2011Health Indus & Mana Holistic Care & Valuation
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Transcript of 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
UsersUsers ProvidersProvidersService
GovernmentGovernment
SuppliersSuppliers$
Resources
$
$Management
Utilization control, managed care Supply
-utilization review- Reasonable volume- Payment schemes (DRGs,
capitation)- Practicing patterns (CBA,CEA)
Demand
- copayment- deductible- availability of providers & careprovision
Responsiveness
Financial barrier
StintingQualityEfficiency
Creamskimming
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A regulated, agent-principal,
inefficient market Problems Everywhere!
Resource production & allocation
Manpower production (Edu.) Technology dissemination (CEA) Plans & providers productive
efficiency Budget cap Care rationing
Quality/Safety Manpower qualification Drugs, devices permissionOrganization accreditationAdequate, appropriate care
Equity
Financial contribution Financial barrier
Selection incentive
Third partypayer
UsersUsers ProvidersProvidersService
GovernmentGovernment
Management
SuppliersSuppliers$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
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
Health Health Sub-acute Old Age
Promotio Screening Primary Secondar Tertiary Chronic Mental Function lost Self Support CareSetting
Home
Community
Institution
Acute Disable
Systems
Transformation/Production
Policies
Distributors Producers
Fiscal
intermediaries
Third party
Payer
Contributors
ManagementRegulation
ManagementRegulation
Consumers
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Organization Forms and Funding
Systems
Transformation/Production
Policies
Distributors Producers
Fiscal
intermediaries
Third party
Payer
Contributors
ManagementRegulation
ManagementRegulation
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
Transformation/Production
Policies
Distributors Producers
Fiscal
intermediaries
Third party
Payer
Contributors
ManagementRegulation
ManagementRegulation
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
Health Health Sub-acute Old Age
Promotio Screening Primary Secondar Tertiary Chronic Mental Function lost Self Support CareSetting
Home
Community
Institution
Acute Disable
Systems
Transformation/Production
Domestic Mkt
Policies
Distributors Producers
Fiscal
intermediaries
Third party
Payer
Contributors
ManagementRegulation
ManagementRegulation
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.