2170 Nikkei Forum home healthcare speech

Towards next-generation home healthcare

September 17, 2010

Good afternoon ladies and gentlemen. I’m honored to be here today at this Nikkei Healthcare Forum to discuss what I think is one of the most important issues facing the world today.


How do we provide high-quality healthcare in a sustainable way? How do we help the elderly and chronically ill to live as full and rewarding a life as possible – now and in the future?


But before I say any more, I’d like you to meet one of the people whose quality of life we are discussing today…




Mabel is part of a rapidly growing population – the elderly and chronically ill. And like Mabel, most of these people want healthcare services that do more than just keep them alive and treat their ailments. They want quality of life.


But at the same time, healthcare costs are spiraling out of control. And there aren’t enough qualified doctors and nurses to go around.


This all means that healthcare needs to change – and fast. It needs to become more efficient and more patient-centric. If we want a society that offers people like Mabel the quality of life they deserve then home healthcare needs to play a bigger role.


Here in Japan, the government has already recognized this. In 2006, the Ministry of Health, Labor and Welfare announced an ambition to ensure safe and reliable medical care that improves the patient’s quality of life based on home healthcare. The Ministry is also working on a revision to the Elderly Care Insurance System that will allow seniors to choose home healthcare.


If the switch to home healthcare is to happen, it is up to companies like Philips to deliver the technologies and products that make it possible. Solutions that are reliable, easy-to-use and address real issues for patients and healthcare professionals. This is what I mean by the phrase “next-generation home healthcare” in the title of this talk.


Later I will tell you about some of the next-generation home healthcare solutions that Philips has already developed – including a revolutionary medical alert service that we will be introducing to Japan in the near future.


The changing challenges of healthcare in developed countries
But first, let’s all be clear about the urgency. Home healthcare is not a luxury. It has a vital role to play in enabling sustainable healthcare that delivers a high quality-of-life in our aging world.


We are getting older
I guess we’ve all seen the figures. UN statistics show that the proportion of the population aged 65 or over has been rising since about the 1990s. But in the next few years, that trend is really going to take off. It’s called hyper-aging.


Japan is probably the most hyper-aged country in the world. Today, the over 65s make up 22% of Japan’s population. By 2025, the ratio will be 30% – or some 35 million people. And by 2050, almost 40% of the Japanese population will be over 65 – and one in four will be over 75!


We are getting sicker
We’re getting sicker as well as older. More and more of us are living for longer and longer with some form of chronic illness. These days, people can live with – and need treatment for – conditions like heart disease, diabetes, even cancer for years.


That’s partly because we are living longer – so there’s more chance of becoming ill.


We don’t take care of ourselves
But it’s also down to lifestyle factors. We just aren’t taking good enough care of ourselves. Too many of us, all over the world, are eating high-calorie, high-fat, high-salt diets. And as a result, conditions like obesity, heart disease and cancer have spread from developed countries and are now global issues.


The World Health Organization predicts that 50% of the developed world will be chronically ill by 2050. There is no way we can provide effective long-term care for that many people in hospital.


Demand for healthcare is growing
So there is going to be more pressure on healthcare systems that are already stretched.


At the moment, Japan has one of the best healthcare services in the world. You have twice as many hospitals and three times as many hospital beds per person than other developed countries.


There is also more demand for healthcare. Japanese people visit their doctor three times more often than people in other developed countries. And if they need to go into hospital, they tend to stay twice as long. As the population continues to age, both those figures are likely to go up.


So although you have plenty of hospital beds right now, if healthcare remains almost exclusively hospital-based, space will soon start to run out.


What’s more, the Japanese government predicts that the total population will fall over the coming years. That means there will be fewer young people training to be doctors and nurses. So fewer qualified healthcare professionals to care for more elderly and ill patients. In fact a recent prediction suggests the ratio of health workers to over 65s in Japan will be 30% lower by 2025.


People around the world and in Japan have been talking about this healthcare skills shortage for some time. It will only get worse.


Of course, even if we could find enough trained healthcare professionals, just using more of the same form of healthcare will cost countries a lot more money. Many nations already spend more on healthcare than they are comfortable with – around 10% of GDP for developed countries. Japan currently spends less than the average at around 8% of GDP. But if current trends continue, developed countries will be spending over 20% of their GDP on healthcare in the not-too-distant future.


I don’t think any country can sustain that level of healthcare spending – not with all the other calls on public funds. We need a more sustainable alternative.


We expect better choices
And while healthcare systems are trying to cope with skills shortages and spiraling costs, we – the general public – are demanding more from them.


The doctors I meet tell me patients often come to appointments armed with huge amounts of information downloaded from the web. They have patients who more-or-less demand a particular drug or treatment. Some even go as far as to insist they are referred to hospitals that have a certain type of equipment.


That’s part of a wider trend. Patients want more choice in where and how they get their healthcare. You can see that in the rise of medical tourism and spa-like hospitals. People are increasingly making healthcare choices for lifestyle and quality-of-life reasons. Healthcare isn’t just about treating illnesses any more, it’s about engaging with people as clients.


Challenges in aging developed countries
So in summary, the big challenges facing healthcare in developed countries like Japan where the population are:


1. More chronic disease – meaning more people are sicker for longer
2. Patients who expect more choice in life and in care
3. Spiraling costs and a lack of qualified care givers


And each of these trends is accelerating as time goes by. The big question is, how do we address them?


Future of healthcare in aging developed countries
We can – and must – make hospital-based healthcare more efficient. We need to make it easier for hospitals and clinicians to share information on patients, illnesses and therapies. And we can improve the speed, quality and range of services available through outpatient clinics. These measures will increase the number of patients doctors can treat and reduce the number of people that have to be admitted to hospital – taking some of the pressure off our hospitals.


But solutions like outpatients clinics can only go so far. And they don’t address people’s demands for more choice and better quality of life.


This is why we need more home healthcare. Those healthcare activities that can be carried out in the home, should be carried out in the home. And right now, that means those activities focused on prevention and monitoring.


Home healthcare is ideal for elderly and chronically ill people – those people who are most likely to need healthcare and whose life is most affected by it. Effective home healthcare means fewer and shorter inpatient stays, freeing up valuable resources in hospitals.


More importantly, patients who can stay at home tend to be happier and have a better quality of life. Who here would look forward to a stay in hospital? I know I wouldn’t.


But we can only hope to realize these benefits if patients themselves are willing to use home healthcare services. For that to happen, the services must be easy-to-use, easy-to-access and, perhaps most importantly, focused around real consumer needs.


As a global company focused on health and wellbeing, Philips has done a lot of work to understand what people want from home healthcare.


Healthcare is a core part of our business – along with lighting and consumer lifestyle products and solutions. Through these three legs of our company, we interact with millions of consumers every day. This gives us a deep insight into how people interact with technology.


We also produce the Philips on Health and Wellbeing study. This dedicated research investigates people’s opinions of their own health and the healthcare system in their country.


People focused
All of this insight feeds into our approach to healthcare.


Our healthcare innovation begins with the day-to-day experiences and needs of patients and care providers – after all, these are the people we are trying to help.


Care cycle driven
We aim to address these people’s needs throughout the care cycle from prevention and screening to diagnosis, treatment and health management. That means looking beyond specific modalities or departments. Decisions made during screening can have a big impact on treatment – so we think about the whole picture.


Care anywhere
That includes considering where people are when they are being cared for. A system that will be used in a hospital by a doctor will be very different to one used at home by the patient themselves – or even by a paramedic in an ambulance.


We are also thinking about what kind of care will be delivered where, and how to make sure it all links up smoothly – so people get the most effective all-round care.


Meaningful innovation
By combining our extensive consumer insight with our people-focused, care-cycle driven approach to healthcare, we aim to apply technology in a way that makes a real difference to people’s lives.

Building a bridge with innovation
In home healthcare, we’re focusing our activities on three areas

1. Sleep and respiration
2. Independent living
3. Remote monitoring


Home monitoring vision
In these areas, our long-term plan is to provide patients with a variety of devices for monitoring their health and well-being. Depending on the type of monitoring required and resources available, the information from these devices can be sent to clinicians to keep an eye on the patient. Or that monitoring and interpretation can be outsourced to Philips. We would then do a first-level screening, only alerting the patient’s doctor when an issue arises.


A key part of this vision is a data management and integration platform that allows information about the patient to be collected and stored in a consistent way – whether it comes from devices operated by the patient themselves, their doctor or a Philips monitoring center. That platform has to be compatible any electronic health record protocol used in the area to enable effective linked-up care between the home and the hospital.


In the rest of this talk, I’d like to tell you about some of our solutions for the last two of our three home healthcare focus areas: independent living and remote monitoring.


Firstly, independent living and in particular what we call “aging in place”.


A 2007 survey carried out in the US found that almost 9 out of 10 seniors would prefer to grow older in their own homes. For older people, the chance to stay at home isn’t just about avoiding hospital food or sleeping in your own bed. Being admitted to a hospital or care home is often seen as a suggestion that they can’t look after themselves anymore. To some, that’s embarrassing – to others it’s a serious blow to their self-confidence and state of mind.


That’s why we at Philips believe it’s important to help seniors maintain their independence. And the two biggest threats to that independence are falls and difficulty managing medication.


In the US alone, 13 million over 65s will fall this year. That’s more than one every two and a half seconds. Of those, half won’t be able to get up on their own and 600,000 people will be admitted to a nursing home.

Also, around 40% of nursing home admissions and 1 in 10 hospital admissions among seniors are related to people not following their medication regime properly. That costs the healthcare system over 100 billion dollars each year. And remember, I’m still talking about just one country – the US.


Philips Lifeline addresses both these threats – allowing seniors to live independently in their own home with the confidence that help is only a button-push away if they need it. And until they need it, they would hardly know it is there. There’s isn’t anyone fussing over them, trying to do things that they can quite happily do for themselves.

For people with elderly relatives, Philips Lifeline means peace of mind – no more worrying what could happen to Mom or Dad when you can’t be there.


It has been bringing that peace of mind to over six million people in North America since 1974.


The typical subscriber
Those six million are typically older people – the average age is 82 – who have one or more chronic conditions, take a variety of medications and have limited mobility.


Does that sound like someone you know?


Aging in place

Philips Lifeline is actually a collection of options. The standard package is a medical alert service.


If you have an elderly relative who lives on their own, you’ll probably know what it’s like to worry about what would happen if they fell over when they are home alone. The nightmare visions of Mom or Dad lying there on the floor for hours unable to get up – possibly in pain.


The Lifeline Medical Alert service means there is no need to worry. If Mom or Dad has any kind of problem – like a fall – they just press a button on a pendant or wrist strap and they are immediately in touch with one of our caring and highly skilled Personal Response Associates at the Lifeline Response Center.


The Personal Response Associate talks to the subscriber and assesses the situation. Then, if it’s needed, they send help by contacting a neighbor, a family member or the emergency services.


But what if your loved one has fallen and can’t press the button. That’s an even scarier thought – it could mean they are unable to move, disorientated or unconscious.


But a new Lifeline option can put minds at rest here too. It can automatically detect most falls and call for help when the faller can’t. We call it Philips Lifeline with AutoAlert.


(Click here to watch Auto Alert video) 


Lifeline with AutoAlert is a great example of what we mean by people-focused, meaningful innovation. The thirty second recovery period avoids what some elderly people see as the embarrassment of getting help from others when it isn’t needed. But if there really is a problem, the emergency services could be on their way within minutes.


Philips Medication Dispenser
While the medical alert services provide assistance in case of a fall, the third Lifeline option targets the other big threat to independence in our later years – managing medication.


We all know that your short-term memory can fade as you get older. But as you get older, you often have to take more pills – sometimes at specific times of the day.


You can see how that could to lead to mistakes in your medication regime – either forgetting to take your pills for a day or two or taking too many pills in one go. This is a big concern for family members of seniors living independently. And dropping by two or three times a day just to say “Have you remembered to take your pills?” can lead to a lot of stress for caregivers and seniors alike.


The Philips Medication Dispensing Service
So, to eliminate mishaps and reduce the stress, the third Lifeline option is a medication dispensing service. The caregiver simply loads up the special Philips Medication Dispenser with the appropriate doses of medication to last until their next visit.


Whenever the subscriber needs to take their medication, the dispenser plays a verbal reminder. The subscriber presses a button, and the medication they need to take at that time is released. There’s no chance of overdosing.


If a dose is missed, the dispenser automatically contacts the Personal Response Associate who will then get in touch with a family member or caregiver. They can then call in on the person to check if there are any problems.


98.6% of people who use the Philips Medication Dispensing Service adhere to the medication plan their doctor prescribed – better than with any other similar service. And the better the adherence, the less need there is for hospital stays, and the healthier and happier life is for the patient.


In the words of one caregiver whose mother uses the service, “This way I know everything is working good, she's taking all her pills, and on time. That’s taken such a load off my mind.”


Lifeline – key benefits
Philips Lifeline truly is a win-win solution.


For the subscribers themselves, it means independence. They can live in their own home, free to do what they want when they want. But they have the confidence of knowing that, if something does go wrong, help will be there fast.  And there’s no need to worry about being a burden to loved ones or paying for expensive assisted living services.


Family members know their loved ones are safe and living the independent lifestyle they want – Mom or Dad is never alone with Lifeline. They don’t have to find the money for a nursing home or personal home care, something that places a huge amount of stress on a lot of families.


Lifeline also allows healthcare professionals to discharge elderly patients from hospitals earlier and more safely. Doctors can be confident the patient will stick to their medication schedule, so is less likely to be readmitted. Beds are freed up for other patients and waiting lists reduced.


And for governments, it’s a route to reducing healthcare spending. Because each situation is assessed by trained responders, emergency services are only called out when they are needed. Earlier intervention – whether in response to a fall or a patient not taking their medication – means shorter hospital stays – reducing the need for expensive long-term care. Moreover, helping a senior to live an independent life is less expensive than other alternatives like publically funded nursing homes.


Philips approach in Japan
I said earlier that Philips Lifeline has helped six million people in North America. Now, I am very pleased to announce that Philips will be launching the service in Japan in the near future. You may be wondering why we chose Japan.


Well, like any business decision, it was partly down to the numbers. As I explained at the start, Japan is probably the most “hyper-aged” country in the world. There are more elderly people here – and they live longer. So there is a bigger market for Lifeline in Japan, more people who could benefit from our help.


Around the world, Japan is renowned for its veneration of its elders – for the way you care for parents and grandparents within the family. But times are changing. A government whitepaper from this year found that 40% of all Japanese households include someone over 65. But of those, over 20% were one-person households. A senior citizen living alone.


And two-thirds of seniors living alone worry about that fact. Their top three causes for concern were:

• their health
• not having someone to look after them
• a feeling of isolation


These are precisely the people that Lifeline is designed to help – and we think it could make a big difference to their lives in all three of these areas. Knowing that someone is always on hand to help you when you need it will be a huge reassurance.


Event Anticipation and Early Detection
Finally, I’d like to tell you about another area where Philips’ next-generation home healthcare solutions can have a big impact on people’s lives today – remote monitoring for chronically ill people.


These solutions move much of the long-term follow-up care for chronically ill patients out of the clinic and in to the home. That frees up healthcare professionals so they can spend more time where they can do more good – rather than on routine tests.


But it also means patients aren’t tied down to appointment schedules – they are free to live a normal life. It can actually improve their health as well.


With in-home monitoring, you can check the patient’s status much more frequently – and in some cases continuously. You can detect any abnormalities much earlier – before the patient suffers a serious incident. And if you can detect and diagnose a problem earlier, treatment is usually quicker and easier, patient outcomes better and recovery times shorter.


Philips Telehealth
A good example of this is Philips Telehealth. This is a follow-up monitoring platform for chronically ill patients.


Telehealth combines easy-to-use wireless measurement devices and secure communications. Patients measure their own vital signs such as blood pressure, blood oxygen and blood sugar levels simply by pressing one button. They can also fill in short surveys about their health status and how they are feeling. All this data is then securely transmitted to the patient’s doctor for analysis.



The blend of objective and subjective data lets doctors make more timely treatment decisions, so patients end up in hospital less.


Another example of how our remote monitoring services work, this time focusing on cardiac care, is INR@Home. This allows people who are taking blood thinners – for instance after heart valve replacement surgery – to test their own anti-coagulation levels, or how long it takes their blood to clot. If those levels stray too far from normal, the results can be deadly.


With INR@Home, patients can test their anti-coagulation levels every week in their own home – rather than visiting the doctor every four to six weeks. According to a 2006 study published in the respected medical journal The Lancet, weekly self-testing can reduce the chances of stroke by 55%, major hemorrhaging by 35% and death by 39%.


Extending cardiac care
The last service I’d like to tell you about today is also focused on cardiac care. Using telephone lines and the Internet, Philips Remote Cardiac Monitoring Service provides at-home follow-up support for more than 200,000 cardiac patients including people with pacemakers, implanted defibrillators or suspected arrhythmia.


For instance, a patient’s pacemaker can be routinely tested over a standard telephone through a technique called Transtelephonic Pacemaker Monitoring. The data is sent to highly skilled and experienced technical staff who can spot even the most subtle irregularities. And monitoring centers are staffed 24 hours a day, 7 days a week.


Embracing the healthcare paradigm change
Philips Lifeline and remote monitoring solutions are perfect examples of how next-generation home healthcare can support more traditional hospital- and clinic-based healthcare services.


They can reduce the number of people that are admitted to hospitals and care homes. And they can help those patients that are admitted to get home sooner. All while ensuring they get the excellent care they need.


Fewer and shorter hospitals stays means lower healthcare costs. It means less pressure on our hospitals. And it means greater independence and quality of life for elderly and chronically ill people.


That is why I urge you to embrace home healthcare. The 20th century model of hospital-based care needs to be reformed to reflect the 21st century’s demographic and economic realities.


Healthcare needs to focus more on prevention, screening and early diagnosis – for the sake of the patient and for the sake of the bottom line. Home healthcare has to play a greater role than it does currently.


That demands technology and business solutions like the ones I have talked about today. But it also requires greater buy-in from governments, healthcare services and insurance providers.

Giving people the best healthcare possible
All of us here have a stake – whether personal or professional – in making healthcare the best it can be.


Home healthcare makes healthcare better. It makes healthcare more affordable, more efficient and more human-focused. It takes the pressure off overstretched healthcare systems, and it ensures the best possible quality of life for us all – no matter what our health or age.


In short, home healthcare gives us all the best possible healthcare.


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