This document summarizes a presentation by Ricardo Baptista Leite on time trends in health for the next decade. It discusses the evolution of healthcare in Portugal, challenges facing the Portuguese national health service like an aging population and non-communicable diseases. It also covers trends toward value-based and patient-centered care, the role of information and communication technologies in areas like precision medicine, and ensuring the financial sustainability of health systems.

1. Time Trends in Health for the
Next Decade
7th July 2016 – Athens, Greece
Divani Caravel Hotel
Ricardo Baptista Leite, MP, MD, PhD(c)
Medical Doctor and Member of the Portuguese Parliament
Member of the Parliamentary Health Committee | Foreign Affairs Committee
Head of Public Health | Catholic University of Portugal
Guest Lecturer | NOVA Medical School and NOVA Information Management School
City Councillor of Cascais
ricardo.baptistaleite@gmail.com | @RBaptistaLeite

2. Time Trends in Health for the Next Decade
Portugal: Cascais – Sintra – Estoril Coast
@RBaptistaLeite

3. The Evolution of Healthcare in Portugal
@RBaptistaLeite
Infant Mortality Rate (per 1000 live births)Life Expectancy at Birth
Incidence of HIV and AIDS
Time Trends in Health for the Next Decade

4. Portuguese
NHS
Universal
coverage
Global
Tendency to be free of
charge
Quality
Access
Citizen
centered
The Future of the Portuguese NHS
@RBaptistaLeite
Time Trends in Health for the Next Decade

5. The Evolution of Healthcare in Portugal
@RBaptistaLeite
Health expenditure per capita below the average of OECD countries (OECD, 2011)
Time Trends in Health for the Next Decade

6. 2011 | Portugal: TROIKA
@RBaptistaLeite
Time Trends in Health for the Next Decade

7. Annual health spending growth below the
average of OECD countries (OECD, 2010-2013)
@RBaptistaLeite
The Evolution of Healthcare in Portugal
Time Trends in Health for the Next Decade

8. The Evolution of Healthcare in Portugal
@RBaptistaLeite
Despite spending less per capita, Portugal has better health indicators in
comparison with the average OECD countries (OECD, 2011)
USA
Time Trends in Health for the Next Decade

9. The Evolution of Healthcare in Portugal
@RBaptistaLeite
Economist Intelligence Unit | Top Tier by Outcomes (EIU, 2014)
USA
Time Trends in Health for the Next Decade

10. Financial Situation of the Portuguese NHS: What to Expect?
Innovation: costs in healthcare (projection)
Expenses in healthcare (in % of GDP)
2010-2060
Scenario
Source:
OEDC Average
OEDC Average
OEDC Average
@RBaptistaLeite
Time Trends in Health for the Next Decade

11. Portuguese National Health Service: Future Challenges
Life Expectancy at birth
Slightly above EU average
@RBaptistaLeite
PT
EU
Time Trends in Health for the Next Decade

12. Health Life Years at Birth, Women
5 years behind from EU average
@RBaptistaLeite
PT
EU
Time Trends in Health for the Next Decade
Portuguese National Health Service: Future Challenges

13. Demographic Evolution
Year 2000 and Prospect for 2050
@RBaptistaLeite
PT
EU
In 2050, over 2/3 of the Portuguese population will be ≥ 65yo
Time Trends in Health for the Next Decade
Portuguese National Health Service: Future Challenges

14. High Prevalence of NCD’s
Example | Type 2 Diabetes Mellitus
@RBaptistaLeite
PT
OECD
Time Trends in Health for the Next Decade
Portuguese National Health Service: Future Challenges

15. Lack of Human Resources
@RBaptistaLeite
Troika years:
+ 6.000 MD’s
+ 4.500 Nurses
2011: 2.1 Million without a GP
2015: 770K without a GP
However…
Time Trends in Health for the Next Decade
Portuguese National Health Service: Future Challenges

16. Healthcare in the European Social Model
Core Values: an European Picture
Universal coverage
Equity in the access
Offer of high quality
healthcare
Solidarity in funding
1.
2.
3.
4.
@RBaptistaLeite
Time Trends in Health for the Next Decade

17. The Evolution of Medicine
@RBaptistaLeite
Time Trends in Health for the Next Decade
• Promote health
• Preserve health
• Restore health, when compromised
• Minimize suffering and malaise
Goals of Medicine
Nutbeam D. Health Promotion Glossary. Health Promotion International, 13(4): 349-364. 1999
http://ww2.ecclesbourne.derbyshire.sch.uk/

18. The Evolution of Medicine
@RBaptistaLeite
Time Trends in Health for the Next Decade

19. Industrialization of Healthcare
@RBaptistaLeite
Time Trends in Health for the Next Decade
Health Factory, Norway, 2010

20. Cost reduction in health management
Reduce low added value healthcare
Time Trends in Health for the Next Decade

21. Cost reduction in health management
Reduce low added value healthcare
Failure to reduce the burden of disease
Time Trends in Health for the Next Decade

22. Reduce low added
value healthcare
Reduce excessive
margins without
reducing healthcare
Efficiency
Structural reforms
Health promotion and prevention
Starting
point
Adapted from WHO
National Health Services: The Future
@RBaptistaLeite
Time Trends in Health for the Next Decade

23. Social Determinants of Health
@RBaptistaLeiteDahlgren and Whitehead, 1991
Time Trends in Health for the Next Decade

24. The Future of the National Health Services
What is the future of Health Care?
“In health care, the days of business
as usual are over.”
Michael Porter
Porter ME, Lee TH, The Strategy That Will Fix Health Care, Harvard Business Review, October 2013 @RBaptistaLeite
Time Trends in Health for the Next Decade

25. Supply-driven health care
system organized around
what physicians do
Patient-centered system
organized around what
patients need
Focus on the volume and
profitability of services
provided – physician visits,
hospitalizations,
procedures, and tests
System based of patient
outcomes achieved
Fragmented system, in
which every local provider
offers a full range of
services (silos)
System organized in which
services for particular
medical conditions are
concentrated in health-
delivery organizations and
in the right locations to
deliver high-value care
The Future of the National Health Services
@RBaptistaLeitePorter ME, Lee TH, The Strategy That Will Fix Health Care, Harvard Business Review, October 2013
Time Trends in Health for the Next Decade

26. Supply-driven health care
system organized around
what physicians do
Patient-centered system
organized around what
patients need
Focus on the volume and
profitability of services
provided – physician visits,
hospitalizations,
procedures, and tests
System based of patient
outcomes achieved
Fragmented system, in
which every local provider
offers a full range of
services (silos)
System organized in which
services for particular
medical conditions are
concentrated in health-
delivery organizations and
in the right locations to
deliver high-value care
The Future of the National Health Services
@RBaptistaLeitePorter ME, Lee TH, The Strategy That Will Fix Health Care, Harvard Business Review, October 2013
Time Trends in Health for the Next Decade

27. @RBaptistaLeitePorter ME, Lee TH, The Strategy That Will Fix Health Care, Harvard Business Review, October 2013
Time Trends in Health for the Next Decade
The Future of the National Health Services

28. @RBaptistaLeite
Time Trends in Health for the Next Decade
The Future of the National Health Services

29. @RBaptistaLeite
Time Trends in Health for the Next Decade
Community
Value-based Healthcare
The Future of the National Health Services

30. Definition of Value
@RBaptistaLeite
Time Trends in Health for the Next Decade
Porter M. N Engl J Med 2010;363:2477‐81

31. Outcomes Matter
Time Trends in Health for the Next Decade
@RBaptistaLeite

32. ICHOM
Time Trends in Health for the Next Decade
@RBaptistaLeiteICHOM – Internation Consortium for Health Outcomes Measurement

33. @RBaptistaLeitePorter ME, Lee TH, The Strategy That Will Fix Health Care, Harvard Business Review, October 2013
Time Trends in Health for the Next Decade
The Future of the National Health Services

34. @RBaptistaLeite
ICT Challenges in Healthcare
Time Trends in Health for the Next Decade

35. @RBaptistaLeite
ICT Challenges in Healthcare
Time Trends in Health for the Next Decade

36. • “20% of medical advice we give is probably wrong just because we are
different from each other.”
Dr. Mehmet Oz @ WEF
• Failure rates! Number of patients who fail first time use of drugs:
– 70% Alzheimer’s and Cancer drugs
– 50% Arthritis drugs
– 40% Depression drugs
• Currently, in a way we are using a trail and error approach in real time –
with the human body!
@RBaptistaLeite
Precision and Personalised Medicine
ICT Challenges in Healthcare
Time Trends in Health for the Next Decade

37. @RBaptistaLeite
Precision and Personalised Medicine
ICT Challenges in Healthcare
Time Trends in Health for the Next Decade

38. • Ten years after sequencing the human genome we do not have the
knowledge, education or informatics tools to implement clinical
genetics, genomics, proteomics, meta bolomics or epigenetics into
practical personalised medicine.
• Predictive and personalised medicine informatics needs to be a
research and education theme in its own right.
• The healthcare related scientific community has too few
informaticians and unfortunately many of those that we do have
are without the breadth of understanding of the field to make the
kind of advances that are needed.
Golubnitschaja O, et al: General Report & Recommendations in Predictive, Preventive and Personalised Medicine 2012:
White Paper of the European Association for Predictive, Preventive and Personalised Medicine. The EPMA Journal 2012, 3:14. @RBaptistaLeite
ICT Challenges in Healthcare
Time Trends in Health for the Next Decade

39. Source : IBM Center for Applied Insights
How to get here?
@RBaptistaLeite
ICT Challenges in Healthcare
Time Trends in Health for the Next Decade

40. Cognitive Computing| Artificial Intelligence
@RBaptistaLeite
Cognitive Computing
Cognitive Computing is the simulation of human
thought processes in a computerized model
ICT Challenges in Healthcare
Time Trends in Health for the Next Decade

41. In 2006 the IBM “WATSON” project was born
WATSON is based on “knowledge management”
Instead of
EMR’s that are based on “registry management”
@RBaptistaLeite
ICT Challenges in Healthcare
Time Trends in Health for the Next Decade

42. WATSON for Healthcare
Integration of knowledge with data towards generating better
decisions and outcomes
@RBaptistaLeite
ICT Challenges in Healthcare
Time Trends in Health for the Next Decade

43. @RBaptistaLeite
ICT Challenges in Healthcare
Time Trends in Health for the Next Decade

44. Em resumo…
Saúde Sustentável
In a nutshell…
Time Trends in Health for the Next Decade

45. Time Trends in Health for the Next Decade
7th July 2016 – Athens, Greece
Divani Caravel Hotel
Ricardo Baptista Leite, MP, MD, PhD(c)
Medical Doctor and Member of the Portuguese Parliament
Member of the Parliamentary Health Committee | Foreign Affairs Committee
Head of Public Health | Catholic University of Portugal
Guest Lecturer | NOVA Medical School and NOVA Information Management School
City Councillor of Cascais
ricardo.baptistaleite@gmail.com | @RBaptistaLeite