Emerging Trends For Healthcare industry
(July 2011)
As Countries progress economically, Healthcare costs
increase, so does the ability of people to pay for them. These increased costs
are attributed to the use of pharmaceuticals; increased number of visits to the
Emergency Department; Longer Hospital stays over the life span of any individual
due to longevity and geriatric problems; multiple surgeries, especially after
attaining 60 years of age and increased use of technology to deliver and receive
Healthcare.
With the rapid rate of socio-economic growth that is being
witnessed all across the world, the volume of Healthcare services required will
have a significant impact on the economy, consumers, and Healthcare
professionals in any country.
It is our firm belief
that most countries in the world shall have to increase their direct spending on
delivery of Public Health as well as on Curative Health through Hospitals and
other such custodian Healthcare Institutions to at least 10 of their Gross
National Income in next 7 – 15 years.
This increased availability of resources for Healthcare shall
impact Healthcare Industry in a major way in next two decades. It shall not only
integrate the Healthcare delivery across all countries, developing or developed,
but will also standardise various Healthcare delivery modules and the outcome of
this Healthcare delivery.
It shall definitely improve Life Expectancy at birth, lower
the Infant Mortality Rates, Maternal Mortality rates, which together shall lead
to increased population burden.
Emerging Trends
-
Healthcare
Industry is becoming a major employer in most of the countries in the world.
-
Hospitals will become Acute
and Intensive Care providers while Intermediate level care will move to Patient
Homes or Nurse managed Nursing Homes.
-
Hospitals will have Virtual
ICUs for most of Critical Care Departments with remote Intensivist based control
room for providing Intensive Care.
-
Hospitals will be required to
integrate new department of Tissue Engineering and Regenerative Medicine to
provide Tissue Engineering Laboratories, Bioreactors and Robotics to carry out
these precise processes on their patients.
-
Hospitals will be required to
integrate Nano Technology in Healthcare Delivery, which has created Diagnostic
Tools and Therapeutic Modalities for Healthcare Industry which are now in
various stages of approval for clinical use.
-
Patients will have Electronic
Patient File with some service provider and patients will allow healthcare
providers to access to this, when required.
-
Patients will have choice of
scaffold based healing solutions which shall reduce Average Length of Stay in
IPD.
-
A new Diagnostic Modality
Photoacoustic Imaging using Ultrasound
and Lasers shall be available very soon to for diagnostic studies at
sub-cellular level.
-
Group Purchasing Alliance in
Developing Countries will take over Healthcare Provisioning.
Emerging Trend: Healthcare Industry is becoming a major employer in most of the
countries in the world.
The Healthcare Industry requires wide variety of people with
various educational backgrounds to function. Most of the occupations in the
Healthcare Industry require less than four years of education and training after
school; but all occupations that carry out diagnosis and treatment must employ
highly educated, trained and adequately skilled persons who require many years
of education and training beyond school as well some regulated form of License
or Certification to practice. (ILO - ISCO -88, Major Group 2 Professionals,
Group 22 Life Science and Health Professional)
Generally, the ratio of these skilled to unskilled
occupations in a Healthcare System is 20:80. In Hospitals, the ratio of these
skilled to unskilled occupations in a Healthcare System is 40:60.
The Healthcare Industry has emerged as one of the largest
industry and Employer in the world in 2008, and provides 1.34 (Afghanistan) to
14.3% (USA) of all jobs and occupations in various countries. Even at 14.3% USA
has deficiencies in some types of skilled occupations like Nursing and
Technicians.
NOUS predicts that most of the countries will follow USA and will
provide many more jobs in Healthcare directly proportional to their investment
in Healthcare in next 25 years. The major thrust shall be in African Countries
and then in Asian Countries. The growth in employment in Healthcare Industry
shall be @ 2 -3% average in most of the countries in the world.
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Emerging Trend: Hospitals will become Acute and Intensive Care providers while
Intermediate level care will move to Patient Homes or Nurse managed Nursing
Homes.
The growing expectations for better Healthcare Services and
exorbitant cost of purchasing private Healthcare will force Public Hospitals to
scale up their operations to realize the benefits of economy of scale. The
better educated citizen in most countries including India, China, Africa and
Latin America is already challenging the poor standards of Hygiene, lack of
respect and privacy, high morbidity and mortality rates of Public Hospitals.
The Rich and Famous of any country can source Healthcare from
anywhere in the world; the Rich but not so Famous purchase private Healthcare;
but average enlightened middle class citizen will change the Public Healthcare
Provider and make it not only accountable but also more efficient.
NOUS predicts that the structure of Hospitals in near future will
change and they shall become providers of Intensive care and Acute care Level
Healthcare. The present trend of providing 10 – 30% of total beds as Intensive
Care beds will change to 50 – 60%. The present trend of providing 20 – 40% of
total beds as Acute Care beds will change to 30% or more. There will be fewer,
less than 20%, beds for Intermediate Care in Hospitals. These shall be for
Paediatrics and Obstetrics.
Some Hospitals like Military Hospitals will have more
Intermediate Care Beds (upto 50%) for long convalescence. All other Hospitals
will gradually become Acute Care Hospitals.
The presently available Intermediate Care Beds for
convalescence will move to Nurse managed Nursing Homes or Patient’s Homes.
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Emerging Trend: Hospitals will have Virtual ICUs for most of Critical Care
Departments with remote Intensivist based control room for providing Intensive
Care.
The increasing demand for Intensive care coupled with
non-availability of critical care physicians and nursing staff has given birth
to Virtual ICUs where using technology based solutions, Intensive Care Units of
different types are being staffed with regular staff but virtually monitored by
Critical Care Trained Intensivist.
This not only enlarges overall reach for Intensive care but also reduces the
cost at which the care is delivered.
The span of patient numbers that an
Intensivist can treat increases from 16 to 96, the severity adjusted ICU
mortality rates reduce by 10% even when the staff employed in ICUs is not fully
trained for critical care and average length of stay in ICU also decreases by
20% (It reduces from 2.5 – 3 days to 2 – 2.5 days).
NOUS predicts that in very near future all large Hospitals will
have owned Virtual ICUs where as small Hospitals will have third party managed
Virtual ICUs. At present, the high cost of technology to be employed for
creating Virtual ICUs is the only factor that is restricting growth of Virtual
ICU beds.
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Emerging Trend: Hospitals will be required to integrate new department of Tissue
Engineering and Regenerative Medicine to provide Tissue Engineering
Laboratories, Bioreactors and Robotics to carry out these precise processes on
their patients.
The rapid advances in Tissue Engineering and Regenerative
Medicine has provided the following Human Organs and Tissues which are available
or will be shortly available for clinical use. The manufactured organ would be
engineered for its recipient with cells from their own body, ensuring that the
organ would not be rejected.
Ø
Blood
Ø
Blood Vessels
Ø
Liver
Ø
Lungs
Ø
Teeth
Ø
Trachea
Ø
Urinary Bladder
The process requires controlled and supervised activities to
culture and grow stem cells and then altering their Genetic Code. This shall
require provisioning of fully controlled tissue engineering laboratories either
as on site facility or remote University Based facility.
NOUS predicts that in future, all hospitals will have this new
department of Tissue Engineering and Regenerative Medicine which shall provide
Tissue Engineering Laboratories, Bioreactors and Robotics to carry out these
precise processes on their patients. This will also influence Hospital design as
more clean rooms will be required to carry out this work.
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Emerging Trend: Hospitals will be required to integrate Nano Technology in
Healthcare Delivery, which has created Diagnostic Tools and Therapeutic
Modalities for Healthcare Industry which are now in various stages of approval
for clinical use.
The rapid advances in Nanotechnology have developed a large
number of Nanoparticles for delivering drugs, heat, light or other substances
into Human Body so as to reach specific types of cells (such as cancer cells)
and cell components. The Nanoparticles are engineered so that they are attracted
to diseased cells, which allow direct treatment of those cells. This technique
reduces damage to healthy cells in the body and allows for earlier detection of
disease. Nanoparticles, particularly ones made of precious metals, provide or
enhance signals in imaging approaches beyond fluorescence microscopy.
Magnetic Resonance Imaging, Photo Acoustic Imaging and Raman
Spectroscopy approaches all draw on this branch of materials science.
Compared with existing fluorescent proteins and
small-molecule dyes, nanotech probes can offer signals that are several fold
brighter and hundreds of times more stable. The newer Nano diamonds do not blink
like older Quantum dots or bleach like Proteins. They are useful for long-term
tracking molecular activities, monitor cell processes at the nanometre scale,
inside cells. Using these diagnostics, Physicians shall be able to tailor
individual therapies to the very molecules that shall be treated. Thus one shall
be able to distinguish a patient's cancer from other cancer types.
Molecular imaging is gradually being established as a
definitive branch of science and Medical schools in USA offer fellowship after
postgraduate training in radiology. As of now, Nanotechnology is impacting
diagnostics and treatment schedules in Cancer.
All Nanotechnology work areas are treated as Clean rooms, 25%
or so confirm to Class 10 Clean Rooms and rest are Class 100 to Class 1000.
NOUS predicts that in future, Hospitals will be required to
integrate Nano particles based Diagnostic Tools and Therapeutic Modalities in
Healthcare Delivery, especially in treatment of cancer and geriatric disorders.
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Emerging Trend: Patients will have Electronic Patient File with some service
provider and patients will allow healthcare providers to access to this, when
required.
Today, every patient has to have a number of Healthcare
Providers starting with General Practitioner to a number of specialists and
super specialists. The patient files are becoming bulkier and un-organised.
Advent of Electronic Patient Files and web based repositories will provide
seamless integration between various providers at various locations and at
various time of patient’s life cycle. This shall help in proper reviews at all
stages, control costs and improve patient management by basing it on problem
solving rather than symptom management.
There are a number of third party Medical Record Management
Companies doing this work in USA. Sooner than later, this will become available
to all hospitals as it brings better patient management at reduced cost of
Medical Record keeping. There are certain issues related to privacy, provision
of access and ethics which are being resolved.
NOUS predicts that once these issues are fully addressed, it shall
become universal to have Electronic Patient File with some service provider and
patient will provide access to this file when he consults or takes treatment.
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Emerging Trend: Patients will have choice of scaffold based healing solutions
which shall reduce Average Length of Stay in IPD.
Bio-degradable, scaffold integrated bandages are now
commercially available where patients own cells (taken by skin biopsy procedure)
are allowed to grow into natural skin closure. This provides scar less wound
healing. This not only helps in desired healing solutions but also reduces ALSO,
graft related problems and increases success rates for Skin Grafts.
Soon, bio degradable scaffold shall be available for growing one’s teeth. There are in fact about 28
lines of stem cell based tissues being worked upon.
NOUS predicts that in near future, Patients will have choice of
scaffold based healing solutions which shall not only provide almost natural
healing but also reduce Average Length of Stay in IPD.
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Emerging Trend: A new Diagnostic Modality Photoacoustic Imaging using Ultrasound
and Lasers shall be available very soon to for diagnostic studies at
sub-cellular level.
Photoacoustic Imaging, a biomedical imaging modality has been
developed based on the Photoacoustic Effect. Non-ionizing laser pulses are
delivered into biological tissues. Some of the delivered energy is absorbed and
converted into heat, leading to transient thermoelastic expansion and wideband
(e.g. MHz) ultrasonic emission. The generated ultrasonic waves are then detected
by ultrasonic transducers to form images.
When radio frequency pulses are used in place of lasers, the
technology is referred to as Thermoacoustic imaging.
The optical absorption in biological tissues can be due to
endogenous molecules such as haemoglobin or melanin, or exogenously delivered
contrast agents. Since blood has higher concentration of endogenous molecules
compared to surrounding tissues, Photoacoustic imaging can visualize blood &
blood vessels and is a useful tool for studying Haemodynamics. It is also used
in vivo for tumour angiogenesis monitoring, blood oxygenation mapping,
functional brain imaging, and skin melanoma detection, etc.
Two types of Photoacoustic imaging systems, Photoacoustic
Computed Tomography (PAT) or Thermoacoustic Computed Tomography (TAT) with
Photoacoustic Microscopy (PAM) have been developed. A typical PAT or TAT system
uses an unfocused ultrasound detector to acquire the Photoacoustic signals
whereas a PAM system, on the other hand, uses a spherically focused ultrasound
detector with 2D point-by-point scanning.
PAT & TAT shall be used in Brain Lesion Detection,
Haemodynamic mapping of organs and Diagnosis of Breast Cancer. PAM shall be used
for in vitro blood oxygenation mapping of tissues.
NOUS predicts that in future clinicians are going to make wide
spread use of this Diagnostic Modality - Photoacoustic Computed Tomography (PAT)
or Thermoacoustic Computed Tomography - for diagnostic studies at sub-cellular
level.
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Emerging Trend: Group Purchasing Alliance in Developing Countries will take over
Healthcare Provisioning.
The trading practices in providing Capital Equipment and
Hospital Supplies will change as Group Purchasing Alliance shall establish and
operate thereby regulating the whole business of Healthcare provisioning. The
market is now operating on profit margins which provide for non-ethical issues,
cartelisation, poor performance of warranties, up gradation, etc. There is
another factor of slippage of scheduled payments. The time has come when all
players involved in Healthcare provisioning have to mature to make the system
more effective and responsive.
Group Purchasing Alliance will catalyse this process.
NOUS predicts that in near future, Group Purchasing Alliances of
Healthcare Providers in Developing Countries will take over Healthcare
Provisioning.
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