Empowering Patients in Asia

A discussion of patient as a consumer should take into account the economic status of country to which he / she belongs. Economic status to a great extent affects the power of patients as consumers in those markets. This is because the economic maturity of a country in many cases also defines its healthcare system.

There is no homogenous model of healthcare across the Asia Pacific region. Australia's medical care system resembles that of the United Kingdom, with free medical care and reimbursement for a broad range of medicines. Government-subsidised private health insurance has stemmed the tide of people leaving health funds, now covering around 30 per cent of Australians. Both Korea and Taiwan have introduced national health insurance systems that cover nearly all of their population, but cracks are beginning to show with the increasing financial burden due to the prevalence of the diseases that ageing population and changing lifestyles bring about. Malaysia and China, on the other hand, have health systems that feature a mix of a private and public healthcare catering to different segments of the society.

In developed countries, national health insurances are struggling with a hefty financial burden. In developing countries, where a significant proportion of the population is unable to pay for their own healthcare, the governments are making efforts to reduce costs to provide healthcare access for the poorer segments of their society. Many of the measures implemented are short-term and are only aimed at alleviating the symptoms. Here, the patient information that is geared towards disease prevention and disease awareness can enable early detection and contribute to containing the rising costs of healthcare.

Indicators show that the debate on patient empowerment in diagnosis and treatment is increasing in Asia. An increasing number of Asian consumers, instead of relying only on healthcare providers, are accessing other sources such as the media and Internet for healthcare information.

Small but persistent changes in the healthcare landscape in Asia are driving this demand. Improved primary care in rural areas has led to an increase in access to generic as well as innovative drugs. Better diagnosis options and increased disease awareness coupled with increased health insurance coverage, further prompt the Asian population to be more involved in their health matters and to seek and demand better healthcare information.

With these trends and changing patient habits and behaviour, it is very much evident that patient empowerment is the basis for modern healthcare in Asia. What is patient empowerment? It simply implies better access to information, more patient responsibility and a greater focus on prevention of disease.

Patient empowerment

In many Asia Pacific countries the doctor-patient relationship is strong with the doctor acting as the ultimate source of medical information for the patient and his / her family. Such a paternalistic model demands heavy intervention from the state (government) and the medical professionals as this system works on the assumption that the patient has no knowledge on medical and healthcare matters. However, modern healthcare systems should take the patients seriously as a dialogue partner in the management of disease. One can only benefit from a healthcare system that is patient centred-a healthcare system which is designed and delivered to address each individual patient's needs and preferences. This model allows more choice, personalised care and effective patient involvement.

While it is acknowledged that this may not yet be possible in all Asian communities due to a number of factors, such as limited information channels and education levels, an increased interest is being observed from the patients to obtain information on how to manage health issues beyond the hospital or general practitioner's office in many developing countries. For example, many young Asian working women in urban centres seek information on medical solutions that allow them to plan their families and space their pregnancies.

It is clear that patients in the future will no longer accept being passive recipients of healthcare and advice. Instead, they will like to become proactive consumers, with better access to quality information about their diseases and treatments and more control on decisions affecting their health.

This is particularly relevant when it comes to chronic disease prevention and control, where the actions of the patient outside the ambit of clinic or hospital, in terms of diet and lifestyle modification, have a major impact on optimum management of the disease.

Unfortunately, unlike in most other industries, the consumer does not have a say in what he or she consumes. Therefore, any move towards more patient empowerment will require at a minimum, a process of education and better patient information.

Information to patients

In some parts of Asia, government regulations mean that medicine or treatment information to patients by the industry is restricted or not allowed. Yet better access to health and drug information would empower citizens to take a more active role in managing their health, leading to healthier behaviours, better compliance and more efficient use of healthcare resources.

Sharing of quality health and medicine information from multiple sources including the pharmaceutical industry should be allowed. This is particularly important in countries where general disease awareness on even the most common health problems is low. Being able to recognise symptoms and seeking medical help early are crucial steps in keeping the population healthy.

Pharmaceutical companies are a key source of information that patients can access. In particular, they have a part to play in raising disease awareness and encouraging patients to take a more active role in managing their conditions. However, the information from pharmaceutical companies has come under increasing scrutiny. Thus, the challenge they face as an industry is to provide unbiased and useful information in an ethical manner. This requires a significant amount of self-regulation and urge to accept greater responsibility towards the society and patients in particular. Care should be taken to ensure that information is evidence-based, of high quality and reliable to gain public trust.

Regulatory authorities may restrict the manner in which pharmaceutical companies provide information, but ultimately, health information to the consumer should be acceptable and be judged depending on its quality, rather than the source which provides it.

Bayer's initiatives in increasing patient empowerment

Bayer is making serious efforts to empower patients by cooperating with governments, patient groups and medical associations to provide information. The emphasis is on providing training to experts, sharing patient information, improving awareness and prevention of diseases. One such initiative is supported by the Chinese Ministry of Health Disease Control Bureau, called Bayer Cup - Diabetes TV contest. Ten thousand diabetics from more than 100 municipal hospitals in Beijing, Shanghai, Guangzhou and Qingdao take part in the national quiz on diabetes in China. With the broadcast of the final nationwide round attracting more than 100 million TV viewers.

Another programme is to train 10,000 healthcare professionals in Western China in partnership with China's Ministry of Health. A second programme with the Ministry of Health aimed at healthcare professionals was launched in April 2008. Bayer Healthcare's HOME campaign aims at improving the capability of community healthcare practitioners in China and build strong chronic disease management system in the community through a three year training programme. In Thailand, Bayer supports Multiple Sclerosis Society to provide a platform to communicate, exchange experiences and identify treatment options.

Focus on prevention and better disease management

In the future all stakeholders of healthcare must focus more on prevention of disease. The main cause of death in the world today-about 17 million people per year-is the result of chronic, non-infectious diseases, such as heart disease, stroke, cancer, chronic respiratory diseases and diabetes. They are most often caused by known and preventable risk factors like unhealthy diets, physical inactivity and alcohol and tobacco consumption. While the disease burden in Asia Pacific in the past decades has mainly been driven by communicable diseases associated with poverty and poor standards of living, rising affluence and urbanisation have shifted the disease burden in the region to non-communicable, lifestyle diseases.

Long deemed to be a scourge of the West alone, obesity is an emerging problem in the Asian region. Obesity is considered to be a major risk factor in the development of diabetes and cardiovascular heart diseases. The changes in lifestyles such as decreased physical activity and an unhealthy diet have tripled obesity rates in the past 10 years in developing countries.

If the number of deaths from the so called "lifestyle" diseases-such as cardiovascular and respiratory diseases, diabetes and obesity-is to be reduced, public authorities and healthcare stakeholders, including the industry, will have to adopt a comprehensive approach to disease prevention and control including all segments of the society.

Way forward

Sharing patient information will ultimately lead to better disease awareness, disease prevention and early detection. Effective treatment can then be provided to the patient immediately upon being diagnosed at the outset of a disease reducing long-term financial burden and suffering.

Knowledgeable and responsible patients make responsible consumers of healthcare. To achieve this, governments, doctors and the industry need to work constructively together to empower patients and encourage them to take responsibility to look after their health. These efforts will contribute greatly to addressing some of the issues that ail current healthcare systems and will ultimately make healthcare affordable.