From Obamacare to Discovery Health – Deloitte experts on the global health industry
There are few industries that get people as worked up, or that require as much regulation, care, and clever policy-making as healthcare. The healthcare-related problems facing countries around the world are similar – costs are ever-rising, quality is erratic, outcomes are hard to define, and people have strong feelings about all the issues. In this interview, global healthcare sector experts from Deloitte weigh in on many of the crucial issues facing the healthcare industry around the world. From the problems surrounding the implementation of Obamacare to the tensions between private and public medical care in South Africa, these experts offer a birds' eye view of this dynamic and crucial industry. Taking aim at America's obesity epidemic, South Africa's inefficient public spending, and the proper place of private healthcare insurers, the interview is not short on controversial comments. – FD
GUGULETHU MFUPHI: The Health Care Industry has entered a time of dramatic transformation, fuelled by population growth and the availability of new medical and information technologies. Rus Rudish and Valter Adao, Global Health Care Sector Leaders at Deloitte, joins us now for more. Rus let us start off with you, for a more global perspective on things. We know that people are getting older and living a little bit longer.
GUGULETHU MFUPHI: Yes, not that we are complaining, but naturally this does put a lot of pressure, not only on pharmaceutical companies but the Health Care Industry as a whole. What do you see, from a global perspective?
RUS RUDISH: Well, we see global trends and they are global trends as opposed to country trends, and when you look at, and Valter will talk to this, what is happening here. It is also happening in the rest of the world and so some of those trends are, and some of the issues, some of the challenges, are access to care. Are there enough doctors? Are there enough nurses? Are there enough clinical professionals and, in rural areas in particular, how do you get to the people that live in the rural areas, especially in huge countries, such as India and China and the likes. Access to care is perhaps the top issue that we see on a global basis. Secondly, regardless of, and hopefully you can tell I come from the United States, but regardless of whether it is there which there's a lot of discussion about the Health Care this week, based on some of the things that have happened on the Exchanges there in the last day or so. But we spend upwards of twenty percent of our GDP in our country on Health Care, so whether it is twenty percent or something about half of that here or even less in another country the cost is always too high. We cannot afford it. The Government has spent at that level and has not found a way to be able to maintain the level of Health Care that's needed in investment, going forward, at the level of cost in spending that, so the cost is too high. Almost, invariably the total costs is too high, which is number one and number two. Thirdly, notwithstanding the cost, the quality of care is very erratic. Very erratic between countries and even within countries and in the different parts of countries – it is somewhat separated from the actual cost. There is not a clear association between the cost that is spent by countries and the actual quality and, again, my country is a good example. We're more in the middle in the quality measures, whereby we spend the most, per capita, on the cost side.
GUGULETHU MFUPHI: Valter, let's come to you now. We heard mentioning the fact that the access to care is something that in South Africa we can relate to, maybe not so much because we are more in metropolitan areas, but not only that, but cost in South Africa is also something that is also rather erratic but I'd say more on the expensive side. Are we doing enough to change this?
VALTER ADAO: Well, we've got a challenge that is pretty unique to South Africa. In a sense that we've got a Private Health Care Market that is comparable to First World Countries and, together with that, comes a price tag for that type of care. And my view on that is that, as long as the Private Health Care Providers and Insurers are reinvesting some of the profits that they make back into the business to further develop the market and further develop the type of care that we have. I think that is fair, and that ensures that we remain and we retain access to First World type Health Care. There's a different angle, that when we look at cost, there is probably a different angle that one could consider. You want to get the best type of result of the money that you invest into Health Care, so one could say that if you are investing a significant amount into Health Care and you're outcomes are poor that that would be deemed as expensive Health Care. That is one of the challenges that we have in our public sector, in that we spend about eight and a half percent of our GDP, which, according to PAN African Trends, is very high but yet our Health Care outcomes are one of the lowest. You know, we don't have the kind of Health Care outcomes that we can brag about.
ALEC HOGG: But we're improving. You've seen the mortality rates, the longevity in this country has shot up in the last few years, as we are getting our hands in over HIV. Isn't that a positive development?
VALTER ADAO: Yes, correct. Without a doubt it is a positive development but if you take a look at the ratio of expenditure versus the severity of the types of outcomes we are achieving I think a lot more can be done.
ALEC HOGG: So lots of room for improvement?
VALTER ADAO: One hundred percent.
ALEC HOGG: I just wanted to ask you, Rus, you talk a lot about or you told us about twenty percent of the GDP in America is spent on Health Care but you've also got the most obese people in the world. I mean, isn't that a little bit kind of self-served?
RUS RUDISH: Your'e looking at one of them.
ALEC HOGG: Not at all. You are thin by Omaha's standard anyway but isn't that kind of an educational issue that you need to be addressing in the U.S. rather than fixing people because they overdo it themselves?
RUS RUDISH: Yes, I think that's right and one could argue, whether it is in the U.S. or anywhere, that there are a couple of ways and not simplicity two ways to deal with cost and with the quality and with the outcomes. Number one is being more efficient in the actual infrastructure of the Health Care Delivery System but, first and foremost, one could argue that the citizens, the population, the consumers need to take better care of themselves. And so one of the big challenges, beyond what the Health Systems would do, is the lack, for example, of people that have come to see a doctor or to a hospital, being given prescriptions to take and take their meds on a routine basis and they don't do it. And so to monitor that so one of the, hopefully over the next several years, we will get better technology into Health Care and have more, whether it is a fit bit that is connected back to your physician or to your hospital or to your provider of care, but where you can actually monitor the patients. Because one of the biggest challenges is the patients or the people themselves do not do what they are supposed to do.
ALEC HOGG: Sure. Just before, we close this off. Here, in South Africa, at the moment, we've banned cigarette advertising. We're about to ban alcohol advertising. From your experience, is that going to stop people from getting sick?
RUS RUDISH: Not enough. We did that a long time ago and I think it helped, so I wouldn't say it didn't help but it is a percentage of an overall plan. I really do think that for the long term we will have to be connected back, on a routine basis, like we run a lot of things in our lives these days, back to our caregivers, so that they can, at some level watch us to make sure that we are doing what we need to do.
GUGULETHU MFUPHI: I just want to come back to you Valter. Rus, you did mention the skills there, there is a skill shortage, as well as bringing in new technologies but won't that just increase the costs for an emerging economy like South Africa?
VALTER ADAO: To bring in new technologies?
GUGULETHU MFUPHI: New technologies as well as developing skills.
VALTER ADAO: Without a doubt. We have to develop skills and South Africa is not alone in its challenge to secure and retain skills in the country. Together with that, we've got a ageing specialist population and not just a general population but, once again, that is comparable to other world challenges. From a technology perspective, there might be a cost involved in investing into the technology, but the outcomes we could derive from that technolog could be quite positive. Rus spoke about Pro-Active Health Care, where individuals take responsibility for Health Care and try to stay healthy. We are quite effective in South Africa with some of our Insurers, Health Care Funders, that have got incentive programmes in place.
ALEC HOGG: Discovery; you can say their name. We don't mind.
VALTER ADAO: Absolutely, well Discovery,
ALEC HOGG: World leading.
VALTER ADAO: Absolutely. Through the use of clever technologies, mobile enabled technologies, I think what you'll see is Health Care Providers getting pro-active in managing patient conditions. So, picking up issues before they become serious and eventually driving up costs. Being able to manage, for example, diabetic patients remotely, and on a more regular basis, could probably improve quality of life and reduce the long-term cost of Health Care. So I do think investment is required. In order to make those investments, by private companies, profits are required but, in the long term, I think it does lead to stretching the Health Care Rand and it is something we all need to focus on; it is a joint accountability we need to take for as private and public sector.