Plenary Session I (b) (ii)
Abstract
Rapidly aging and how to deal with problems relating aging are major challenges common in East and South-east Asian countries. Reform of the total society is needed to deal with aging related problems and make the society and social systems sustainable. Although Japan is highly industrialized and Japanese makers are highly competitive in global markets, there are several areas which are protected by barriers such as authorization by governments and governmental financial aid. Education, agriculture and healthcare are highly protected areas, and regarded as main battle fields. In Japan, health sector reform led by P.M. Koizumi (2001-2006) was characterized by neoliberalism; tried to strengthen the power of the cabinet office (secretariat of the P.M.) compared to each assigned ministry, implement internal market through deregulation. The reform was succeeded by P.M. Abe whose government lasted less than 1 year (2006-2007) because of his health problem. Reform by Koizumi and Abe specified several important areas for reform with recommendations, and suggested that 1) change of decision making process among governments would be effective, 2) political stability was essential since the reform takes relatively long time (at least several years). After experiencing serious retreat by the government of Democratic Party of Japan (2009-2012), Abe came back to the government again in 2012, and has been leading the reform. Japan witnessed 1) increase of the elderly and worsened fiscal situation, 2) the role of healthcare as a safety net in case of disaster such as earthquake and tsunami in 2011 and 3) introduction of expensive new medical technologies. They accelerate the reform with some modification. Areas for deregulation are clearly distinguished from areas under public control, where the power of authority was strengthened. Regional health plan and integrated healthcare system are characterized by strict control of number of hospital beds by function based upon the expected number of patients in future. OPDIVO (Nivolumab) is highly effective in about 20% of patients with lung cancer or malignant melanoma. The average annual cost per patient is about 35,000,000 JPN, and is clearly unacceptable. It changed the revising process of national tariff for medications from every two years to every year paying attention to real sales compared to expected sales, and encouraged precision medicine. As an infrastructure, genome bank of cancer patients will be built to facilitate genome-base diagnosis as for responsiveness to expensive anti-cancer medications resulting in cost-effective personalized medicine. My presentation will address Japan’s experience from 2011 and try to extract lessens learned.
Plenary Session I (c)
Abstract
Thailand has performed admirably in its health reform over the last few decades and achieved universal health insurance. The challenges now faced by Thailand are similar to most developed countries; an ageing and increasingly urban population reflecting adult mortality and risk factors of an upper-middle income population and the need to modify institutional structures to reflect these changing circumstances. The approach to these challenges has focused on the move to District Health Systems as the access point to healthcare and the service delivery structure demands competent qualified leadership and management. The main concept of this approach is relevant to the concept and principle of the WHO’s DHS development based on primary health care as specified in the Harare Declaration signed in 1987. The aims of this concept are to improve quality of life of people and to encourage people to have better self-care and to look after each other in their own communities. This approach provides recognition of the need to build the capacity and capability of health professionals in the management and leadership of health systems. The purpose of this paper is to discuss the current initiatives in reforming the Thai health system at the district level by improving quality of primary care services and strengthening governance and management capacity of district health boards in order to meet the concept of DHS development. Also, this paper will discuss the role of the recently established College of Health Systems Management of Naresuan University, Thailand in those initiatives within the context of attaining Sustainable Development Goals (SDGs) implementation.
Plenary Session I (a)
Abstract
This presentation describes the Australian Health care system which is positioned as one of the best performing health systems across the range of OECD countries. The Australian health system is complicated as there is shared funding and service delivery between the States and the Commonwealth (National government). While we have a national health insurance system we do not have a simply structured national health system. The system has experienced continuous health reform focused on structure and restructure. Demand and utilization of services are high while health expenditure has risen faster than either population growth or ageing. The challenges for the Australian health system are identified as managing downward fiscal pressure and increasing capacity and demand for services; ensuring we deliver the right mix of care for the chronically ill, frail aged by allocating resources optimally and a continued concern for improved quality and safety of care. The responses to these challenges are likely to be a focus on improving the effectiveness of care; greater investment to address social determinants of health and sustainable development goals (SDGs) and perhaps harmonizing health insurance systems. The article is developed from the contemporary literature about the Australian health system and the future directions are identified from invited expert papers in the current issue of APJHM 3(11). The article describes possible responses to the challenges described and suggests emerging themes and approaches to health reform that are likely to move the emphasis of reform from structure to an emphasis on health outcomes through the use of knowledge, research and social movement to improve collaborative and networked practice. The presentation concludes by suggesting possible future directions from an analysis of the language of health reform.
Plenary Session I (b) (i)
Abstract
Rapidly aging and how to deal with problems relating aging are major challenges common in East and South-east Asian countries. Reform of the total society is needed to deal with aging related problems and make the society and social systems sustainable. Although Japan is highly industrialized and Japanese makers are highly competitive in global markets, there are several areas which are protected by barriers such as authorization by governments and governmental financial aid. Education, agriculture and healthcare are highly protected areas, and regarded as main battle fields. In Japan, health sector reform led by P.M. Koizumi (2001-2006) was characterized by neoliberalism; tried to strengthen the power of the cabinet office (secretariat of the P.M.) compared to each assigned ministry, implement internal market through deregulation. The reform was succeeded by P.M. Abe whose government lasted less than 1 year (2006-2007) because of his health problem. Reform by Koizumi and Abe specified several important areas for reform with recommendations, and suggested that 1) change of decision making process among governments would be effective, 2) political stability was essential since the reform takes relatively long time (at least several years). After experiencing serious retreat by the government of Democratic Party of Japan (2009-2012), Abe came back to the government again in 2012, and has been leading the reform. Japan witnessed 1) increase of the elderly and worsened fiscal situation, 2) the role of healthcare as a safety net in case of disaster such as earthquake and tsunami in 2011 and 3) introduction of expensive new medical technologies. They accelerate the reform with some modification. Areas for deregulation are clearly distinguished from areas under public control, where the power of authority was strengthened. Regional health plan and integrated healthcare system are characterized by strict control of number of hospital beds by function based upon the expected number of patients in future. OPDIVO (Nivolumab) is highly effective in about 20% of patients with lung cancer or malignant melanoma. The average annual cost per patient is about 35,000,000 JPN, and is clearly unacceptable. It changed the revising process of national tariff for medications from every two years to every year paying attention to real sales compared to expected sales, and encouraged precision medicine. As an infrastructure, genome bank of cancer patients will be built to facilitate genome-base diagnosis as for responsiveness to expensive anti-cancer medications resulting in cost-effective personalized medicine. My presentation will address Japan’s experience from 2011 and try to extract lessens learned.