Healthcare Insurance Industry: A Global View
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1 KPJ National Healthcare Conference December, 2005 Putrajaya, MY Healthcare Insurance Industry: A Global View Presented by: Hank Kearney PHM 2005 PHM
2 Congratulations KPJ Healthcare Berhad on 25 years of excellent patient care!
3 Introductions WHY: Private Health Insurance Medical Consultants and USA Case Studies in Progress Conclusions
4 PHM Insurance consultancy and training firm Product & business development for hospitals and health insurance companies Knowledge transfer
5 WHY
6 Government changes are limiting health budgets Aging population Social compact
7 Health care is world s largest service business 2010 Private global investment in healthcare = $4trn vs. $1.5trn in , $750bn in emerging markets
8 health care as % of GDP for the 29 members of OECD doubled 3.9% to 7.6% % USA 12% Germany Malaysia? Current Healthcare Sustainable?
9 Each 1% increase in societal wealth = 1/2% increase in health care costs
10 Funding Health Care: Options for Europe. E. Mossiallos & A. Dixon. WHO OECD 2000 data. PHM
11 Funding Health Care: Options for Europe. E. Mossiallos & A. Dixon. WHO OECD 2000 data. PHM
12 Private health insurance Health care as a commodity - Market forces drive best system Patient as source of revenue - French fries Lifestyle tied to system resources Genetic innovations will drive up uninsured Wall Street drivers Under priced insurance
13 Medical Consultants, Negotiations, and The Future
14 Medical consultants and private health insurance - USA Historically combative - control issue? Anti-collusion, referral and ownership restrictions Medicare Often basis for all negotiations Concierge medicine
15 Who s in Control? The clinician or insurance company? Is it about the money? Or just control? It s the patient
16 Who s in Control? Patient manger yes Insurance manager no. Maybe. Would you really want to? Management of risk Risk-based capital Hospital systems selling off insurance division
17 Medical consultants and private health insurance - USA Physician-patient relations will cease to be a problem for the insurance company. Patient satisfaction NOT an insurance function, it s a physician-patient relation
18 Health System in Change Poland a case study in development Growing economy with legacy health system All primary care doctors private Public fees set by government Growing private payments via insurance
19 Health System in Change Poland a case study in development >28% cash payments out of system Brain drain 4,000 medical doctors filed to leave PL in 2005 Additional 2 billion zloty request for doctors in 2005
20 Health System in Change Poland a case study in development 4th Q 2005 First private insurance plan with contracts for in-patient hospital stays at state hospital. Next steps» Satisfaction measures» Quality improvement links to pay
21 Private Health Care in US Concierge Health Care - Full Circle?
22 Concierge Health Care - Full Circle? Annual physicals & preventative plan Preferred appointment times 24/7 MD availability /fax access Rx facilitation - Pharma, home, mail Coordination of referrals Claims facilitation Private Reception, Dedicated staff PHM
23 Concierge Health Care $1,800 - $3,000 plus fees patients per physician (vs. up to 3,000) Political movements to ban concierge programs NO INSURANCE
24 PHM USA, Poland
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