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Christina Nesheva

GlaxoSmithKline plc

TEDCRED 50+

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What is the future of healthcare? How can it become health care vs sickness treatment? What role do technology and innovation play?

Healthcare costs are rising, the population is aging and medical needs are greater than ever. How can patients receive better quality care at an affordable price? How can we leverage technology to provide better and more affordable healthcare around the world?

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    Oct 19 2011: I agree with most respondents; Education is the key to health care vs. sickness treatment.

    My problem with the US medical care debate is the automatic assumption that Health Insurance should be part of the solution. Insurance is traditionally purchased to protect yourself against something that you don't want to happen. It can't work, economically, when the general population uses insurance to pay for events that are certain to happen, or that you hope will happen.
    IE:
    1. Treatment of chronic illness. You know you need the treatment, so it will cost more overall to indirectly pay for it via Insurance.
    2. Health care. Again; you want to be healthy, so paying an insurance policy to pay for your efforts to remain healthy is more expensive than paying it yourself.
    3. Sickness treatment. This is the only aspect of Medical care that works as an insurable event. You don't want to get sick, so you don't want to use your health insurance policy for this. Therefore; this represents an economically insurable risk. But sickness treatment is only 1 of 3 broad categories within the Medical care arena that are economically insurable.
    These aren't the only problems with using insurance to pay for Medical care, but I hope they illustrate the problem. ?
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      Oct 19 2011: I wonder if at the moment Insurance is given such an important role because it offers the necessary effectiveness metrics for treatment. Metrics drive innovation, insurance companies and consortiums drive metrics. I'd be nowhere in my team's innovation without ICD-9, but coding today is done mostly for billing purposes, driven again by insurance companies. And this is just one example.

      Also we have to consider the economic value of stability. Paying more is not always bad. You don't just pay tfor treatment, you pay for the safety net that WHILE you're getting your treatment, chronic or not, any sudden hikes in costs or changes in standard of care, or acute incidents, and incedental trauma will not take unexpected $20,000 out of your pocket, derailing your entire financial life (thinking of average americans here).

      I'm not saying insurance today isn't flawed throughout. I am FAR FROM defending today's model, but it's not just something that you deprioritize or think of ways to get rid of. I think it's something which needs re-design, but should always be a part of the system when considering the holistic "health CARE", not just incedental medical treatments. And it should reward behaviors such as healthy diets, supplementation, and exercise or active lifestyle, which should become increasingly easy in the world of Big Data.
      • Oct 19 2011: You miight consider if science and evidence -based practice offers the necessary effectiveness metrics for treatment, not insurance companies.
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        Oct 20 2011: Insurance is not flawed, in my opinion. And insurance has it's place in health care.

        I'm suggesting we insure the 'insurable' portions of health care, and recognize that some health care costs are not 'insurable'. Here's an illustration:

        You insure a house against catastrophic damage (something that you hope will never happen), but you don't insure the house against regular maintenance, because that would bring an additional cost into the equation - the cost of the insurance company itself. Hiring an insurance company to pay for your yard work and house maintenance would be much more expensive that paying for it yourself, right? That is also true for routine medical visits and treatment of chronic illness.

        It's another matter entirely to say "I want a collective group to subsidize my chronic health issues and routine office visits". This is a valid concern for the poor, but this issue should be treated as another matter entirely.
        If someone wants/or needs that kind of financial help, it's less expensive in the long run to treat that as the separate issue that it truly is.

        Insurance is a very expensive way to pay for routine expenses, and that's a big reason health costs are increasing rapidly.
    • Oct 20 2011: Insurance is obviously part of the problem, so should be part of the solution. -in my humble opinion, Insurance companies act like gangsters: you have to purchase the policy for you to be protected, if not you will die. period!
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        Oct 23 2011: Like gangsters? Wow. I think you need to change insurance companies. Mine never came to my house and gave me an "offer I could not refuse".

        To me, I CHOSE to buy insurance to mitigate the risk. I could take the same amount of money and save it in the event of some catastrophe, but I make a CHOICE to buy insurance. And the neat thing is that I can CHOOSE a lower price by doing everything I can to stay healthy.

        However, now if the government REQUIRES me to buy insurance... well, then I suppose the government is now becoming a gangster, but that is a different story.
        • Oct 24 2011: seems that you had many alternatives to choose your health insurance. Can you tell us? and, YES, it is precisely that I had received: an "offer I could not refuse", again, gangsters or even worse -I did not realize they were making more profits by avoiding the costs of visiting me at home, as you pointed out.
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        Oct 24 2011: Edgar, yes. There are websites which list many alternatives. Do you really want me to advertise them here? Some are more expensive than others, but that is the free market. Why are you limited?

        You say they are making a "profit", but you are likely misusing terms. They bring in more money than they spend on YOU, but that is how they work. Somehow, they have to pay for the extra costs that occur. Many people get much more paid for them then they ever paid into insurance (which is the whole point of insurance). That money does not grow on trees. It comes from managing costs. If, in the end, the net of all revenue less all costs is positive, THEN they have a profit. To me, that is fine since that is what businesses strive to do(but not all do). Would you rather the insurance companies scrape by? Or, perhaps you prefer they lose money and go out of business?
        • Oct 24 2011: Let me ask you something. What if you decide not to buy a health insurance policy? Simple, you will not be able to solve even a regular health event by yourself, quickly the situation will get worse for you, and sooner or later you will be at high risk of death. So, back to the beginning of this conversation, you do not have a better choice Drew, you are forced to accept that "offer I could not refuse", imposed by the current health system through insurance companies, whatever that nice webpage you were close to advertise. It is buy or not to buy, if you do not buy then you will die! --- Sorry, I still find this modus operandi similar to the gangsters!
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        Oct 24 2011: Edgar, I am not sure what you expect. You say how important insurance companies are yet you don't want them. Which is it?

        As you point out, you DO have a choice not to go with insurance companies. Many people do and they are not dead. Yes, it is very risky (FYI: there are many things about life that are risky.) But without insurance companies, how else would you manage the risk?

        I think you real issue is with the cost of healthcare, not the cost of insurance. If your issue is with the cost of insurance, then please respond to the second part of my previous response.
        • Oct 24 2011: They are not dead yet, but will be soon if they are not cared. That's my point, the fact that one of two choices is equivalent to shorten lifetime or an early death [I can't imagine to whom I would give that kind of alternatives to elect]. That's absolutely unethical, and sadly nobody seems to notice! We have accepted that doing bussiness with the pain and suffering of people is a good thing. As in Stockholm syndrome, we have learnt to love our captors, sometimes to the point of defending them.
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        Oct 24 2011: Edgar, I am not sure what you expect. You say how important insurance companies are, yet you don't want them. Which is it?
        • Oct 25 2011: That's the easy part: I would like to have a system where everyone equally has the best possible health --- How to get to that system? would be possible if at least we were looking in that direction. --- I do not see insurance companies in any role in that world. I really do not hate insurance companies; I just simple believe that health should not be their business. Moreover, health of people should not be a business the way it is in these days. Let me explain, insurance companies base their income on an adverse events that are more common among the people every day, so that their businesses will eventually become unsustainable, simply because you cannot expect to increase premiums forever. And they know about it, so they are just taking advantage of such widespread pathological optimism, and continue to use a wonderful business tool they have what is increasing premiums at will, until the government decides to put a stop to these guys and take seriously this problem.
        • Oct 25 2011: Now, it is not a secret that health is related to economy in several ways. So. health-related areas of economy should also be matter of intervention. In general, you will have few healthy people generating the resources to maintain or recover a lot of unhealthy people; so, economy won't grow. On the other hand, economy in their hurry of growing is pushing people to consumerism; as result you have a money-driven society with all the harmful consequences that implies; or just a typical individual, eager for junk food and banal things, propelled by advertising, that is becoming more obese every day, illiterate, unsatisfied, irritable, and anxious, in other words, an army of unhealthy people that contributes nothing to society and economy. We have to do something smart about that, soon!

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