Taiwan has one of the world’s most efficient, accessible, and effective healthcare systems, offering quality care at affordable prices. Yet despite this success, the rapid aging of Taiwan’s population is presenting an unprecedented challenge to Taiwan’s National Health Insurance (NHI) system. According to the National Development Council, this year 14% of Taiwan’s population will be 65 years old or older, placing Taiwan among the world’s “aged societies.” More significantly, in an unprecedented seven years, compared to the decades-long intervals seen in most European and East Asian societies, Taiwan will enter the ranks of “super-aged” societies – where those 65 years old or older comprise 20% of the population – by 2025.
The aging population has big consequences for the NHI, with the elderly already consuming some 30% of its entire budget, and that proportion looks likely to balloon over the coming years.
As a healthcare technology company, Medtronic is promoting a drive for “value-based” healthcare that might offer a way for Taiwan to gain control over its healthcare budgets while still continuing to provide its famously high-quality healthcare.
According to Noah Friedman, Senior Director of Strategy and Value-Based Healthcare for Medtronic Greater China, the concept of value-based healthcare, which was developed by eminent Harvard University business professor Michael Porter, entails organizing the healthcare system in a way that seeks to “align healthcare outcomes with payment for those outcomes,” rather than the traditional model by which healthcare products and services are paid for on the basis of volume. “Ideally, value-based healthcare will bring better outcomes at the same cost or the same outcomes at lower cost,” says Friedman.
The key questions driving value-based healthcare are: Does the patient get better? And over what timeframe?
Friedman says that although Taiwan already does a great job providing quality healthcare, a value-based approach would provide opportunities for improvement in treating specific diseases “where the payment and incentives can be more directly linked to patient outcomes.” Diabetes is an example of a chronic disease that is becoming more prevalent as the society ages and for which the costs can be astronomical – both in terms of the individual’s health and to the NHI – if the disease is not managed effectively. Diabetes can result in kidney failure, and a substantial proportion of the NHI budget goes to providing dialysis for patients with total kidney failure.
“If healthcare is paid for by volume according to the medical services provided during hospital stays, you aren’t taking into account the period of time that could be devoted to prevention,” says Friedman. “If you look at it over a greater timeframe, then the concept of paying a little more upfront for prevention can be compelling.”
Medtronic is a leader in providing many of the medical devices that can promote value in healthcare. According to James Hsiao, Vice President and Senior Managing Director for Taiwan and Hong Kong, Medtronic has developed a medical device for measuring blood glucose levels for diabetes patients that is not only more convenient but allows for continuous measurement of blood glucose levels.
“A decade years ago, monitoring blood glucose required a large device, and due to the inconvenience, patients were reluctant to use it,” he says. Medtronic developed the Continuous Glucose Monitoring System (CGMS), a tiny digital recorder, about the size of a NT$10 coin that inserts subcutaneously and can check the blood sugar continuously over six days at five-minute intervals. “The recording system is the same, but changing the convenience level increased acceptance by both patients and physicians,” he says. “This really helps the physicians treat the patients.”
On the other area, Parkinson’s disease (PD) is another condition associated with aging that can have long-term and devastating consequences for both sufferers and the healthcare system. In PD, patients slowly lose control over their motor functions, and their bodies are often consumed with tremors. Medications can improve motor function control and reduce tremors, but they gradually lose effectiveness, putting PD sufferers at risk of falls and other accidents, as well as the inability to swallow.
In response, Medtronic has developed a radical new therapy called “deep brain stimulation.” It is an electronic device (Neurostimulator) surgically implanted, providing electrical stimulation in the brain that can help improve movement disorder and reduce tremors. “Patients can see their performance improve immediately when turning the device on.” says Hsiao.
Although this treatment is not appropriate for every PD sufferer and requires lengthy and difficult surgery, it is considered so effective that the NHI proactively offered to reimburse for the Neurostimulator (battery), which might need to be changed every four years approximately depending on the patient’s situation.
These are just two of the many advanced medical devices and systems that Medtronic offers on the Taiwan market to enable medical conditions to be treated more effectively, improving patient outcomes and reducing costs.
The company also develops remote monitoring systems that allow physicians to monitor elderly and frail patients who are unable to easily get to hospitals for follow-up, as well as navigation systems for minimally invasive surgical procedures that have dramatically improved patient outcomes and reduced complications and infections over the past decade.
Equally important, Medtronic provides substantial training for Taiwan’s physicians/surgeons/HCPs. These doctors often are then instrumental in spreading knowledge and techniques to other Asia countries including Mainland China, which will be introduced/launched these advanced products at later time. “Many Taiwan doctors have become leaders in contributing their knowledge from the clinical side on how to use limited resources to provide patients with optimal care,” says Hsiao. “Medtronic is pleased to be able to be a part of this process.”