Facing the challenges and getting to the core of the policy issue and implementation
By Mohan Manthiry
Currently the estimated annual global healthcare spending is more than USD$4.2 trillion and is increasing every year. There exists a wide variation in terms of spending for healthcare. Developed countries are spending more than 10% of their GDP, with the highest being USA at almost 18% and the majority of developing and poor countries spend less than 4% of their GDP for healthcare. Malaysia allocated 4.4% of the GDP for healthcare in 2013.
Within the countries, we are witnessing the increasing inequalities in income levels and access to social services, healthcare being a major component. The current trend globally in countries is the depleting middle class and the recent Oxfam report on wealth distribution gave us some startling statistics – “The combined wealth of the richest 1 percent will overtake that of the other 99 percent of people next year unless the current trend of rising inequality is checked, Oxfam warned in January 2015 ahead of the annual World Economic Forum meeting in Davos”. Excerpts from the 2015 Oxfam report:
“Oxfam made headlines at Davos last year with the revelation that the 85 richest people on the planet have the same wealth as the poorest 50 percent (3.5 billion people). That figure is now 80 – a dramatic fall from 388 people in 2010. The wealth of the richest 80 doubled in cash terms between 2009-14. Billionaires listed as having interests in the pharmaceutical and healthcare sectors saw their collective net worth increase by 47 percent. During 2013, they spent more than $500 million lobbying policy makers in Washington and Brussels”.
The recent Ebola outbreak laid bare the weakness in the healthcare systems in the poor countries. The current trend and experiences globally tells us that the health will not automatically evolve to become fair and equitable for all naturally. Governments need concerted and deliberate policy decisions to tackle this issue.
In the words of the Director General of World Health Organisation on 10 February 2015 in Singapore, “Universal health coverage is one of the most powerful social equalizers among all policy options. It is the ultimate expression of fairness. If public health has something that can help our troubled, out-of-balance world, it is this: growing evidence that well-functioning and inclusive health systems contribute to social cohesion, equity, and stability. They hold societies together and help reduce social tensions.”
“The rise of NCDs (non-communicable diseases) adds considerably to the costs of health care. The costs of cancer care, for example, are becoming unaffordable for even the wealthiest countries in the world. In 2012, the US Food and Drug Administration approved 12 drugs for various cancer indications. Of these 12, 11 were priced above $100,000 per patient per year. How many countries can afford this cost?
Prevention is by far the better option, but this, too, is more problematic than for infectious diseases, many of which can be prevented by vaccines or cured by medicines, all delivered by the health sector.”
The latest WHO report identified chronic disease as the leading cause of death and accounts for 70% of all mortality globally. These chronic or non-communicable diseases which include heart disease, obesity, diabetes and cancer which can be attributed directly to negligent health behaviours are preventable. The challenge to nations is on how to address this difficult task of getting their citizens to maintain healthy habits. And also how to effectively address the increasing healthcare needs of the population at an affordable cost level.
The most probable and perhaps the only way forward is to get every individual to take charge of their own personal health. Motivating people to take responsibility for their own health is now a global initiative and has become a strategy for patient engagement. By closely associating and taking an active role in your own health, would reduce negligent and risky health behaviours and encourage patients to keep their health in check.
Now, how do we build this strategy and bring about the required change management in the attitude and behaviour of the individuals towards their healthcare? The good news is we have now the technology to assist and support this difficult lifestyle modification. The numerous strategies are all hovering around the mobile technology that has permeated the society and our daily lives. Some of the interesting developments are:
- Healthcare apps to be connected real time with your healthcare providers, to receive healthcare news, services, advise, information and to monitor personal health risks;
- Receive notification and reminders on medication and health checks;
- Reach out to your doctors online for advise, second opinion and follow-ups;
- Manage your own personal health record on the mobile. This eventually develops your close understanding of your own health conditions, enabling you better management of your health outcomes. At the same time be able to reach out to your doctor with accurate and detail historical information on your personal health condition. This eventually reduces medical errors and better diagnosis and treatment plan;
Wearable technologies. Innovations in healthcare, capitalising on the mobile technologies is one way-forward. However, long term strategies are needed and instilling good healthy behaviour should start from the young. Education plays an important part. Introducing healthcare as a subject in the curriculum of schools from the primary level will be an excellent way to ensure that the long term strategies on healthcare geared towards prevention and wellness materialises. This would be a cost-effective strategy and would ensure the next generation of Malaysians have better control and shall take charge of their healthcare.
Instilling good habits from young is a noble and cost-effective method than trying to bring behavioural changes to adults who are already prone to unhealthy lifestyle.
Health is very important for the development and well-being of a nation and its people. It requires political leadership and highly committed public-private partnership and investment.
SOME STARTLING STATISTICS ON NCD FROM MINISTRY OF HEALTH MALAYSIA
Malaysia – NCD
accounts for 70% of total deaths
Cost of Managing
Diabetes in Malaysia
PER PATIENT PER YEAR
NHMS (National Health and Morbidity Survey) 2011 estimated 1.1 million diabetes patients with MOH hospitals (1.1 m x RM 19k)