Forecasting!
2. Health Systems in Context!
3. Trends in G8 / Industrialized Countries!
4. Turkey 1995 – 2050!
5. Implications!
6. Perspectives: Value!
7. Questions!
Copyright
©
2012,
Prac3calignment
Incorporated
11. Life Expectancy in G7, Both Sexes, 1970 - 2008!
85
CANADA
80
FRANCE
75
Life
Expectancy
(Years)
GERMANY
70
ITALY
65
JAPAN
60
UK
55
USA
50
1970
1972
1974
1976
1978
1980
1982
1984
1986
1988
1990
1992
1994
1996
1998
2000
2002
2004
2006
2008
Year
12. Life Expectancy in G8, Both Sexes, 1970 - 2008!
85
CANADA
80
FRANCE
75
GERMANY
Life
Expectancy
(Years)
70
ITALY
65
JAPAN
RUSSIA
60
UK
55
USA
50
1970
1972
1974
1976
1978
1980
1982
1984
1986
1988
1990
1992
1994
1996
1998
2000
2002
2004
2006
2008
Year
13. Life Expectancy in G8 and Turkey, Both Sexes, 1970 - 2008!
85
CANADA
80
FRANCE
75
GERMANY
Life
Expectancy
(Years)
ITALY
70
JAPAN
65
RUSSIA
60
UK
USA
55
TURKEY
50
1970
1972
1974
1976
1978
1980
1982
1984
1986
1988
1990
1992
1994
1996
1998
2000
2002
2004
2006
2008
Year
14. General Health System Trends in G7 (except Russia)!
More people living longer! Overtreatment!
Chronic illness at earlier age! Inaccessibility!
Evidence-based conformance! Cost containment!
System disruption! Capital investment!
Copyright
©
2012,
Prac3calignment
Incorporated
15. How do we set the right path? (Doğru yolu nasıl bulurum?)!
More people living longer! Overtreatment!
Healthy life expectancy ! Appropriate Use !
Chronic illness at earlier age! Inaccessibility!
Evidence-based conformance! Cost containment!
Appropriate Innovation ! Appropriate Financing !
System disruption! Capital investment!
Copyright
©
2012,
Prac3calignment
Incorporated
16. 1. Forecasting!
2. Health Systems in Context!
3. Trends in G8 / Industrialized Countries!
4. Turkey 1995 – 2050!
5. Implications!
6. Perspectives: Value!
7. Questions!
Copyright
©
2012,
Prac3calignment
Incorporated
17. Turkish
Popula3on
Distribu3on,
Both
Sexes,
1995
8,000,000
7,000,000
6,000,000
Cohort
Popula3on
5,000,000
4,000,000
3,000,000
2,000,000
1,000,000
0
0-‐4
5-‐9
10-‐14
15-‐19
20-‐24
25-‐29
30-‐34
35-‐39
40-‐44
45-‐49
50-‐54
55-‐59
60-‐64
65-‐69
70-‐74
75-‐79
80-‐84
85-‐89
90-‐94
95-‐99
100+
Age
(5-‐year
Cohorts)
18. Turkish
Popula3on
Distribu3on,
Both
Sexes,
2000
8,000,000
7,000,000
6,000,000
Cohort
Popula3on
5,000,000
4,000,000
3,000,000
2,000,000
1,000,000
0
0-‐4
5-‐9
10-‐14
15-‐19
20-‐24
25-‐29
30-‐34
35-‐39
40-‐44
45-‐49
50-‐54
55-‐59
60-‐64
65-‐69
70-‐74
75-‐79
80-‐84
85-‐89
90-‐94
95-‐99
100+
Age
(5-‐year
Cohorts)
19. Turkish
Popula3on
Distribu3on,
Both
Sexes,
2005
8,000,000
7,000,000
6,000,000
Cohort
Popula3on
5,000,000
4,000,000
3,000,000
2,000,000
1,000,000
0
0-‐4
5-‐9
10-‐14
15-‐19
20-‐24
25-‐29
30-‐34
35-‐39
40-‐44
45-‐49
50-‐54
55-‐59
60-‐64
65-‐69
70-‐74
75-‐79
80-‐84
85-‐89
90-‐94
95-‐99
100+
Age
(5-‐year
Cohorts)
20. Turkish
Popula3on
Distribu3on,
Both
Sexes,
2010
8,000,000
7,000,000
6,000,000
Cohort
Popula3on
5,000,000
4,000,000
3,000,000
2,000,000
1,000,000
0
0-‐4
5-‐9
10-‐14
15-‐19
20-‐24
25-‐29
30-‐34
35-‐39
40-‐44
45-‐49
50-‐54
55-‐59
60-‐64
65-‐69
70-‐74
75-‐79
80-‐84
85-‐89
90-‐94
95-‐99
100+
Age
(5-‐year
Cohorts)
21. Turkish
Popula3on
Distribu3on,
Both
Sexes,
2015
8,000,000
7,000,000
6,000,000
Cohort
Popula3on
5,000,000
4,000,000
3,000,000
2,000,000
1,000,000
0
0-‐4
5-‐9
10-‐14
15-‐19
20-‐24
25-‐29
30-‐34
35-‐39
40-‐44
45-‐49
50-‐54
55-‐59
60-‐64
65-‐69
70-‐74
75-‐79
80-‐84
85-‐89
90-‐94
95-‐99
100+
Age
(5-‐year
Cohorts)
22. Turkish
Popula3on
Distribu3on,
Both
Sexes,
2020
8,000,000
7,000,000
6,000,000
Cohort
Popula3on
5,000,000
4,000,000
3,000,000
2,000,000
1,000,000
0
0-‐4
5-‐9
10-‐14
15-‐19
20-‐24
25-‐29
30-‐34
35-‐39
40-‐44
45-‐49
50-‐54
55-‐59
60-‐64
65-‐69
70-‐74
75-‐79
80-‐84
85-‐89
90-‐94
95-‐99
100+
Age
(5-‐year
Cohorts)
23. Turkish
Popula3on
Distribu3on,
Both
Sexes,
2025
8,000,000
7,000,000
6,000,000
Cohort
Popula3on
5,000,000
4,000,000
3,000,000
2,000,000
1,000,000
0
0-‐4
5-‐9
10-‐14
15-‐19
20-‐24
25-‐29
30-‐34
35-‐39
40-‐44
45-‐49
50-‐54
55-‐59
60-‐64
65-‐69
70-‐74
75-‐79
80-‐84
85-‐89
90-‐94
95-‐99
100+
Age
(5-‐year
Cohorts)
24. Turkish
Popula3on
Distribu3on,
Both
Sexes,
2030
8,000,000
7,000,000
6,000,000
Cohort
Popula3on
5,000,000
4,000,000
3,000,000
2,000,000
1,000,000
0
0-‐4
5-‐9
10-‐14
15-‐19
20-‐24
25-‐29
30-‐34
35-‐39
40-‐44
45-‐49
50-‐54
55-‐59
60-‐64
65-‐69
70-‐74
75-‐79
80-‐84
85-‐89
90-‐94
95-‐99
100+
Age
(5-‐year
Cohorts)
25. Turkish
Popula3on
Distribu3on,
Both
Sexes,
2035
8,000,000
7,000,000
6,000,000
Cohort
Popula3on
5,000,000
4,000,000
3,000,000
2,000,000
1,000,000
0
0-‐4
5-‐9
10-‐14
15-‐19
20-‐24
25-‐29
30-‐34
35-‐39
40-‐44
45-‐49
50-‐54
55-‐59
60-‐64
65-‐69
70-‐74
75-‐79
80-‐84
85-‐89
90-‐94
95-‐99
100+
Age
(5-‐year
Cohorts)
26. Turkish
Popula3on
Distribu3on,
Both
Sexes,
2040
8,000,000
7,000,000
6,000,000
Cohort
Popula3on
5,000,000
4,000,000
3,000,000
2,000,000
1,000,000
0
0-‐4
5-‐9
10-‐14
15-‐19
20-‐24
25-‐29
30-‐34
35-‐39
40-‐44
45-‐49
50-‐54
55-‐59
60-‐64
65-‐69
70-‐74
75-‐79
80-‐84
85-‐89
90-‐94
95-‐99
100+
Age
(5-‐year
Cohorts)
27. Turkish
Popula3on
Distribu3on,
Both
Sexes,
2045
8,000,000
7,000,000
6,000,000
Cohort
Popula3on
5,000,000
4,000,000
3,000,000
2,000,000
1,000,000
0
0-‐4
5-‐9
10-‐14
15-‐19
20-‐24
25-‐29
30-‐34
35-‐39
40-‐44
45-‐49
50-‐54
55-‐59
60-‐64
65-‐69
70-‐74
75-‐79
80-‐84
85-‐89
90-‐94
95-‐99
100+
Age
(5-‐year
Cohorts)
28. Turkish
Popula3on
Distribu3on,
Both
Sexes,
2050
8,000,000
7,000,000
6,000,000
Cohort
Popula3on
5,000,000
4,000,000
3,000,000
2,000,000
1,000,000
0
0-‐4
5-‐9
10-‐14
15-‐19
20-‐24
25-‐29
30-‐34
35-‐39
40-‐44
45-‐49
50-‐54
55-‐59
60-‐64
65-‐69
70-‐74
75-‐79
80-‐84
85-‐89
90-‐94
95-‐99
100+
Age
(5-‐year
Cohorts)
29. Turkish Population Distribution: 1995, 2010, 2050!
Population Count!
8,000,000
6,000,000
4,000,000
2,000,000
0
Age, Five Year Cohorts !
Copyright
©
2012,
Prac3calignment
Incorporated
31. 1. Forecasting!
2. Health Systems in Context!
3. Trends in G8 / Industrialized Countries!
4. Turkey 1995 – 2050!
5. (Some) Implications!
6. Perspectives: Value!
7. Questions!
Copyright
©
2012,
Prac3calignment
Incorporated
32. (Some) Implications: Difficult Questions!
1. What are the objectives of an effective health system?!
2. How will Turkey finance its health system?!
3. How will care be distributed?!
4. How will Turkey optimize its Health Human Resources?!
5. What changes will Turkey make in policy, services, urban planning, etc.?!
6. How will Turkey control the size of its civil service to maintain low costs?!
7. How will Turkey manage ʻBlack Swanʼ events?!
Copyright
©
2012,
Prac3calignment
Incorporated
33. (Some) Implications: Scenario Questions!
1. What would happen if Turkeyʼs borders changed?!
2. Would anything change if there were a national homecare program?!
3. How could Turkeyʼs health system provide care to other countries, such as Syria, Iraq,
Azerbaijan, and Turkmenistan?!
4. Should smokers pay more for health care? Should healthy people pay less?!
5. What if people were responsible for their own care—from diagnosis to treatment?!
!
Six-Sigma DMAIC Tool: “5 Whys” – Understanding Causes!
Scenario Planning Tool: “5 Hows” – Understanding Implications !
!
Copyright
©
2012,
Prac3calignment
Incorporated
34. (Some) Implications!
1. Financial!
2. Health Human Resources!
3. Care Delivery!
4. System Governance!
Copyright
©
2012,
Prac3calignment
Incorporated
35. (Some) Implications!
8,000,000
Financial! $20,000
7,000,000
6,000,000
Health Human
5,000,000
$15,000
Resources!
4,000,000
Care Delivery! 3,000,000
$10,000
2,000,000
System 1,000,000
$5,000
Governance! 0
=
Average
THEX
per
Year
per
Person
=
Average
THEX
per
Year
per
Person
w
Chronic
Illness
=
2010
Popula3on
Distribu3on
(count)
=
2050
Popula3on
Distribu3on
(count)
36. (Some) Implications!
1. Fewer taxpayers to support increased system needs and demands!
a. Accessibility delays!
Financial! b. User fees!
c. Revised insured services schedules!
Health Human
Resources! 2. Increasing average cost of care!
3. Current design of private system competition ~ drives up public service cost!
Care Delivery!
4. Private hospitals owned by insurance companies ~ constrains administrative
System costs!
Governance! !
Worst practice: !for-profit private insurance in US!
Best practices:
! !Kaiser Permanente (US)!
! !Klalit (Israel)!
! !Bayındır Sağlık Grubu!
37. (Some) Implications!
1. Clinical Fragmentation!
Financial!
• NURSING: ! !RN, RPN, LPN, NP, NA, RN +!
• CANADA/USA/UAE: RN SHORTAGE or RN DISTRIBUTION PROBLEM?!
Health Human
Resources! 2. Clinical roles impacted by PHR / EHR as caseload increases!
!
Care Delivery! 3. Functional “Adjustment” (Administrators, Project Experts)!
System 4. HHR clinical training… 8 – 12 year training period!
Governance! a. 1995 – 2010: Pediatrics required!
b. 2010 – 2025: Chronic illness specialists required!
c. 2020 – 2050: Gerontology, palliative specialist required!
38. (Some) Implications: How Much Is the Population Growing?!
Financial!
Population 2010! Density 2010!
Health Human
Resources!
77,800,000! 96 people / km2!
Care Delivery!
Population 2050! Density 2050!
System
101,000,000! 129 people / km2!
Governance!
Copyright
©
2012,
Prac3calignment
Incorporated
39. (Some) Implications: Where Is the Population Growing?!
Financial!
Health Human
Resources!
Care Delivery!
System
Governance!
Urban growth = 1985 – 2000 = 2000 – 2015 !
Copyright
©
2012,
Prac3calignment
Incorporated
40. (Some) Implications: Where Are Healthcare Capital Investments (2010-2020)?!
Financial!
Health Human
Resources!
Care Delivery!
System
Governance!
83%! 17%!
Copyright
©
2012,
Prac3calignment
Incorporated
41. (Some) Implications!
Financial! Location! HHR! Financing! Method!
• Hospital ! $$$$$$! • Doctor! $$$$$! • Who pays?! • Pill!
Health Human
• Clinic ! $$! • Pharmacist! $$! • Who earns?! • Direct care!
Resources!
• Home! $! • Nurse! $! • How much?! • Surgery!
Care Delivery! • LTC ! $$$! • Psychologist! $$! • When?! • Injection!
System • School! $$! • Physiotherapist! $$! • Conditions?! • Discussion?!
Governance! • Work ! $$! !
• Remotely! $$$!
Copyright
©
2012,
Prac3calignment
Incorporated
42. (Some) Implications!
Financial! General Trends in Adoption / Life Cycles!
Innovation! High è Low!
Health Human a. b. c. d. e.
Resources! Quality Variance! High è Low!
Adoption
Price & Profit! High è Low… Medium!
Care Delivery!
# Competitors! Few è Many è Few!
System Ubiquity ! Few è Many Customers!
Governance!
Social Value! Low è High!
Regulation! Low è High !
Time
Copyright
©
2012,
Prac3calignment
Incorporated
43. (Some) Implications!
Financial! Technology Clinical Technology Organizational ! Health !
Innovation Adoption
V1! Practice! V2! Practice! Policy!
Health Human
Resources!
Care Delivery!
System
Governance!
Time
Copyright
©
2012,
Prac3calignment
Incorporated
44. (Some) Implications!
Implications!
Technology Clinical Technology Organizational ! Health !
1. Government needs help!
Financial! V1! Practice! V2! Practice! Policy!
Innovation Adoption
2. Execution gap!
3. Unnecessary cost and risk!
Health Human 4. Regulatory short-circuiting!
Resources! 5. Stakeholders must
collaborate!
Care Delivery! Time !
Solutions: !
System Collaborative Governance!
Governance! + Lean Government!
!
Philanthropic role!
!
Personalized treatment?!
Copyright
©
2012,
Prac3calignment
Incorporated
45. (Some) Implications!
Collaborative Governance: !
When should governments collaborate with the private sector?!
Financial!
Health Human Creation of Additional Resources?!
NO
Resources! Consider if:!
Better Public Outcomes
1. Cost advantage!
Probably should not!
Care Delivery! 2. Future benefit!
3. Strengthen government (!?)!
System Consider if:!
Governance! 1. High urgency!
(Value)?!
Probably should!
2. High importance!
3. Impeding priorities!
YES
Adapted
from
Zuckerman
and
Donahue,
Collabora've
Governance
Copyright
©
2012,
Prac3calignment
Incorporated
46. 1. Forecasting!
2. Health Systems in Context!
3. Trends in G8 / Industrialized Countries!
4. Turkey 1995 – 2050!
5. Implications!
6. Perspectives: Value !
7. Questions!
Copyright
©
2012,
Prac3calignment
Incorporated
47. Perspectives: Organization Value, not Outputs!
Organization Governance!
Organization Strategy!
!
Operations Strategy!
!
Procurement & Supplier Relations!
!
Materials Management! Execution Value!
Supply:! Employee Relations!
• HHR, resources,
technology, etc.!
Operations
Demand:!
Inputs!
Processes!
Outputs! ?
• Health determinants,
preferences, etc.!
Structures & Volumes! Processes! Results!
Organizational Value!
48. Perspectives: System Value, not Outputs!
Treatment!
System
Incident! Doctor / Nurse!
Discharge!
A
Timeline" B
Healthy! Symptoms?! Diagnosis! Recovery!
Copyright
©
2012,
Prac3calignment
Incorporated
49. Perspectives: System Value, not Outputs!
Treatment!
System
Incident! Doctor / Nurse!
Discharge!
A
Timeline" B
= R.I.W. "
Healthy! Symptoms?! Diagnosis! Recovery!
y
Screening x = RU Period "
&
Prevention!
Copyright
©
2012,
Prac3calignment
Incorporated
50. Perspectives: System Value, not Outputs!
System value:!
!
1. Not just A to B!
2. Efficiency of ʻxʼ = effectiveness and efficiency of ʻyʼ!
3. More than sum of organizationsʼ values!
!
How do we align organizations within a system? !
!
!
!
!
!
!
!
Patient-Centred Service….!
Interdependent Shared Incentives ( )!
Lean Government (!)!
!
Copyright
©
2012,
Prac3calignment
Incorporated
51. 1. Forecasting!
2. Health Systems in Context!
3. Trends in G8 / Industrialized Countries!
4. Turkey 1995 – 2050!
5. Implications!
6. Perspectives!
7. Questions!
52. Tesekkür ederim: iyi uçmalar…! Practicalignment | Forecasting
!
!
!
!
Matthew Lister !mlister@practicalignment.com !
