Tuesday, 2 February 2016

WEF/ Bain report online

My report is online on the WEF website. Let me know what you think!

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After demonstrating in Maximizing Healthy Life Years that health can have a positive return on investment, the 2016 report How to Realize Returns on Health shows how to tackle the silent NCD pandemic: why we should focus on Maximizing Healthy Life Years (MHLY) instead of just treating disease, why we need to act boldly now and how investments into health can have healthy returns in a multi-stakeholder environment by creating Ecosystems of Health.
Developed by the World Economic Forum in collaboration with Bain & Company, this report covers
  • How investments into health can have healthy returns
  • How Ecosystems of Health align private and public stakeholders across sectors and industries
  • How the individual must be put at the center to make these ecosystems happen
  • How Ecosystems of Health create the foundation for market-driven solutions to tackle NCDs and to Maximize Healthy Life Years
  • Important success factors for healthier lives

Thursday, 28 January 2016

Are sugar taxes the answer?


Two tools for putting direct financial value on what are otherwise societal costs are regulation and taxes. One example are taxes on sugar which seek to reflect some of the societal cost incurred by obesity: In France beverages with added sugar or sweetener have been subject to an excise duty since 2012 and added sugar in soft drinks has been taxed as part of the Public Health Product Tax in Hungary since 2011 [1, p. 18f].

The effects of these taxes were firstly the desired decrease in consumption. The Mexican soda tax led to a decrease of purchase of sugary drinks by 12% in the first year and most importantly, the biggest reductions have occurred among the poor [1]. 
On the other hand, profitability stayed mostly stable. However, in some case cases profitability also de- or increased [2, p. 30ff] – an indication that price sensitivities vary across products and brands. Thus, taxes appear to not be suitable universal tool. It can be useful to shift buying patterns for commodities, e.g. from cooking oils high in saturated fats to those lower in these fats, but consumers will continue to purchase what they consider indulgences, such as chocolates or high end ice cream, with a certain indifference to the price. Also the introduction of food taxes is highly controversial and usually limited to a small set of food products. In Hungary only 8% of the average total energy intake of an adult women come from added sugars in the taxed product groups (chocolate, sweets, soft drinks) [2, p. 46]. Added sugars in other common product groups such as cakes, biscuits, ice cream, preserves, condiments or fruit yoghurts are currently not subject to the tax. The difficulties in deciding where to draw the line highlight one of the key weaknesses of using taxes as a key policy option.

However, another important effect of these food taxes are that they accelerate reformulations already partially under way to respond to consumer demands for “lighter” or healthier products. An impact assessment of the Hungarian Public Health Product Tax found that 40% of manufactures reformulated their products. Of the reformulations, 30% completely removed the targeted ingredient and 70% reduced its quantities [3, p. 32]. However, the same effect can be obtained by setting clear standards and thereby creating a market for healthy: The Dutch Choices Foundation (cf. p. 7) was able to show that most products carrying their logo have been reformulated to meet their criteria, for example by reducing added sugar in sauces. Furthermore, new products specifically formulated to meet the choices criteria were developed following the launch of the logo [3, p. 10].

Passing regulation mandating healthier products is unlikely to succeed but indirect measures that shape markets in a way that align RoH with RoI are possible. For example current occupation health and safety reporting requirements could be expanded into employee health and the health impact of products and services. The latter creates more transparency for customers, who can use this information in their purchasing decisions. In this regard valuable lessons can be learned from the effect an increased emphasis on sustainability has had on consumer purchasing decisions and consequently the products portfolios of manufactures. Employee health reporting would allow reflecting better health in risk assessments, thereby increasing shareholder value. Other forms of regulations could be standards regarding upper levels of acceptable health impact and the possibility to buy health certificates from low impact companies, analogous to emission certificates.

(The views expressed in this piece are my own and do not reflect the WEF or Bain)


[2]        ECSIP consortium, “Food taxes and their impact on competitiveness in the agri-food sector,” 2014.
[3]        World Cancer Research Fund International, “Curbing global sugar consumption,” 2015.


Wednesday, 27 January 2016

Health at the Annual Meeting


Health featured prominently on the program of this year's WEF Annual Meeting. There were over 35 sessions on health in the official and the private program. The meeting started with US Vice-President Joe Biden's moonshot to combat cancer (video above) and later during the meeting the Forum launched health as its 10th Global Challenge. As the health team we had worked hard for the latter, so it was really great to see this become reality.

The new Global Challenge will on the one hand continue my work on how to keep people healthier for longer but also combine it with work on health security and how to handle and combat epidemics of infectious diseases. The idea behind the Global Challenge mirrors the insight from my work that these are issues that transcend healthcare and have to be addressed collaboratively across industry and sector boundaries.

Friday, 22 January 2016

Summary of my World Economic Forum/ Bain report

I am at Davos right now, where we will launch the report which I authored for the World Economic Forum. Below the summary - will let you know once the report goes live on the WEF website :)



"How to Realize Returns on Health" - Executive summary
This report focuses on the role of different stakeholders in shaping an ecosystem of health and how to use market forces to make such a system, and the associated returns on health (RoH), happen.
Maximizing Healthy Life Years (MHLY) are investments in preventing non-communicable diseases (NCDs) and mental ill-health. These investments can pay off and generate opportunities across all industries, not just typical healthcare players. All industries are becoming concerned about the health of consumers through the direct or indirect impact of products and services they use, the impact of corporate operations on communities, and the health of employees and the work environment.
An ecosystem of health is always specific to a particular issue, i.e. the RoH sought. Such an ecosystem can align stakeholders with different perspectives around a common goal about desirable returns. The fundamental architecture of an ecosystem of health is based on two roles: health shapers and designers/deliverers. Health shapers who are motivated by social benefits, such as government and non-governmental organizations (NGOs) or organizations from the private sector, can utilize a range of mechanisms to (re)shape markets in a way that ensures delivering on health outcomes is a viable business. By setting standards and norms, aggregating demand or catalysing behaviour change, these health shapers align RoH with return on investment (RoI) and enable positive business cases for a second type of stakeholder that designs and delivers offerings. This report illustrates these concepts of ecosystem roles (shaping, designing, delivering) and includes multiple examples from different sectors and industries.
In some cases, RoH and RoI are already aligned in the current environment, delivering a short-term payback for private ventures. If they are not, health shapers can strengthen the alignment either by decreasing barriers or by creating additional incentives, such as cost/benefit sharing.Cost/benefit sharing is a renegotiation of costs and benefits and can take either the form of spreading the cost of improved health among stakeholders, sharing the benefits, or both. It can unlock the value of healthy living when beneficiaries of good health and investors are not aligned. This is particularly critical if the project requires a large investment but benefits different stakeholders.
An ecosystem of health creates the foundation for market-driven solutions to tackle NCDs and MHLY. Because markets depend on customers, the individual must be at the centre to make these ecosystems happen. The engine to set MHLY in motion is to increase both demand and supply for healthy products and services. The behaviour of individuals and their underlying habits and social norms play an important role in creating demand and ensuring supply translates into demand. On the other hand, important levers to translate demand into supply include financial viability, either by providing a short-term payoff or through attractive cost/ benefit sharing. Supply can also be driven by an attractive long-term payoff, often a combination of direct financial returns and indirect returns, such as a competitive advantage. Long-term payoffs are more durable with innovative financing models, such as impact bonds, or stronger ties of health impact to shareholder value, e.g. through inclusion of health in stock market indices.
Looking ahead, key areas for action are laying the foundations for ecosystems of health, shaping an individual-centric environment for MHLY and providing the tools and platforms for multistakeholder collaboration and innovation.

Tuesday, 19 January 2016

WEF Secondees

So, the Annual Meeting of the World Economic Forum in Davos is about to start. As this means our WEF assignments are almost over, Bain & Company posted short profiles of my colleague Lyu and myself on their website.



Lyu is working on Future of Electricity:
"The Future of Electricity 2016 focuses on how to improve investment attractiveness of power markets in fast-growing countries. The countries need to attract $13 trillion of capital to power sector between 2015 and 2040 to be able to serve enormous new demand for electricity as their economies grow. During the assignment, the team developed eight recommendations for improving investment attractiveness of power markets in fast-growing economies that will help them to achieve social and economic objectives, including universal access to reliable affordable power and environment sustainability."
... and his take on the WEF is:
"Managing the Future of Electricity project in the World Economic Forum was invaluable experience. It combines in-depth industry analysis, its implications for the world and interaction with key stakeholders that shape global agenda in power: CEOs, other senior executives and policy makers. It was also very enjoyable to work side by side with people that live by the Forum's motto – 'To improve the state of the world.'"

My project has been looking at the "Future of Healthy":
"In the first year, the project established "Maximizing Healthy Life Years" as the new currency of economic prosperity and demonstrated that health can yield a positive ROI. The second year of the project focused on how to align multiple stakeholders across sectors and how to set up the right incentives for investments in health. "Ecosystems of Health," which are specific to a particular "Return on Health," align health value with economic value and are set up by shaping markets and supply chains accordingly. These systems harness the forces of demand and supply to improve health of individuals and populations, while also delivering a positive return on investment."
... and I also thought it was a great experience:
"The work at the World Economic Forum was an exciting opportunity to pursue my interest in healthcare. It also allowed me to link my work at Bain, focused at the business side of health, with the work around systemic change that I did for the English National Health Service prior to joining Bain. Being part of the Forum brought me in contact with some of the most inspiring people and working with global leaders really allowed me to have an impact on the global agenda. I truly believe that a problem on the scale of non-communicable disease can only be solved by collaborative action of stakeholders and by harnessing market forces."

Thursday, 19 November 2015

Who should own our health data?

I already mentioned that we had a workshop in San Francisco earlier this year. I summarized some of our insights in a blog post for the World Economic Forum: Who should own our health data?

Monday, 16 November 2015

Annual Meeting of New Champions in Dalian

One of the exciting parts of my work at the World Economic Forum is that I get to meet interesting people all over the world. I have been running a workshop series on different aspects on how to prevent non-communicable diseases. In June, we were in San Francisco looking what value proposition IT/ tech can have in this space, in September we were in Dalian for the Forum's Annual Meeting of New Champions (also dubbed "Summer Davos"), where we looked into how physical and built environments shape health and in October we ran a final workshop in Tokyo on consumerization of health.

Dalian was particularly exciting as this was my first WEF summit and gave me an idea what to expect from Davos. And we had a fantastic group of people attending my workshop, including two ministers of health, executives from the for- and not-for-profit sector as well as leading academics. Gates Cambridge, my scholarship during my PhD at Cambridge, actually wrote a blog about it, which you can find here.


Thursday, 12 November 2015

OECD Health Indicators 2015

For all the number crunchers among us, the OECD has published its "Health at a Glance 2015" report with dashboards and data on health indicators & status, pharmaceutical spending, non-medical determinants of health, health workforce, health care activities, access to care, quality of care, health expenditure and financing, the pharma sector, and ageing and long term care.

My favorite chart is public and private per capita health spending in the OECD countries:
The US are the biggest spender (adjusted by purchasing power) by a large margin but they are also outspending all other countries except the Netherlands and Norway on public health spending. Or to put differently: the amount of public money the US spends on health would be enough to cover all health costs in most other countries.

The full report can be found here:

My work at the World Economic Forum

As you might know, since May I have been taking a semi-break from my work at Bain & Company. Until the Annual Meeting in Davos in January, I am seconded to the World Economic Forum as a project manager for the Future of Healthy project.

FoH is a two year project on the prevention of noncommunicable diseases (NCDs). Last year it was all about a paradigm shift from curing disease/ preventing deaths to actually Maximizing Healthy Life Years and how interventions that do so are investments that pay off (the report can be found here). My project is looking at how to bring stakeholder from different sector and industries together and how to align their incentives with positive health outcomes.


Thursday, 13 August 2015

Incentives

Over three years ago, when I was still living in the UK, I had an IUD (inter-uterine device or "copper coil") fitted. For those of you who are not English: Health care by the National Health Service is free at the point of service and this includes contraception. Hence I paid nothing for my IUD. Now it makes intuitive sense that the IUD won't be good forever and I was actually given a piece of paper stating that it will have to be replaced after 10 years - which I figured was fair game.

When I moved back to Germany, I suddenly hear that an IUD (also copper ones) supposedly have to be replaced after 3 to 5 years. Now, you have to know that contraception is usually not covered by German insurance. I leave it to you to draw your own conclusions.

I still did a bit of research and what I found is even more interesting:

Saturday, 30 November 2013

My second paper: "Why are healthcare services fuzzy?"

My second paper just got published in AMJ, an open access journal. Below the abstract and the link to the journal. Very excited to see this finally happen.

Why are healthcare services fuzzy?

Abstract

Background
Healthcare organisations are an enigma to many people in- and outside the service. Organisational fuzziness is a common state, characterised by a lack of clarity, lack of awareness, lack of organisational knowledge, and the reliance on practice and custom instead of transparency.
Aims
The objective of this study was to obtain a better understanding of what causes this fuzziness and provide an actionable description of fuzzy organisations. Such a description is essential to managing and preventing organisational fuzziness.
Method 
We used a longitudinal case study in an integrated health- and social care organisation to obtain a thorough understanding of how the organisation functions. These in-depth insights allowed the identification of three generators of fuzziness.
Results
We found that the three main generators of organisational fuzziness are change, informal organisation and complexity. Organisational fuzziness is thus partly due to the inherent complexities of human systems. However, also continuous change and the inability of the system to adapt its formal structures resulted in structures deteriorating or no longer being appropriate.
Conclusion
Existing approaches to explain unclear or absent structures in healthcare organisations by describing these organisations as complex adaptive systems (CAS) are too simplistic. While aspects relating to people and their interactions are indeed complex, fuzziness of structural aspects are often the result of continuous change and insufficient organisational capacity to adapt to it.

http://www.amj.net.au/index.php?journal=AMJ&page=article&op=view&path[]=1857

Thursday, 31 October 2013

Paper now open access

Just to let you know, my paper on the contributions of carers and staff in service design is now available as open access:

http://onlinelibrary.wiley.com/doi/10.1111/hex.12107/pdf

Thanks to the CLAHRC for making this happen :)

Tuesday, 8 October 2013

The final reckoning: how much should end of life care cost?

This is a repost from a blog article I was invited to write for the Gates Scholars Blog

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The big innovation in the 19th and 20th century was the acknowledgement that health is a systemic issue. If people do not seek medical advice for small problems due to economic reasons, these small problems can become big problems and cause further poverty. This realisation led, for example, to the establishment of the NHS in 1948.

Nowadays we are facing the sustainability challenge: will we be able to keep affording the systems set up as a result? One problem is the ageing populations of many developed nations – it is estimated that in the US on average between 25% and 56% of healthcare spending occurs in the final 12 months of life. A second problem is, ironically, continuing progress in the medical sciences which allows us to treat more diseases and prolong lives. But the associated costs are spiralling out of control. Also, scientific progress creates illusions regarding what it possible and feasible. Combined with the lack of a culture that discusses death as a part of life many doctors find themselves under pressure to do whatever is possible, regardless of quality of life – or costs.

The latter point – placing a monetary value on life – might sit very uncomfortably with some readers. However, when we look at health as a systemic issue the question of money is bound to arise in one form or another. Every dollar or pound can only be spent once. A cancer treatment that prolongs life for a couple of months (at often a pretty terrible quality of life) can cost £40,000, which could also pay the annual salary of a palliative nurse. In the United Kingdom the discussion is open. The National Institute for Clinical Excellence (NICE) makes decisions about which treatments are covered by the National Health Service (NHS) based on the calculation of quality-adjusted life years. But systems which do not have this transparency, such as the fragmented German system of different public and private payers and various associations representing healthcare providers, also have to make decisions regarding which treatments are considered effective and value for money in order to contain costs and kept health insurance affordable.

Another issue which affects the sustainability of our healthcare systems is the human side. Organisational structures are filled by people, both staff and patients. As the people in them change structures have to adapt and vice versa. A system in which structures and people are out of synch will not work in the long run. A popular contemporary line of argument is that because healthcare is fundamentally an interaction between people, it is complex and non deterministic. Other arguments for this complexity model are based on the enormous variety of issues faced by healthcare providers, although this is strictly speaking not a characteristic of complexity but rather indicates a complicated problem. Semantics aside, the focus on complexity are as one-sided as the earlier models of rational technocratic top-down blueprints which the complexity model seeks to supersede. It is not a question of one or the other, but rather ‘horses for courses’.

A climbing rose is a good simile for how organisational success depends on interactions between staff and structures. A climbing rose (staff) requires a scaffold (structures) to reach its full potential. The shape of the scaffold will have a key influence on the shape of the final rose bush, but it is not possible to completely determine the shape of the bush from the shape of the scaffold and sometimes it becomes necessary to change the shape of the scaffold. On the other hand, the best scaffold in the world is worthless without the right, good, healthy plants.

I think the challenges we face are so big that a more open discussion regarding end of life care will be inevitable. On the other hand, a new direction in the policy debate that seeks to reconcile technocratic approaches to structures with insights about the complexity of human interaction should help to ensure a system that can adapt to changing environments and new challenges.

Tuesday, 1 October 2013

Paper: What can carers contribute to service design?

My paper is finally out - I submitted it last year in June and it was published as early view this July. I carried out a study with three groups of stakeholders and assessed to which degree they agree on priorities for service design.

Of course I am biased, but I think this is really important and interesting research as it is the first time that we can quantify the contribution of different stakeholder groups which historically had different amount of influence on the service design process. For example, experts and policy makers usually have a lot of influence, carers (and patients, but unfortunatly I was not able to include them) usually have much less. One of the reason why they have so much less influence is because those with the power over the process doubt how useful their contribution can be (I guess you can call this a certain degree of professional arrogance) and this is exactly where my work chimes in. I can actually show that they can contribute new idea which established stakeholders recognize as valuable.

The article is available as open access:
http://onlinelibrary.wiley.com/doi/10.1111/hex.12107/abstract

Exploring the boundary of a specialist service for adults with intellectual disabilities using a Delphi study: a quantification of stakeholder participation

Eva-Maria Hempe, Cecily Morrison, Anthony Holland

 

Background
There are arguments that a specialist service for adults with intellectual disabilities is needed to address the health inequalities that this group experiences. The boundary of such a specialist service however is unclear, and definition is difficult, given the varying experiences of the multiple stakeholder groups.
Objectives
The study reported here quantitatively investigates divergence in stakeholders’ views of what constitutes a good specialist service for people with intellectual disabilities. It is the first step of a larger project that aims to investigate the purpose, function and design of such a specialist service. The results are intended to support policy and service development.
Study design
A Delphi study was carried out to elicit the requirements of this new specialist service from stakeholder groups. It consisted of three panels (carers, frontline health professionals, researchers and policymakers) and had three rounds. The quantification of stakeholder participation covers the number of unique ideas per panel, the value of these ideas as determined by the other panels and the level of agreement within and between panels.
Findings
There is some overlap of ideas about of what should constitute this specialist service, but both carers and frontline health professionals contributed unique ideas. Many of these were valued by the researchers and policymakers. Interestingly, carers generated more ideas regarding how to deliver services than what services to deliver. Regarding whether ideas are considered appropriate, the variation both within and between groups is small. On the other hand, the feasibility of solutions is much more contested, with large variations among carers.
Conclusions
This study provides a quantified representation of the diversity of ideas among stakeholder groups regarding where the boundary of a specialist service for adults with learning disabilities should sit. The results can be used as a starting point for the design process. The study also offers one way to measure the impact of participation for those interested in participation as a mechanism for service improvement.

Tuesday, 24 September 2013

US Health Care Spending

Two interesting links, explaining why US Health Care costs are so high (also in comparison to other developed countries). In a nutshell: lack of transparency about costs + inherent power imbalances = a flawed market.

Time Magazine - "Bitter Pill: Why Why Medical Bills Are Killing Us"
http://content.time.com/time/magazine/article/0,9171,2136864,00.html

8-minute video. "Why Are American Health Care Costs So High?"
http://www.youtube.com/watch?v=qSjGouBmo0M