Assistance in daily living in Japan Care continuity across countries for international patients in Thailand Among people at higher risk are elderly people who have chronic illnesses that require long-term attention in all settings. Dr. John Campbell of the University of Michigan spoke at the Conference on Challenges of Population Aging in Asia (14-16 April 2014) on Japan’s Universal Long Term Care Insurance (LTCI) system. The LTCI has tried to meet needs for Assistance in Daily Living (ADL) by providing a range of services from visiting home nurse, to day care with rehabilitation to nursing homes with more medical service. Its benefits cover 90% of assessed need for both institutional and community-based care. However, expenditure on LTCI kept rising, reaching Y80 billion in 2012 and accounting for 1.7% of the GDP. To tackle growing demand, the government plans to include services in senior housing, develop 24-hour availability of both LTC and medical services, as well as mobile community support with local government leadership. HIMSS Asia Pacific Exclusive Article Bumrungrad International is the largest private hospital campus and largest private clinic in Southeast Asia. Bumrungrad’s International Medical Coordination Office (IMCO) works with the home doctors of its international patients. Access to the most current medical records, including up-to-date laboratory tests, x-rays, or scans can be transmitted between home doctors and Bumrungrad to ensure proper care. Bumrungrad harnessed technology to ensure care continuity when it adopted Global Care solutions in 2001. Nearly every service and record is digitized and integrated using secure wireless technology. Bumrungrad offers two residential facilities for recovering patients and their family members. The first, Bumrungrad Hospitality Suites, is a serviced apartment complex with support services, including maid and concierge service and an appointment desk linked directly to the hospital which is within walking distance. The other, Bumrungrad Residences, is connected to the main hospital building by an air-conditioned, elevated walkway. International patients need not worry about language barriers because nearly all Bumrungrad doctors speak English, and over 140 interpreters are available to cover the language needs of patients from almost any country. Bumrungrad’s contact center answers over 500 emails daily. Bumrungrad is a success story for care continuity and a model to be emulated.
Transcript
Continuity of care is ensuring that care between healthcare providers is coordinated so that the patient experiences one seamless flow throughout his or her care continuum. For continuity, the environment and system have to be as seamless as possible, covering primary care to acute care. This article will look at case studies on care continuity in selected Asia Pacific countries, including those with a focus on the elderly or those with chronic diseases.
Assistance in daily living in Japan
Care continuity across countries forinternational patients in Thailand
Among people at higher risk are elderly people who have chronic illnesses that require long-term attention in all settings. Dr. John Campbell of the University of Michigan spoke at the Conference on Challenges of Population Aging in Asia (14-16 April 2014) on Japan’s Universal Long Term Care Insurance (LTCI) system.
The LTCI has tried to meet needs for Assistance in Daily Living (ADL) by providing a range of services from visiting home nurse, to day care with rehabilitation to nursing homes with more medical service. Its benefits cover 90% of assessed need for both institutional and community-based care.
However, expenditure on LTCI kept rising, reaching Y80 billion in 2012 and accounting for 1.7% of the GDP. To tackle growing demand, the government plans to include services in senior housing, develop 24-hour availability of both LTC and medical services, as well as mobile community support with local government leadership.
HIMSS Asia Pacific Exclusive Article
Bumrungrad International is the largest private hospital campus and largest private clinic in Southeast Asia. Bumrungrad’s International Medical Coordination Office (IMCO) works with the home doctors of its international patients. Access to the most current medical records, including up-to-date laboratory tests, x-rays, or scans can be transmitted between home doctors and Bumrungrad to ensure proper care. Bumrungrad harnessed technology to ensure care continuity when it adopted Global Care solutions in 2001. Nearly every service and record is digitized and integrated using secure wireless technology.
Bumrungrad offers two residential facilities for recovering patients and their family members. The first, Bumrungrad Hospitality Suites, is a serviced apartment complex with support services, including maid and concierge service and an appointment desk linked directly to the hospital which is within walking distance. The other, Bumrungrad Residences, is connected to the main hospital building by an air-conditioned, elevated walkway.
International patients need not worry about language barriers because nearly all Bumrungrad doctors speak English, and over 140 interpreters are available to cover the language needs of patients from almost any country. Bumrungrad’s contact center answers over 500 emails daily.
Bumrungrad is a success story for care continuity and a model to be emulated.
HIMSS Asia Pacific Exclusive Article | 02
Array of care providers creates doctor-shopping in Hong Kong
Creation of national registry and deployment of smart technology in Singapore
To improve primary care, Hong Kong proposed several strategies which included:• Developing comprehensive care by multi-disciplinary teams• Improving continuity of care for individuals• Promoting patient safety through the efficient use of resources• Strengthening preventive approach to tackle chronic diseases• Enhancing inter-sectoral collaboration to improve the availability of quality care,
especially care for chronic disease patients.
However, challenges remain because of the development of specialty services and multi-disciplinary care make it increasingly common for patients to reach an array of providers in multiple types of settings, making “doctor-shopping” something common.
In Singapore, up to 48% of disease burden is linked to chronic diseases such as diabetes, hypertension, high cholesterol and stroke, and the number of cases is expected to reach 600,000 by 2030. By 2030, an increase in life expectancy will see the number of elderly citizens triple to 900,000.
Earlier this year, Channel NewsAsia reported on a pilot project to standardize Intensive Care Unit data with the setting up of a national registry. Health Minister Gan Kim Yong said that given the relatively high mortality and costs associated with intensive care, improving understanding of the burden of critical illness in Singapore would facilitate improvement of the quality and continuity of care, better capacity planning and optimize resource utilisation.
Singapore has launched several other initiatives and deployed many other measures. With a shortage of hospital capacity, Singapore plans to implement telehealth services to allow residents to access healthcare from their homes, monitor their health conditions and receive medical attention when needed.
The Smart Health-Assist program is planned to help manage chronic diseases with smart devices such as wearable devices, or sensors embedded in public housing smart homes. “Data will be processed from these wearables and the homes, and brought back to the caregiver and respective healthcare institutions for processing,” said Jacqueline Poh, Managing Director of the Infocomm Development Authority (IDA).
This model is pre-emptive rather than reactive, preventive rather than curative. It can potentially reduce visits at hospitals’ emergency departments or inpatient admissions.
Much room for healthcare development in Indonesia
Indonesia’s population is expected to grow about 22 percent between 2010 and 2040. Challenges loom large as there are only 0.6 hospital beds per 1,000 people in Indonesia compared to the global average of three beds and the average of five beds for the Organisation of Economic Cooperation and Development (OECD) countries. Indonesia has only 0.4 doctors per 1000 people, lower than the global average of 1.4 doctors and while the OECD average is cited as 3.2 doctors.
Due to its geography, autonomy was granted provinces, districts and cities to manage their own primary, secondary and tertiary healthcare delivery. As such, there is no integration along the spectrum of care and the primary care physician plays very little role and has little incentive to make proper referrals to secondary care providers.
Individuals often self-refer themselves directly into a hospital while most specialists also have dual-practice arrangements, shuttling between a public hospital and one or two private hospitals in the same city. Such “doctor-hopping” compounds the challenges of creating care continuity.
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Conclusion
Let’s get back to the baseline. Why is there a demand for out-of-hospital care strategies? At the 2011 Amsterdam forum which discussed the challenges of care continuity, Rene Amalberti predicted that 80% of surgery would become day-surgery, 20% of interventions would move to offices and out-of-clinic facilities and there would be massive transfer of post-op care to primary care between the years of 2010 to 2020. He also spoke of growing delegation of care to nurses and growing remote medicine due to IT innovations. On a less optimistic note, older patients would need longer periods of care, especially those with chronic diseases.
Clearly, all these signal a pressing need to coordinate and provide adequate care over a continuum of healthcare services.
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