Health System Forecasting: Perspectives for Turkey!Matthew Lister!                                       Practicalignment ...
Health System Trends in G8 Countries: Perspectives for Turkey!                            1.  Forecasting!                ...
Health System Trends in G8 Countries: Perspectives for Turkey!                            1.  Forecasting: Three depths of...
Forecasting & Scenario Planning!                                                                  Hospital Admissions: Ank...
Health System Forecasting!Question!                          Prediction!              Forecasting!1.  How much will the Tu...
1.  Forecasting!                          2.  Health Systems in Context!                          3.  Trends in G8 / Indus...
Health Systems Context: Rank These Global Industries by “Value” (L–H)!     ANNUAL	  GLOBAL	                               ...
Health Systems in Context: Industry Rank by Global “Value” (L – H)!  9.1	                       ALL GOLD MINED GLOBALLY TO...
Health Systems in Context! 1.  Complex Systems: Non-linear, value of whole > sum of values of parts, highly     interdepen...
1.  Forecasting!                          2.  Health Systems in Context!                          3.  Trends in G8 / Indus...
Life Expectancy in G7, Both Sexes, 1970 - 2008!                                    85	                                    ...
Life Expectancy in G8, Both Sexes, 1970 - 2008!                                    85	                                    ...
Life Expectancy in G8 and Turkey, Both Sexes, 1970 - 2008!                                    85	                         ...
General Health System Trends in G7 (except Russia)!           More people living longer!                             Overt...
How do we set the right path? (Doğru yolu nasıl bulurum?)!         More people living longer!                             ...
1.  Forecasting!                          2.  Health Systems in Context!                          3.  Trends in G8 / Indus...
Turkish	  Popula3on	  Distribu3on,	  Both	  Sexes,	  1995	                            8,000,000	                          ...
Turkish	  Popula3on	  Distribu3on,	  Both	  Sexes,	  2000	                            8,000,000	                          ...
Turkish	  Popula3on	  Distribu3on,	  Both	  Sexes,	  2005	                            8,000,000	                          ...
Turkish	  Popula3on	  Distribu3on,	  Both	  Sexes,	  2010	                            8,000,000	                          ...
Turkish	  Popula3on	  Distribu3on,	  Both	  Sexes,	  2015	                            8,000,000	                          ...
Turkish	  Popula3on	  Distribu3on,	  Both	  Sexes,	  2020	                            8,000,000	                          ...
Turkish	  Popula3on	  Distribu3on,	  Both	  Sexes,	  2025	                            8,000,000	                          ...
Turkish	  Popula3on	  Distribu3on,	  Both	  Sexes,	  2030	                            8,000,000	                          ...
Turkish	  Popula3on	  Distribu3on,	  Both	  Sexes,	  2035	                            8,000,000	                          ...
Turkish	  Popula3on	  Distribu3on,	  Both	  Sexes,	  2040	                            8,000,000	                          ...
Turkish	  Popula3on	  Distribu3on,	  Both	  Sexes,	  2045	                            8,000,000	                          ...
Turkish	  Popula3on	  Distribu3on,	  Both	  Sexes,	  2050	                            8,000,000	                          ...
Turkish Population Distribution: 1995, 2010, 2050!Population Count!                    8,000,000	                      6,0...
Turkish Population Distribution: 1995, 2010, 2050!                                                                  CHRONI...
1.  Forecasting!                          2.  Health Systems in Context!                          3.  Trends in G8 / Indus...
(Some) Implications: Difficult Questions! 1.              What are the objectives of an effective health system?! 2.       ...
(Some) Implications: Scenario Questions! 1.              What would happen if Turkeyʼs borders changed?! 2.              W...
(Some) Implications!                                            1. Financial!                                            2...
(Some) Implications!                                    8,000,000	  Financial!                                            ...
(Some) Implications!                 1.  Fewer taxpayers to support increased system needs and demands!                   ...
(Some) Implications!                 1.  Clinical Fragmentation!Financial!                      •    NURSING:   !    !RN, ...
(Some) Implications: How Much Is the Population Growing?!Financial!                                                       ...
(Some) Implications: Where Is the Population Growing?!Financial!Health HumanResources!Care Delivery!SystemGovernance!     ...
(Some) Implications: Where Are Healthcare Capital Investments (2010-2020)?!Financial!Health HumanResources!Care Delivery!S...
(Some) Implications!Financial!                                                   Location!                HHR!            ...
(Some) Implications!Financial!                                                                                   General T...
(Some) Implications!Financial!                                                                         Technology   Clinic...
(Some) Implications!                                                                                                      ...
(Some) Implications!                                                                  Collaborative Governance: !         ...
1.  Forecasting!                          2.  Health Systems in Context!                          3.  Trends in G8 / Indus...
Perspectives: Organization Value, not Outputs!                                                          Organization Gover...
Perspectives: System Value, not Outputs!                                                                                  ...
Perspectives: System Value, not Outputs!                                                                                  ...
Perspectives: System Value, not Outputs! System value:! ! 1.  Not just A to B! 2.  Efficiency of ʻxʼ = effectiveness and ef...
1.  Forecasting!2.  Health Systems in Context!3.  Trends in G8 / Industrialized Countries!4.  Turkey 1995 – 2050!5.  Impli...
Tesekkür ederim: iyi uçmalar…!                     Practicalignment | Forecasting !!!!Matthew Lister   !mlister@practicali...
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Turkish health system forecast 2010 2050 for hacettepe

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Turkish health system forecast 2010 2050 for hacettepe

  1. 1. Health System Forecasting: Perspectives for Turkey!Matthew Lister! Practicalignment | Forecasting
  2. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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  
  30. 30. Turkish Population Distribution: 1995, 2010, 2050! CHRONIC-CARE DOMINANT! ACUTE CARE DOMINANT! Copyright  ©  2012,  Prac3calignment  Incorporated  
  31. 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. 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. 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. 34. (Some) Implications! 1. Financial! 2. Health Human Resources! 3. Care Delivery! 4. System Governance! Copyright  ©  2012,  Prac3calignment  Incorporated  
  35. 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. 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 HumanResources! 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 administrativeSystem costs!Governance! ! Worst practice: !for-profit private insurance in US! Best practices: ! !Kaiser Permanente (US)! ! !Klalit (Israel)! ! !Bayındır Sağlık Grubu!
  37. 37. (Some) Implications! 1.  Clinical Fragmentation!Financial! •  NURSING: ! !RN, RPN, LPN, NP, NA, RN +! •  CANADA/USA/UAE: RN SHORTAGE or RN DISTRIBUTION PROBLEM?!Health HumanResources! 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. 38. (Some) Implications: How Much Is the Population Growing?!Financial! Population 2010! Density 2010!Health HumanResources! 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. 39. (Some) Implications: Where Is the Population Growing?!Financial!Health HumanResources!Care Delivery!SystemGovernance! Urban growth = 1985 – 2000 = 2000 – 2015 ! Copyright  ©  2012,  Prac3calignment  Incorporated  
  40. 40. (Some) Implications: Where Are Healthcare Capital Investments (2010-2020)?!Financial!Health HumanResources!Care Delivery!SystemGovernance! 83%! 17%! Copyright  ©  2012,  Prac3calignment  Incorporated  
  41. 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. 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. 43. (Some) Implications!Financial! Technology Clinical Technology Organizational ! Health ! Innovation Adoption V1! Practice! V2! Practice! Policy!Health HumanResources!Care Delivery!SystemGovernance! Time Copyright  ©  2012,  Prac3calignment  Incorporated  
  44. 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. 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,  Collaborave  Governance   Copyright  ©  2012,  Prac3calignment  Incorporated  
  46. 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. 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. 48. Perspectives: System Value, not Outputs! Treatment! System Incident! Doctor / Nurse! Discharge! A   Timeline" B   Healthy! Symptoms?! Diagnosis! Recovery! Copyright  ©  2012,  Prac3calignment  Incorporated  
  49. 49. Perspectives: System Value, not Outputs! Treatment! System Incident! Doctor / Nurse! Discharge! A   Timeline" B   = R.I.W. " Healthy! Symptoms?! Diagnosis! Recovery! yScreening x = RU Period " &Prevention! Copyright  ©  2012,  Prac3calignment  Incorporated  
  50. 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. 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. 52. Tesekkür ederim: iyi uçmalar…! Practicalignment | Forecasting !!!!Matthew Lister !mlister@practicalignment.com !

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