THE FUTURE OF HEALTH CARE DELIVERY A 2050 MODEL OF CARE Case Study // Shenzhen, China.
Abstract // As the world’s cities continue to grow and develop rapidly, megacities of more than 10 million inhabitants will be more common, and access to health care will only become more of an issue as health care organizations try to catch up with their population. Physical access will be an issue as space is a commodity in megacities. Inequity will continue to be a major challenge as those who need health care services the most tend to be the ones without insurance and reside in the communities furthest away from the centralized hospitals. In this study, we explore what advancement technology can yield in the year 2050. We propose interventions in the current health care delivery model that seek to provide accessible, autonomous preventative care to a large population. By uncoupling low-acuity and high-acuity care and designing an autonomous preventive care and diagnosis prototype, we bridge the gap of inequitable access to health care services in Shenzhen, China, while creating a care model that enables consumers to take ownership of their health.
Researchers // Annie Chiang, Holly Harris, Lisbeth Mora, and Chang Zong
November 2017
Introduction Research and Case Study Challenge Statement: Considering the expected environmental, socio-economic, and technological issues of a megacity in 2050, design a citywide intervention that directly improves the health and wellness of its population? Site: Shenzhen, Pearl River Delta, Guangdong, China ,ĞĂůƚŚ ŝŶĚƵƐƚƌLJ ŐƌŽǁƚŚ ƌĂƚĞ ƐŝŶĐĞ ϭϵϳϵ
2014 GDP: 1.6 trillion yuan (approx. 240 billion U.S. dollars)>ŝƐĐĞŶƐĞĚ DĞĚŝĐĂů ŽĐƚŽƌƐ ŽĨ 2014 Year-end Permanent Population & Density: 10,770,000 (10.6% zĞĂƌͲ ŶĚ Annual average growth rate since establishment in 1979) dĞĐŚŶŝĐĂů >ŝƐĐĞŶƐĞĚ ŚŝŶĞƐĞ WĞƌŵĂŶĞŶƚ 2014 Year-end Population Density: 5,398 persons/sq km (one of the highest in China)
WĞƌƐŽŶŶĞů ŽĐƚŽƌƐ DĞĚŝĐŝŶĞ WŽƉƵůĂƚŝŽŶ ,ŽƐƉŝƚĂůƐ ,ŽƐƉŝƚĂů ĞĚƐ ϭϵϳϵ Ϯϱ ϱϵϳ ϵϴϴ ϯϲϰ ϯϭϰ͕ϭϬϬ ϭϵϴϬ Ϯϰ ϲϰϯ ϭ͕Ϭϴϴ ϰϯϴ ϮϬй ϯϯϮ͕ϵϬϬ ϭϵϴϭ Ϯϰ ϳϵϬ ϭ͕ϮϳϬ ϱϭϴ ϭϴй ϯϲϲ͕ϵϬϬ ϭϵϴϮ Ϯϲ ϳϭϳ ϭ͕ϲϬϵ ϳϬϴ ϯϳй ϰϰϵ͕ϱϬϬ Background ϭϵϴϯ ϯϬ ϭ͕ϬϮϯ Ϯ͕ϯϰϯ ϭ͕Ϭϳϯ ϱϮй ϱϵϱ͕ϮϬϬ ϭϵϴϰ Ϯϵ ϭ͕ϲϯϰ ϯ͕Ϭϲϰ ϭ͕ϰϴϰ ϯϴй ϳϰϭ͕ϯϬϬ ϭϵϴϱ ϯϭ ϭ͕ϴϴϱpart ϭ͕ϴϲϮ Ϯϱй ϴϴϭ͕ϱϬϬ Located in the southern of ϯ͕ϴϱϳ China’s Guangdong province ϭϵϴϲ ϯϮ Ϯ͕ϬϮϴ ϰ͕ϲϱϳ Ϯ͕Ϯϭϳ ϭϵй ϵϯϱ͕ϲϬϬ along the eastern shore of the Pearl River Delta, Shenzhen is a megacity ϭϵϴϳ ϯϰ Ϯ͕ϮϮϱ ϱ͕ϭϭϳ Ϯ͕ϰϬϴ ϵй ϭ͕Ϭϱϰ͕ϰϬϬ thatϭϵϴϴ acts as aϯϱlink between Hong and China. In 1979, Ϯ͕ϰϵϲKong ϱ͕ϳϭϱmainland Ϯ͕ϳϱϰ ϭϰй ϭ͕ϮϬϭ͕ϰϬϬ Shenzhen wasϯϱ designated as aϮ͕ϴϯϴ Special Economic Zoneϯ͕ϭϬϯ (SEZ), the first ϭϵϴϵ ϲ͕ϰϱϭ ϭϯйof ϭ͕ϰϭϲ͕ϬϬϬ ϯϴ It ϯ͕ϭϬϴ ϲ͕ϵϵϲ ϯ͕ϰϮϲ its ϭϵϵϬ kind in China. rapidly transformed from a remote fishing villageϭϬй into ϭ͕ϲϳϳ͕ϴϬϬ ϭϵϵϭ ϰϭ people ϳ͕ϲϭϴ today. ϯ͕ϳϯϳ a metropolitan center with overϯ͕ϰϵϴ ten million At the end of ϵй the Ϯ͕Ϯϲϳ͕ϲϬϬ ϭϵϵϮ ϰϱ ϰ͕ϰϲϲ ϴ͕ϱϳϭ ϰ͕Ϯϰϳ ϭϰй 1995, Shenzhen had one of the fastest-growing populations, averaging Ϯ͕ϲϴϬ͕ϮϬϬ ϭϵϵϯ ϰϱ ϱ͕ϭϲϴ ϵ͕ϴϴϴ ϰ͕ϳϵϴ ϭϯй ϯ͕ϯϱϵ͕ϳϬϬ 20% growth since 1980. This rapid growth in combination withϭϭй the ϰ͕ϭϮϳ͕ϭϬϬ ϭϵϵϰ ϰϴ ϲ͕ϬϰϬ ϭϭ͕Ϭϯϰ ϱ͕ϯϰϳ establishment of the SEZ resulted ϲ͕ϲϰϬin Shenzhen ϭϮ͕ϰϰϵ becoming ϲ͕ϬϱϬone of China’s ϭϯй ϰ͕ϰϵϭ͕ϱϬϬ ϭϵϵϱ ϲϯ wealthiest cities. Shenzhen referred as the financial center ϭϵϵϲ ϲϱ Today, ϳ͕ϭϬϱ is ϭϰ͕ϲϱϮto ϳ͕Ϯϲϲ ϮϬй ϰ͕ϴϮϴ͕ϵϬϬ ϭϵϵϳ ϳϮ ϳ͕ϴϭϯ sub-provincial ϭϰ͕ϵϯϮ ϳ͕ϰϬϬ Ϯй ϱ͕Ϯϳϳ͕ϱϬϬ of Southern China. The city claims administrative status, ϭϵϵϴ ϳϮ ϴ͕ϱϱϯ ϭϰ͕ϵϳϱ ϳ͕ϭϵϭ Ͳϯй which is less than the provincial powers held by cities such as Shanghai ϱ͕ϴϬϯ͕ϯϬϬ ϳϭ ϴ͕ϳϮϬ ϭϱ͕ϭϰϯ jurisdiction ϳ͕ϬϲϮ andϭϵϵϵ Beijing. Nevertheless, it still holds administrative overͲϮйits ϲ͕ϯϮϱ͕ϲϬϬ ϮϬϬϬ ϳϮ ϵ͕ϲϭϲ ϭϱ͕ϳϮϬ ϳ͕ϰϭϴ ϱй ϳ͕ϬϭϮ͕ϰϬϬ districts. ϮϬϬϭ ϳϱ ϭϬ͕ϱϰϮ ϭϳ͕ϭϯϱ ϴ͕Ϭϵϳ ϵй ϳ͕Ϯϰϱ͕ϳϬϬ The ϳϳ rapid growth inϭϭ͕ϴϬϴ economy migrant population results ϮϬϬϮ and ϭϴ͕ϲϭϱ ϳ͕ϴϱϯ Ͳϯй ϳ͕ϰϱϲ͕ϮϬϬ in disparities among the primary, secondary, and tertiary industries. ϭϯй This ϳ͕ϳϴϮ͕ϳϬϬ ϮϬϬϯ ϴϱ ϭϮ͕ϲϬϳ Ϯϭ͕Ϯϯϰ ϴ͕ϵϬϵ ϮϬϬϰlooks ϴϳ the ϭϰ͕ϭϴϲ the health ϮϮ͕ϴϵϱ and ϵ͕ϴϰϲ industry ϭϭйin ϴ͕ϬϬϴ͕ϬϬϬ study into issues affecting wellness ϮϬϬϱ ϵϳ ϭϱ͕ϱϳϳ Ϯϱ͕ϲϴϭ ϭϬ͕ϵϲϭ a megacity, with a particular focus on health care accessibility. Inϭϭй this ϴ͕Ϯϳϳ͕ϱϬϬ ϮϬϬϲ ϵϵ ϭϲ͕ϭϵϯ ϰϯ͕Ϯϲϲ ϭϲ͕Ϯϯϴ ϰϴй ϴ͕ϳϭϭ͕ϬϬϬ document we will: ϮϬϬϳ ϭϬϭ ϭϲ͕ϳϲϲ ϰϵ͕ϴϳϳ ϭϳ͕ϰϱϬ ϳй ϵ͕ϭϮϯ͕ϳϬϬ ϮϬϬϴ ϭϬϬ ϭϴ͕ϰϯϱ ϱϬ͕ϲϬϴ ϭϴ͕ϴϬϳ ϴй ϵ͕ϱϰϮ͕ϴϬϬ • ϮϬϬϵ present of China’s care system, an ϭϬϭoverview ϭϵ͕ϴϳϮ health ϱϯ͕ϳϳϴ ϭϵ͕ϵϲϯ ϲй ϵ͕ϵϱϬ͕ϭϬϬ • ϮϬϭϬ highlight the major issuesϮϭ͕ϭϲϲ affecting healthcare in ϮϬ͕ϭϮϮ Shenzhen, and ϭй ϭϬ͕ϯϳϮ͕ϬϬϬ ϭϬϳ ϱϰ͕Ϭϴϭ ϭϭϬ ϮϮ͕ϯϮϮ and ϱϴ͕Ϭϱϵ Ϯϭ͕ϱϭϳ ϳй ϭϬ͕ϰϲϳ͕ϰϬϬ • ϮϬϭϭ propose a new delivery process prototype intervention that will ϮϬϭϮ ϭϭϱ Ϯϲ͕ϭϮϰ ϲϭ͕ϵϲϭ ϮϮ͕ϴϯϭ ϲй ϭϬ͕ϱϰϳ͕ϰϬϬ create equitable health care access in 2050 ϮϬϭϯ ϭϭϳ Ϯϳ͕Ϭϳϵ ϲϱ͕ϳϴϮ Ϯϰ͕ϮϮϭ ϲй ϭϬ͕ϲϮϴ͕ϵϬϬ ϮϬϭϰ ϭϮϮ Ϯϴ͕ϴϱϯ ϲϵ͕ϵϯϲ Ϯϱ͕ϳϮϴ ϲй ϭϬ͕ϳϳϴ͕ϵϬϬ ϯϴϴй ϰϳϯϯй ϲϵϳϵй ϲϵϲϴй ϯϯϯϮй
zĞĂƌ
China
ŚĂƌƚ dŝƚůĞ ϴϬ͕ϬϬϬ ϳϬ͕ϬϬϬ ϲϬ͕ϬϬϬ ϱϬ͕ϬϬϬ ϰϬ͕ϬϬϬ ϯϬ͕ϬϬϬ ϮϬ͕ϬϬϬ ϭϬ͕ϬϬϬ Ͳ
Beijing
ϭϵϳϵϭϵϴϭϭϵϴϯϭϵϴϱϭϵϴϳϭϵϴϵϭϵϵϭϭϵϵϯϭϵϵϱϭϵϵϳϭϵϵϵϮϬϬϭϮϬϬϯϮϬϬϱϮϬϬϳ
Shanghai
Guangdong Shenzhen
Hong Kong
Shenzhen’s Population Growth GDP
12,000,000
1.6
4,000,000
2
SmithGroupJJR | Innovations in Practice Idea Lab 2017
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
million yuan
1981
1979
-
GDP
196 1980
2,000,000
2014
6,000,000
2013
8,000,000
2012
10.8 MIL
10,000,000
trillion yuan
China’s Health Care System: Financial Spending and Insurance The guiding principle of public health in China is that every citizen is entitled to basic health care services. Control of national health legislation, policy, and administration ,ĞĂůƚŚĐĂƌĞ ^ƉĞŶĚŝŶŐ ƉĞƌ ĂƉŝƚĂ͕ ϮϬϭϰ is held by the central government, ƵƐƚƌĂůŝĂ for providing health Ψ ϰ͕ϮϬϳcare to however local governments are responsible Ψ ϰ͕ϳϮϴ its population. Thus, health insurance ĂŶĂĚĂ is publicly provided and financed ŚŝŶĂ Ψ ϰϮϬ Ψ ϱ͕ϬϭϮ by the local government – province, ĞŶŵĂƌŬ prefecture, city, county, or town. &ƌĂŶĐĞ Ψ ϰ͕ϲϮϬ There are three types of publicly financed insurance in China; they 'ĞƌŵĂŶLJ Ψ ϱ͕ϭϭϵ are as /ŶĚŝĂ Ψ Ϯϭϱ follows: •
•
•
/ƐƌĂĞů /ƚĂůLJ :ĂƉĂŶ EĞƚŚĞƌůĂŶƐ EĞǁ ĞĂůĂŶĚ EŽƌǁĂLJ ^ŝŶŐĂƉŽƌĞ ^ǁĞĚĞŶ ^ǁŝƚnjĞƌůĂŶĚ hŶŝƚĞĚ <ŝŶŐĚŽŵ hŶŝƚĞĚ ^ƚĂƚĞƐ
Ψ Ϯ͕ϯϱϯ Ψ ϯ͕ϮϬϳ Ψ ϰ͕ϭϱϮ Ψ ϱ͕ϮϮϳ Ψ ϰ͕Ϭϯϴ Ψ ϲ͕ϰϯϮ Ψ Ϯ͕ϳϱϮ Ψ ϱ͕ϯϬϲ Ψ ϲ͕ϳϴϰ Ψ ϰ͕Ϭϵϰ Ψ ϵ͕ϯϲϰ
Urban employment-based basic medical (1998) which is mandatory for all employees in urban areas. Employees’ unemployed family members are not covered. Urban resident basic medical insurance (2009) which is voluntary at the household level. This policy can cover self-employed persons, children, students, and the elderly. Rural cooperative medical scheme (2003) which is also voluntary at the household level for all rural residents.
International Health Care Spending per Capita CHINA
$420
per Capita Spending
(2014)
$5,012
$4,728 $4,207
$9,364
$6,784
$6,432 $5,119 $4,620
$5,306
$5,227
$4,152
$4,038
$3,207
dĞŝƌ ϯ ,ŽƐƉŝƚĂůƐ $2,353
^ŚĞŶnjŚĞŶ 'ƵĂŶŐnjŚŽƵ $4,094 ϭϭ
ϱϮ
^ŚĞŶnjŚĞŶ
yŝΖĂŶ
ϭϮ
ϲϯ
$2,752
^ŚĂŶŐ
$420
$215
Data Source - OECD 2106
EƵŵďĞƌ ŽĨ ŽůůĞŐĞƐ ĂŶĚ hŶŝǀĞƌƐŝƚŝĞƐ
ŚŽŶŐƋ
These policies cover primary, specialty, and emergency care Chinese Three-tier Hospital System along with hospitalizations and mental health care. Certain services such community health as dental and optometry services are not covered and would be paid for Tier Tier 1 centers and private Teir33Hospitals Hospitals out-of-pocket. Of those using the publicly financed insurance, many highclinics 100 income individuals will purchase supplementary private (commercial) 88 90 district hospitals, insurance to cover additional costs such as deductibles, copayments, and 80 county hospitals, any other expenses they may incur. The publicly financed insurance is 70 Tier 2 55 and private only available to permanent Chinese residents. Some permanent foreign 52 60 50 hospitals residents are covered, but undocumented immigrants and visitors are not 40 covered. A temporary resident card (TRC) will allow a migrant worker to 30 municipal hospitals, receive selected health care services, but many migrants do not have 20 11 provincial hospitals, 10 a TRC and are regarded as unregistered and uncovered. This begins Tier 3 military hospitals, 0 to highlight the disparities in health access among population classes. and university ϭϬ͕ϬϬϬ zƵĂŶ ϮϬϭϬ ϮϬϭϭ ϮϬϭϮ Residents who can afford to pair the publicly financed insurance with a affiliated hospitals >ŽĐĂů 'ŽǀĞƌŶŵĞŶƚ ƵŐĞƚĂƌLJ ZĞǀĞŶƵĞ ϭϯ͕ϰϰϯ͕ϯϯϵ ϭϲ͕ϭϬϲ͕ϱϬϭ ϭϳ͕ϵϮϵ͕ϴϴϲ Ϯ private insurance policy are enabled to receive a better quality of care >ŽĐĂů 'ŽǀĞƌŶŵĞŶƚ ƵŐĞƚĂƌLJ džƉĞŶĚŝƚƵƌĞ ϭϰ͕ϵϴϴ͕ϯϵϬ ϭϳ͕ϴϮϱ͕ϴϮϬ ϭϴ͕ϳϵϮ͕ϵϯϰ Ϯ ϲϭϵ͕ϵϴϳ ϳϴϲ͕ϵϮϲ ϭ͕ϬϱϮ͕ϵϮϱ at a higher reimbursement. Migrant workers have less access to publicly ϭϬ͕ϬϬϬ zƵĂŶ džƉĞŶĚŝƚƵƌĞ ĨŽƌ DĞĚŝĐĂů ĂŶĚ ,ĞĂůƚŚ ĂƌĞ ϮϬϭϬ ϮϬϭϭ ϮϬϭϮ ϮϬϭϯ ϮϬϭϰ ϭϯ͕ϰϰϯ͕ϯϯϵ ϭϲ͕ϭϬϲ͕ϱϬϭ ϭϳ͕ϵϮϵ͕ϴϴϲ ϮϮ͕ϯϭϮ͕ϭϬϬ Ϯϳ͕ϲϵϴ͕Ϭϳϳ financed insurance and fewer financial resources to purchase private >ŽĐĂů 'ŽǀĞƌŶŵĞŶƚ ƵŐĞƚĂƌLJ ZĞǀĞŶƵĞ >ŽĐĂů 'ŽǀĞƌŶŵĞŶƚ ƵŐĞƚĂƌLJ džƉĞŶĚŝƚƵƌĞ ϭϰ͕ϵϴϴ͕ϯϵϬ ϭϳ͕ϴϮϱ͕ϴϮϬ ϭϴ͕ϳϵϮ͕ϵϯϰ ϮϬ͕ϱϮϭ͕ϯϵϰ Ϯϲ͕Ϯϴϯ͕ϭϱϯ Shenzhen’s Expenditure on Medical and Health Care džƉĞŶĚŝƚƵƌĞ ĨŽƌ DĞĚŝĐĂů ĂŶĚ ,ĞĂůƚŚ ĂƌĞ ϲϭϵ͕ϵϴϳ ϳϴϲ͕ϵϮϲ ϭ͕ϬϱϮ͕ϵϮϱ ϭ͕Ϭϲϵ͕ϵϮϱ ϭ͕ϱϳϲ͕ϬϮϴ insurance, resulting in inequitable access to health care. 30,500,000
Provider networks and hospital tiers are linked to the insurance schemes, which dictate where patients can receive covered care. People may choose to use out-of-network services (even outside of their province), but they will be faced with higher costs. Additionally, since each risk-pool has its own policies, there are no universal cost sharing arrangements. Migrant workers experience the largest burden on receiving care because they often use out-of-network care, and there is no cap on out-of-pocket spending. Safety net financial assistance programs are available, but they are funded at the local government level or by donations. Therefore, they are not standardized or equally available. ϭϬ͕ϬϬϬ zƵĂŶ >ŽĐĂů 'ŽǀĞƌŶŵĞŶƚ ƵŐĞƚĂƌLJ ZĞǀĞŶƵĞ >ŽĐĂů 'ŽǀĞƌŶŵĞŶƚ ƵŐĞƚĂƌLJ džƉĞŶĚŝƚƵƌĞ džƉĞŶĚŝƚƵƌĞ ĨŽƌ DĞĚŝĐĂů ĂŶĚ ,ĞĂůƚŚ ĂƌĞ
ϮϬϭϬ ϮϬϭϭ ϮϬϭϮ ϮϬϭϯ ϮϬϭϰ ϭϯ͕ϰϰϯ͕ϯϯϵ ϭϲ͕ϭϬϲ͕ϱϬϭ ϭϳ͕ϵϮϵ͕ϴϴϲ ϮϮ͕ϯϭϮ͕ϭϬϬ Ϯϳ͕ϲϵϴ͕Ϭϳϳ ϭϰ͕ϵϴϴ͕ϯϵϬ ϭϳ͕ϴϮϱ͕ϴϮϬ ϭϴ͕ϳϵϮ͕ϵϯϰ ϮϬ͕ϱϮϭ͕ϯϵϰ Ϯϲ͕Ϯϴϯ͕ϭϱϯ ϲϭϵ͕ϵϴϳ ϳϴϲ͕ϵϮϲ ϭ͕ϬϱϮ͕ϵϮϱ ϭ͕Ϭϲϵ͕ϵϮϱ ϭ͕ϱϳϲ͕ϬϮϴ
27,698,077 26,283,153 22,312,100
20,500,000
17,825,820 14,988,390
18,792,934
20,521,394
17,929,886 16,106,501
13,443,339
10,500,000 ϭϰ͕Ϯϱϰ͕ϳϯϴ ϭϭ͕Ϯϵϰ͕ϳϲϯ ϵϱϲ͕Ϭϰϭ
ϭϬϲй ϳϱй ϭϱϰй
619,987
786,926
1,052,925
1,069,925
1,576,028
2010
2011
2012
2013
2014
500,000
Local Government Bugetary Revenue Bugetary Revenue Local Government
Local Government Bugetary Expenditure Expenditure for Medical and Health Care
In 2014, 6% of Shenzhen’s total Government Expenditure was spent on Medical and Health Care
SmithGroupJJR | Innovations in Practice Idea Lab 2017
3
Shenzhen’s Public Health Due to the rapid economic and population growth, Shenzhen’s development of public health organizations, capacities, and resource distribution fall far behind those in Beijing and Shanghai. In this section we will highlight the top five issues we found to affect health care accessibility in Shenzhen.
ŐŚĂŝ ϱϱ
ƋŝŶŐ
ϲϯ
2. Inequitable Insurance
The disparities among the Chinese health system’s publicly financed insurance schemes are equally relevant to Shenzhen’s population. Insurance inequality has a larger effect on Shenzhen’s public 1. Provider Shortage health due to the fact ^ŚĞŶnjŚĞŶ WŽƉƵůĂƚŝŽŶ ŝƐƚŝŶĐƚŝŽŶ that the majority of its population are migrant workers 2. Inequitable Insurance ϯϭй who do not qualify forZĞŐŝƐƚĞƌĞĚ WŽƉƵůĂƚŝŽŶ coverage unless provided with a temporary resident hŶƌĞŐŝƐƚĞƌĞĚ WŽƉƵůĂƚŝŽŶ ;ŝŶĐůƵĚĞƐ ŵŝŐƌĂŶƚƐͿ ϲϵй 3. Unequally distributed resources and care card. The population distribution map (on the following page) highlights 4. Increased Burden of Chronic Diseases registered and non-registered populations per district. In 2006, to address 5. Non-parallel Development of National Industries the high density of migrant workers, the Medical Insurance System for Migrant Employees (MISM) was formally established. It was open to all 1. Provider Shortage migrant workers in the city, however because it was an employment^ŚĞŶnjŚĞŶ WŽƉƵůĂƚŝŽŶ ŝƐƚŝŶĐƚŝŽŶ ZĞŐŝƐƚĞƌĞĚ WŽƉƵůĂƚŝŽŶ ϯϭй based scheme, persons with high mobility and less formal employment hŶƌĞŐŝƐƚĞƌĞĚ WŽƉƵůĂƚŝŽŶ ;ŝŶĐůƵĚĞƐ ŵŝŐƌĂŶƚƐͿ ϲϵй were excluded. How can a population be cared for when there are no providers? Since ĞŝũŝŶŐthe SEZ designation of Shenzhen in 1979, medical education and top tier hospitals have not maintained a growth parallel with the rapidϴϴpopulation increase, resulting in a provider shortage and unequal Registered Population distribution of providers among Shenzhen residents and immigrants. The Shenzhen University School of medicine was founded in 2008, with its Unregistered Population ^ŚĂŶŐŚĂŝ tƵŚĂŶ 'ƵĂŶŐnjŚŽƵ ĞŝũŝŶŐ (includes migrants) short history, it is still in development to become a top tier school. Shenzhen has invited multiple famous medical schools to open extensions within the megacity, but level of medical education ϲϳ ϴϬit has yet to ϴϮreach the same ϵϭ quality provided in Beijing and Shanghai. The number of licensed doctors reached 25,728 in 2014, but the majority are concentrated within the inner 3. Unequally Distributed Resources and Points of Care districts at tier 3 hospitals. Therefore, migrants and residents who live in the outer districts do not have access to licensed care. Originally the Special Economic Zone (SEZ) only included the Luohu, Futian, Nanshan, and Yanitan districts which are noted on the Number of Colleges and Universities adjacent map as “inner districts”. The inner districts contain Shenzhen’s 100 91 financial and trading center, municipal government, high-tech industries, 90 82 80 and the container terminal and port. In 2010, the SEZ expanded to 80 67 include the remaining “outer districts” which are mostly compromised of 63 63 70 manufacturing industries. Because the outer districts have not financially 60 developed at the same pace as the inner districts, its population who are 50 mostly migrant workers, do not have equal physical access to a high level 40 quality of health care. All of the Grade 3 hospitals are located in the inner 30 20 12 districts, and migrants must travel into the city center to receive top level 10 care. 0
Even though Shenzhen’s ratio of physicians to population is above China’s average, the majority of licensed doctors are concentrated in the city core where at top level hospitals. Community hospitals and clinics located in the outer districts are frequently staff by unlicensed providers and thus deliver a lower level of care.
Shenzhen’s Public Health (2014)
SHENZHEN
2,532 122 Health delivery points of care
4
Hospitals
1
2,338
Sanatoriums
Outpatient Clinics
8
11
Specialized Disease Prevention & Prevention & Control Centers Treatment Stations (antiepidemic)
SmithGroupJJR | Innovations in Practice Idea Lab 2017
10
3
39
Women & Children Agencies
Institutions of Medical Science
Other Health Care Institutions
International Comparison: China’s Number of Physicians per 1,000 Population
SHENZHEN
CHINA
1.49
Physicians per 1,000 population (2011)
Data Source - 2017 World Health Organization | Source: Global Health Observatory
SHENZHEN
2.50
Population Distribution vs. Hospital Location
Physicians
per 1,000 population SHENZHEN (2014)
2.70
Guangming
Hospital Beds Longhua MAP LEGEND
Longgang
per 1,000 population (2014)
Pingshan
Bao’an
General Hospital Grade 3 Hospital
W E' &hd/ E
'h E'D/E'
Luohu
Futian
2,000 - 2,500
1,500 - 2,000
000 - 250
E E^, E KΖ E z E/d E
z E/d E
KΖ E
Bao’an
>KE',h 'h E'D/E'
Nanshan KΖ E
LonghuaW/E'^, E
z E/d E
>KE'' E'
z E/d E>KE',h
>KE'' E'
Luohu
>KE'' E' >KE'' E'
W E'
>KE',h
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W/E'^, E >KE',h >KE',h
Dapeng
z E/d E
SmithGroupJJR | Innovations in Practice Idea Lab 2017 >KE',h
Longgang Yantian KΖ E W/E'^, E
W/E'^, E W E' W E'
E E^, E W E'>KE'' E' 'h E'D/E' 'h E'D/E' W/E'^, E >KE'' E' KΖ E z E/d E>KE',h W/E'^, E KΖ E
>hK,h KΖ E z E/d Ez E/d E
Futian >hK,h
Data Source - 2015 Shenzhen Statistical Yearbook | Shenzhen Statistics Bureau
W E' &hd/ E >hK,h z E/d E >hK,h E E^, E
&hd/ E
Guangming
>hK,h W/E'^, E >KE',h
>KE'' E'
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% Non-Registered >hK,h
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500 - 1,000
KΖ E 'h E'D/E'
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Nanshan E E^, E
&hd/ E
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District Population (1,000 persons)
z E/d E >KE'' E'
>KE'' E'>KE',h
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5
Shenzhen’s Public Health 4. Increased Burden of Chronic Diseases Lifestyle health promotion and disease prevention are critical aspects of a health care system, however data shows that Shenzhen’s population, majority being young migrants, are not practicing preventive care. Smoking, alcohol consumption, and cholesterol levels are increasing while physical activity is decreasing. Additionally, the failure to provide adequate health care increases the risk for chronic disease among the population. Shenzhen is facing an increased burden of chronic infectious diseases, and without proper preventive care, patients are unaware of their diminishing health until it is too late for treatment. In one study on the prevalence of hypertension, 70% of the patients who were surveyed were unaware that they suffered from hypertension. The top causes of disease mortality are those diseases from which patients do not experience noticeable symptoms.
Death Rate of Major Diseases (2014) 1
Malignant Tumor (26%)
2
Heart Disease (22 %)
3
Cerebrovascular Disease (20 %)
4
Respiratory System Diseases (12%)
5
External Injury / Poison (6%)
6
Endocrine, Nutritional, Metabolic Diseases (3%)
7
Digestive System Diseases (2.4 %)
8
Nervous System Diseases (1.1 %)
9
Genitourinary System Diseases (1 %)
10
Infectious Diseases not including TB (1 %)
5. Non-parallel Development of National Industries China’s economy is the second largest in the world, and is in the lead for financial-technology investments. China exponentially breeds financial-technology startups and is home to many of the world’s most valuable firms. Since many of these technology firms and manufacturers have their headquarters in Shenzhen, the city has become known as “China’s Silicon Valley”. Shenzhen is becoming the global hub of innovation in hardware and manufacturing; high-tech industries contribution had an average annual growth rate of 13.6% from 2010 to 2016. There is a large disparity between the exponential growth of Shenzhen’s technology and manufacturing industries when compared to its investment in its health care industry. This presents an opportunity for Shenzhen to use its research and innovation to advance the development of the health care system.
Shenzhen’s Investment in Fixed Assets (10,000 yuan) 16,000,000 13,740,589 14,000,000 11,998,082 12,000,000 9,266,212 10,000,000 6,921,631 8,000,000 5,683,900 6,000,000 4,000,000
3,713,345
3,735,060
4,559,359
4,015,619
3,088,579 2,000,000
Major Players in “China’s Silicon Valley”
220,735
205,028
238,894
238,403
175,951
2010
2011
2012
2013
2014
-
Agriculture, Forestry, Animal Husbandry and Fishery Construction Culture, Sports and Entertainment Education Financial Intermediation Hotels and Catering Services Information Transmission, Computer Servies, and Software Leasing and Business Services Management of Water Conservancy, Environment, and Public Facilites Manufacturing Mining Production and Distribution of Electricity, Gas, and Water Public Services and Social Organizations Real Estate Scientific Research, Technical Services, and Geological Prospecting Services to Households and Other Services Transportation, Storage, and Post Services Wholesale and Retail Trades Health Care, Social Security, and Welfare
6
SmithGroupJJR | Innovations in Practice Idea Lab 2017
Shenzhen’s Health Care Delivery Process ME DEPA
HO
NOW
ENT RTM
W
PHYS I N CIA
TRAN S
L OO
O RTATI N PO
ME
PRACTITI O
COMMUNITY C
K OR
NER
W
HO
SCH
QUEUING
IC LIN QUEUING
SCH
MIGRANT
HOSPI T AL
RESIDENT
REFERRAL
K OR
L OO
Currently, health care delivery looks different between a resident and a migrant in Shenzhen, China. Residents tend to have quicker access to better hospitals and physicians because of the insurance they are provided. Migrants usually are directed to community clinics, where they see practitioners who are not necessarily licensed doctors. If the practitioner at the community clinic diagnoses them as having a condition that needs a physician’s attention, migrants are then referred to a hospital that is usually not covered by their insurance.
PHYS I
ALTH POD HE
N CIA
MY
FUTURE
For the future, we propose a separation of low acuity from hospitals and the addition of technological intervention, resulting in access looking similar between a migrant and a resident. The prototype gives access to physicians without the need to transport one’s self to what is often a distantly located hospital, and gives the patient more control of their health care.
ME
SCH
MYH E
K OR
H TAT ALT
RTATION SPO
OPTIONAL
LTH CARE DA HEA
HOS P L ITA
W
TRA N
CALL FOR
ASE TAB
RESIDENT & MIGRANT
HO
VIRTUAL
L OO
DRONE
MEDICINE DELIVERY
SmithGroupJJR | Innovations in Practice Idea Lab 2017
7
Technological Interventions in the Health Care Delivery Process There are multiple universal issues that affect patient access to health care services, and we have given specific detail to those that affect Shenzhen’s public health the most in the previous sections. However, of these multiple issues we wanted to look specifically how Shenzhen’s technology industry could influence the future of health care delivery and it’s relationship to the other interconnected universal issues.
Universal Issues of Access to Health Care
Services Provided. Western vs. Traditional Medicine
# of Medical Professionals
We began by asking questions about the future possibilities: 1.
How can the advancement of technology in 2050 intervene in the health care delivery process and change the way we access health services?
2.
How can health services be transported and/or distributed so that the physical distance to a physician is not a factor of accessibility?
3.
4.
Facility Location
Affordability/ Insurance
Means of Transit to/from
Education/ Awareness
How can diagnoses happen earlier to combat chronic disease and limit the amount of unnecessary referrals and queuing at health care facilities?
Appointment Availability/ Scheduling
Access to Technology
How can technology eliminate the need for a physician for lowacuity services and lower health care costs?
Where can Technology Intervene? TECH INTERVENTION LESS ACUTE
PREVENTATIVE
CONSULTATION PHARMACY VACCINATIONS LAB SAMPLING
DIAGNOSTICS IMAGING EXAMS
TREATMENT
SPECIALTY
From there, we began to think of ways to address the shortage of health care providers by examining each service’s level of acuity, and where technology could substitute the need for the physical to physically be in the same room as the patient. If artificial intelligence or telemedicine could be used instead of having to staff a provider for certain tasks, then those providers focus on other tasks of higher acuity and specialty. We found that many preventative care services did not necessarily need a provider to physically conduct the task in the same room as the patient. Tasks like vaccinations, diagnostics and consultation, imaging, and even lab work can be done by artificial intelligence, telemedicine, or even autonomously by the patient. In the current health care market there are even instances where technology can be used to perform more acute tasks like surgery via Da Vinci robots. Based on these observations, we developed the idea of separating preventative care from the hospitals that are receiving an influx of patients with non-acute conditions, and instead, we proposed decentralizing these services to be more accessible to patients. If there are challenges in patients transporting themselves to their physician, why not rethink the current model and think of ways that physicians and services can be transported to the patient? Whether it be motorized, self-driving, floating, or flying, mobility is a flexible way of extracting certain health services from a centralized facility to become a more localized method of reaching a community.
ED / TRAUMA SURGERY MED SURG / ICU
MORE ACUTE
Designing for Adaptability
The 2050 prototype would provide non-acute services in a fully automated and autonomous delivery method, avoiding the need to staff a provider. This keeps the hospitals running at their best ability with limited staff, and gives patients ownership of their health by enabling health monitoring and access to self-serviced care, ultimately reducing health care cost. A detailed explanation of each new decentralized point of care is presented in the following sections.
LAND 8
SmithGroupJJR | Innovations in Practice Idea Lab 2017
AIR
SEA
Current Technology and Innovation in Health Care Technology advancements are changing the way health care is delivered to consumers. The future of health technology will enable the transformation of health care systems, improve relationships between patients and their care team, and lower cost of health care delivery. This section highlights a few inspirational examples of how technology has already started to evolve the future of medicine and health care.
Mobile Clinics Increasing healthcare access Geographical and logistical convenience Trusting provider-client relationships Emergency coverage Screenings Initiating preventative care
Managing chronic diseases Enabling self-efficacy Reducing healthcare costs Avoidable emergency department visits Hospitalization and hospital readmission rates Disaster resilience
Applications on Personal Devices HealthTap: The app sends your question to its network of doctors, and one will answer you within a few hours. HealthTap also comes with a library of information on common ailments, so you can be better at spotting symptoms and picking the best remedy.
Wearables WRIXO: The wristband has a Near Field Communication (NFC) chip inside of it. It contains each person’s unique patient ID, which is used to access your medical records.
Telemedicine DaVinci Robots Specialists in NYC treat stranded Puerto Ricans after earthquake InTouch Vita telemedicine robot: connects physicians with their patients regardless of location.
Healthcare Integration into Lifestyle Saks Fifth Avenue Wellery: Wellness center within the store Walmart Care Clinics: retail clinics operating within the store.
Autonomous Care Microneedle Patch: Alternative to needle and syringe immunization Smartphone accessory: Small device connected to smartphone that performs point of care tests from a finger prick.
SmithGroupJJR | Innovations in Practice Idea Lab 2017
9
MyHealth TAT: Live Health Report Always Within Reach The first point of care proposed for the new delivery prototype is an evolution of the common health monitoring wearables found in the 2017 market. MyHealth TAT (technology-aided tracking) is a semi-permanent, paper thin, microchip device applied to the users wrist that constantly monitors body vitals such as temperature, heart and respiration rates, blood pressure, cholesterol levels, and more. It is durable enough to withstand hygienic cleaning, sleeping, and exercising, but it can also be removed and replaced for model upgrades without pain. In addition to vital monitoring, it also has the capacity to notify its user of his or her scheduled appointments at a nearby MyHealth POD (patient-owned delivery) or with a physician, and it can request prescription refills. My Health TAT is linked to its user’s personal identification number which allows patient entry into the POD units, connects to the national health record system, and can locate the user during a time of emergency. Additional descriptions of the MyHealth TAT capabilities are listed on the adjacent page.
HDL LDL
MyHealth TAT Touch activated emblems for the various vitals and additional capabilities that can be enlarged on the main display screen. The main display screen reports on the current status of the patient’s health. For instance, temperature is shown at 98.6 degrees F. If the vital is out of range of the normal, the user may choose to connect to a larger device for suggested remedies, or he or she may choose to seek further diagnosis at a nearby POD. Serious disparities and emergencies will connect the user the nearest health care provider. 10
98.6ÝF 98
SmithGroupJJR | Innovations in Practice Idea Lab 2017
HDL LDL
Body Temperature Assessment of body temperature provides cues for infection, inflammation, and immune system responses. The “normal” body temperature has a wide range, from 97°F to 99°F. As long as the user’s temperature is within this range the check mark will display under the reading on the main screen. If the body temperature is out of range, the user may be alerted to seek tele-consultation to determine diagnosis.
Heart Rate One of the top 10 causes of mortality in the province of Guangdong is heart disease, and as a person ages a change in the rate and regularity of the pulse may signify a heart condition or other health issue that needs to be addressed. An adult’s normal resting heart rate ranges between 60 to 100 beats per minute. If a user’s rate falls below or above that range he or she can seek further consultation at a nearby POD.
Respiration Rate Respiratory system disease was ranked as the fourth cause of death of both rural and urban residents in China, and nearly 30% of the population is still smoking. Monitoring respiration rates may alert a patient when he or she is not breathing at the normal rate. There are various other health issues that affect the respiratory system such as pneumonia and influenza, chronic obstructive pulmonary disease (COPD) and asthma, occupational lung diseases, and tuberculosis to name a few.
Blood Pressure Because there are no symptoms of high pressure, self-tracking is essential. MyHealth TAT can record many readings over time and provide a “time-lapse” picture of the patient’s blood pressure that can help the physician to ensure that treatments to lower high blood pressure are working. If the user’s BP is more than 120 /80 or less than 140/90, the device can connect to the nearest TV or tablet to educate the user on lifestyle changes.
Cholesterol Levels Similar to blood pressure, abnormal cholesterol levels have no symptoms, and many lifestyle choices affect cholesterol such as smoking, frequent alcohol consumption, lack of physical activity, and obesity. Having the knowledge of one’s current HDL and LDL levels allows him or her to make changes to prevent cholesterol related health issues. The MyHealth TAT can provide awareness and education for the user to make lifestyle adjustments.
Other Blood Factors Annual blood testing is the most important step aging adults can take to prevent life-threatening disease. MyHealth TAT can give the user real-time blood factors such as glucose and triglycerides, iron, platelets, and red and white blood cell levels. Since annual blood work is not common practice in Shenzhen culture, this new prototype elevates preventive care and will allow for detection of early-stage diseases such as diabetes.
Body Fat Percentage High percentages of visceral and subcutaneous fat are linked to cardiac disease, inflammatory diseases, diabetes and other health problems. MyHealth TAT can send painless electronic waves through the patient’s body to determine his or her body fat percentage, and it will alert the user to take action if it is out of the healthy range for men or women.
Kidney & Liver By monitoring blood creatinine, glomerular filtration, and urea nitrogen levels, MyHealth TAT can inform the user if his or her kidneys are functioning incorrectly. Kidney function is connected to many other diseases, thus preventive tracking is essential. Additionally, the device can analyze blood proteins and enzymes to alert the user of any disease progression in the liver.
Prescriptions (Traditional and Western) MyHealth TAT has the network capacity to initiate prescription refills or order over-the-counter remedies for minor illness. Once ordered, the delivery can be made by a pharmacy-drone or picked up at a nearby store.
Activity Tracking To promote physical fitness accountability, the user may program activity goals into his or her MyHealth TAT. If targets are not met the device can connect to the TV or tablet to suggest daily lifestyle changes that can help the user meet his or her activity goals.
Sleep and Rest Sleep and the capability to relax the brain are important to physical and mental health. By collecting data on rest and sleep patterns and quantities, the user can receive educational content to improve his or her habits.
In Case of Emergency Because of its bluetooth and network connectability, MYHealth TAT can trigger a call for aide during an emergency whether it is health related or not. Additionally, during a natural disaster it can help responders locate a person due to the devices affiliation with the patient identification.
Additional Capabilities The success of the MyHealth TAT is its connection with the new health delivery system. In addition to the listed capabilities above, it can connect to other technologies and devices such as digital applications and personal tablets. It has the capacity to help a user schedule an appointment with a POD or physician as his or her level of acuity increases, and it can help locate PODs nearby. Due to its semi-permanent application, it is designed for adaptability to future needs, health monitoring, and social programming.
universal connectability
SmithGroupJJR | Innovations in Practice Idea Lab 2017
Education Tele-consultation Health communication Future programming
11
MyHealth Pod: More Accessible Preventative Care The second point of care proposed for the new delivery prototype is a modular health care unit that provides preventative care services. MyHealth POD (patient-owned delivery) is a modular, compact, fully automated examination room operated by hospitals. It can be integrated into infrastructure to be a permanent point of care situated in the workplace or retail space. It can also be distributed as a mobile unit to where care may be needed. The design of the MyHealth POD is flexible, compact, and adaptable to fit in every corner of the city. The unit itself measures at 10’x10’x10’. The unit allows for privacy in its enclosure, but the exterior walls can be accessed for services that do not require a private room such as pharmacy or supply vending. The compact composition of these PODs means space efficient storage in the walls, above the ceiling, and below the floor.
Adaptability and Efficiency 10’
10’
IN THE CEILING: • Imaging / Screening equipment • Light fixtures • Drone and Supplies • MEP / HVAC
SMART GLASS WINDOW • Transparent when vacant • Opaque when occupied IMAGING AND EXAM TOOLS FOLDING EXAM TABLE • Lifted from the floor • Can adjust into an exam chair
LED SCREENS USED TO TELECOMMUNICATE WITH PHYSICIAN
STORAGE FOR PERSONAL BELONGINGS IN THE FLOOR: • Exam table • MEP / HVAC • Wheels
SUPPLIES AND PHARMACY VENDING 12
SmithGroupJJR | Innovations in Practice Idea Lab 2017
Mobility Options of the PODs Although many PODs can be placed in a permanent location such as office buildings, transportation hubs, shopping malls, and urban villages, mobility of the PODs creates flexibility and adaptability to a changing environment and population. PODs can be moved by truck or train, selfdriving, fly with the assistance of drones, or float on the water to provide access to patients in every condition, including emergencies.
SELF-DRIVING
DRIVEN
FLY
FLOAT
Possible Specialty Services of the PODs Besides the basic preventative care services, different variations of PODs can perform specialty services including dental exams, eye exams and imaging for more in depth exams and treatment. For those with chronic conditions like diabetes, patients can schedule a POD for personalized treatment like infusions.
EXAMINATION
DENTAL
TREATMENT
DIABETES INFUSION
EYE
PHYSICAL IMAGING
URGENT CARE
DISASTER RELIEF
Modularity and Assembly of the PODs When a condition occurs where more space is needed to perform services for the community, PODs can be grouped and reconfigured to allow for flexbility. During a disaster, multiple PODs can be assembled to form a temporary clinic for triage and disaster relief.
LINEAR PROCESS FOR EXAMINATION AND TREATMENT
CENTRAL EXAM ROOM AND MULTIPLE ROOMS FOR TREATMENT
SmithGroupJJR | Innovations in Practice Idea Lab 2017
13
MyHealth Scenario 1 LULU, A YOUNG MIGRANT WORKER, IS NOT FEELING WELL...
COUGH! I FEEL COLD... WHAT’S WRONG WITH ME? YOUR BODY TEMPERATURE IS ABOVE NORMAL! PLEASE GO TO A POD!
WELCOME LULU! I HAVE BEEN WAITING FOR YOU!
WELL...OK... FIND A NEAREST ONE...
102ÝF
!
POD EXAM RESERVED!
YOU GOT THE FLU, BUT NO WORRIES! TAKE THE MEDS AND YOU WILL BE FINE! TAK
ET HES EM
EDS
ULT RES
ADDITIONAL MEDS WILL BE DELIVERED TO YOUR HOME
R YOU RE T S E TE OD H BLO
I FEEL MUCH BETTER NOW!
ADDITIONAL MEDICINE IS HERE!
14
SmithGroupJJR | Innovations in Practice Idea Lab 2017
MyHealth Scenario 2 MING, A HARDWORKING ARCHITECT, IS ALWAYS ENERGETIC AT WORK...
THE DRAWING IS GREAT!
TIME FOR ANNUAL EXAM! POD RESERVED AT 8AM OUTSIDE THE OFFICE GLAD TO SEE YOU AGAIN! MING, PLEASE COME IN!
98.6ÝF
THERE IS SOMETHING WRONG WITH YOUR LIVER... YOU SHOULD GO TO A TIER 3 HOSPITAL FOR INDEPTH EXAMS ASAP! NG!
RNI WA
M
RE
O D M NEE
EXA
BAD NEWS... THERE IS MINOR SCARRING ON YOUR LIVER
!!!!
FORTUNATELY, SINCE WE FIND IT EARLY, WE CAN OFFER THESE LIFESTYLE CHANGES TO PREVENT THE ONSET OF DISEASE
SmithGroupJJR | Innovations in Practice Idea Lab 2017
15
MyHealth Prototype Distribution In an effort to distribute healthcare services where needed - from the city center to urban villages - MyHealth PODS live within the urban fabric. Ranging from work places to schools, parks, and transit centers, MyHealth PODS are dispersed to areas with a shortage of licensed medical providers. The adaptable elements provide flexibility to its location, allowing the PODS to be localized within a community. Increasing this physical access shortens the travel times often associated with consulting physicians, and provides the residents the ability to receive medical attention through these decentralized health care services distributed across the city. Using crowdsourcing capabilities to the health care database cloud, MyHealth PODs are distributed across the megacity according to population density and frequency of use to provide equitable access to residents and migrants alike.
WORK
16
RETAIL
PARKS AND RECREATION
SmithGroupJJR | Innovations in Practice Idea Lab 2017
SCHOOL
MEDICAL PRACTITIONERS MYHEALTH PODS
URBAN VILLAGE
TRANSPORTATION SYSTEMS
SmithGroupJJR | Innovations in Practice Idea Lab 2017
17
MyHealth Prototype Implementation Who Pays for the Prototype? Many stakeholders will play a role in implementing the different components of the prototype. The government will have a stake in the national health database. Top tier hospitals will invest in the manufacturing of the pods, using their preferred vendors for medical equipment, supplies, pharmaceuticals, etc. Universities and insurance companies also want to invest in the health database for research and development purposes. Tech companies and retail manufacturers already have stake in the wearables, so they will continue to play a significant role in the compatibility of the MyHealth TAT to the MyHealth POD. Employers will have a stake in the health of their employees and receive incentives from the government to house the PODs in their workplace. Developers who are retrofitting or constructing new buildings will be required by zoning laws to provide space and infrastructure to future locations of PODs. With many parties holding investments in the prototype, we imagine the prototype will be successful as a public private partnership.
Who Owns and Maintains the Pod? The PODs will use automated disinfection after every use. Ultraviolet decontamination technology can destroy lethal bacteria, viruses and fungi and prevent infections. The PODs will be mostly selfcleaning, but inevitably will need periodic maintenance.
18
With hospitals having the most stake in the POD, they will be responsible for the POD being operational and well serviced. Employers and property owners for which the POD resides will be responsible for any of the components feeding into the POD from its exterior such as utilities and infrastructure.
Will Patients use the Pod? Our research has shown that the Chinese people are more trusting of technology in the sharing of personal information than westerners. However, the Chinese trust brand names when it comes to which health care providers they choose to seek. So it is important that the top tier hospitals are the ones that invest in this prototype and use their brand name as advertisement on the Pods. The Pods are meant to be educational about preventative care, as the Chinese people practice both western and traditional medicine, the Pods should be culturally sensitive to that and provide health advice in both traditional and western medicine. By locating pods in workplaces and in transit centers, physical access to preventable care is improved. Patients no longer need to travel far distances to consult a physician, when they can telecommunicate with one within their vicinity. Scheduling appointments easily with their MyHealth TAT prevents having to waste time queuing.
STAKEHOLDER
SUPPLY TO PROTOTYPE
RETURN ON INVESTMENT
GOVERNMENT
ZONING LAWS, FUNDING AND INCENTIVES
HEALTH DATABASE
HOSPITALS
MEDICAL EQUIPMENT, PHARMACEUTICALS, SUPPLIES, NURSING STAFF, BRAND
HEALTH DATABASE, LESS QUEUES AT HOSPITAL & MORE PATIENT VISITS, REVENUE
UNIVERSITIES/ MEDICAL SCHOOLS
RESEARCH, RESIDENCY SERVICE, BRAND
HEALTH DATABASE, MARKETING
INSURANCE CO
INSURANCE PLANS INFO, BRAND
HEALTH DATABASE, MARKETING, MORE PATIENT VISITS, REVENUE
TECH CO/ RETAIL
ARTIFICIAL INTELLIGENCE TECH, MYHEALTH TAT, TRANSPORTATION TECH, BRAND
REVENUE, MARKETING
EMPLOYERS/ PROPERTY OWNERS
PHYSICAL SPACE, UTILITIES
INCENTIVES FROM GOVERNMENT, HEALTHIER EMPLOYEES
DEVELOPERS
PHYSICAL SPACE, INFRASTRUCTURE, AS REQUIRED BY ZONING LAWS
INCENTIVE TO BUILD X MORE UNITS PER ADDITIONAL POD BUILDOUT
FABRICATORS
MANUFACTURING OF MYHEALTH POD, BRAND
REVENUE, MARKETING
SmithGroupJJR | Innovations in Practice Idea Lab 2017
How is This More Equitable? 1.
Autonomous health provided in the MyHealth TAT and POD means removing healthcare providers from non-acute care who were traditionally staffed to retrieve basic personal health information, and results in low cost to the hospitals and affordable visits for patients.
2.
The MyHealth TAT only provides basic health information, while more in depth examinations and results will have to be performed in the POD, resulting in an affordable MyHealth TAT that should be covered by all insurance policies.
3.
Many stakeholders investing in different parts of the prototype results in low cost for the consumer per visit.
4.
Zoning laws will require that a certain amount of PODs will need to be located in any given community based on the density and needs of that population. PODs will collect information about the population based on its visits and store it in a national health database that can be accessed by the government, health care organizations, universities, and insurance companies to better service the population. PODs will also collect information about the environment such as the climate, air quality, toxins, and number of visits. This information will help dispatch and distribute pods according to need and frequency of use.
Information Distribution through Health Care Cloud
ENVIRONMENT & AIR QUALITY MYHEALTH TAT
MYHEALTH POD
HEALTH CARE CLOUD HOSPITALS
UNIVERSITY
INSURANCE CO
GOVERNMENT
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Conclusion A New Model of Health Care Delivery Summary By uncoupling low-acuity and high-acuity care and designing an autonomous preventive care and diagnosis prototype, we bridge the gap of inequitable access to health care services in Shenzhen, China, while creating a care model that enables consumers to take ownership of their health. The first point of care, MyHealth TAT (technology aided tracking), elevates the patient’s health to the forefront of their daily life by allowing current reports on multiple vital functions. The second point of care, MyHealth POD (patient-owned delivery), is an adaptable telemedicine unit that allows a patient to receive a higher level of non-acute care without physically visiting a hospital.
The prototype provides non-acute services in a fully automated and autonomous delivery method, avoiding the need to staff a provider. This keeps the hospitals running at their best ability with limited staff, and gives patients ownership of their health by enabling health monitoring and access to self-serviced care, ultimately reducing health care cost. We believe this solution would have the largest impact on a 2050 megacity population’s public health especially in Shenzhen, China.
Bibliography Cheng, Gang, et al. “Spatial Difference Analysis for Accessibility to High Level Hospitals Based on Travel Time in Shenzhen, China.” Habitat International, vol. 53, 2016, pp. 485–494., doi:10.1016/j.habitatint.2015.12.023. “China’s Audacious and Inventive New Generation of Entrepreneurs.” The Economist, The Economist Newspaper, 23 Sept. 2017, www.economist.com/news/briefing/21729429-industries-and-consumers-around-world-will-soon-feel-their-impact-chinas-audacious-and. “Density of Physicians (Total Number per 1000 Population, Latest Available Year).” World Health Organization, 2017, www.who.int/gho/health_workforce/physicians_density/en/. Fang, Hai. “The Chinese Health Care System.” International Health Care System Profiles, The Commonwealth Fund, international.commonwealthfund.org/countries/china/. “Medpod Mobile Medical Center.” Medpod, medpodhealth.com/products/mobiledoc/. Lam, Kelvin Kf, and Janice M Johnston. “Health Insurance and Healthcare Utilisation for Shenzhen Residents: a Tale of Registrants and Migrants?” BMC Public Health, vol. 12, no. 1, Dec. 2012, doi:10.1186/1471-2458-12-868. Liu, Mengting. “Shenzhen Has Invited 173 ‘3 Famous Groups.’” Edited by Kexin Xu,Shenzhen News, ShenzhenNews.com, 12 Nov. 2017, www.sznews.com/news/content/2017-11/12/content_17729788.htm. Owen, Tony. “Pop-Up Health Clinics Help Fill A Void in Care.” BeCore, BECORE Publisher Logo, 12 Oct. 2017, www.becore.com/pop-up-health-clinics-help/. “Shenzhen Medical Institutions Set up Planning (2016-2020) Announced.” Shenzhen Health Planning Commission, 13 June 2017. www.yigoonet.com/article/22539127.html. “Shenzhen Population 2017.” World Population Review, 20 Oct. 2017, worldpopulationreview.com/world-cities/shenzhen-population/. Shenzhen Statistical Yearbook 2015. Shenzhen Statistics Bureau, NBS Survey Office on Shenzhen, China Statistics Press. Siwicki, Bill. “NewYork-Presbyterian Specialists Use Telemedicine to Treat Stranded Puerto Ricans.” Healthcare IT News, 9 Nov. 2017, www.healthcareitnews.com/ news/newyork-presbyterian-specialists-use-telemedicine-treat-stranded-puerto-ricans. Zhang, D., et al. “Public Health Services in Shenzhen: a Case Study.” Public Health, vol. 125, no. 1, 2011, doi:10.1016/j.puhe.2010.10.007. “2015 Invest In SHENZHEN: Build A Winning Future.” investshenzhen.org, en.szinvest.gov.cn/ne/events/201706/t20170626_7278311.htm. “2016 Top 10 Companies.” Globalization Shenzhen 100, Shenzhen 100, www.shenzhen100.com.cn/2016top10/.
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SmithGroupJJR | Innovations in Practice Idea Lab 2017
Research Team
Annie Chiang San Diego, CA Architectural Discipline Healthcare Studio I’ve worked on Sharp Chula Vista Ocean View Tower, a 106 patient bed tower located in Chula Vista, CA from design development through construction. My passion in health care lies in the user experience of the staff and patients alike. I also have a passion for research specific to how health care facilities can be designed to be more resilient in the face of perils induced by climate change and other stressors. The Idea Lab 2017 has been an exciting exploration of innovative design thinking for me. I have learned that although this year’s challenge may be situated in Shenzhen, China, the problem of inequitable Healthcare access is all too common a problem around the world. Being able to understand the problem from a systemic standpoint has expanded my understanding of how architectural solutions can integrate itself in a larger solution.
Holly Harris Chicago, IL Architectural & Planning Disciplines Healthcare Studio I like to describe my design process as “analytically creative” and my experience ranges from large scale, data-driven health system planning to small scale graphic representation. As strong conceptual and operational thinker, I seek reason when exploring design decisions, and I am fascinated with projects that tell a story from conception to completion. My passion for health care design blossomed through my encounters with patients and care givers, from which I have learned to design with empathy and humility. My interested to pursue research influenced me to apply for Idea Lab 2017, and understanding the complexity of China’s healthcare system has been a satisfying challenge. Access to health care is an issue among multiple nations, and this research project allowed our team to design a new delivery prototype and intervention for the 2050 horizon.
Chang Zong Detroit, MI Planning Discipline Healthcare Planning
Lisbeth Mora Los Angeles, CA Architectural Discipline Healthcare Studio My passion for health care is centered on improving the patient experience and creating comfortable healing environments through planning and design. Having worked on health care projects of varying scales from programming to master plans, these experiences have shaped my interest in medical planning. I see the complexities as opportunities for innovation, and I am particularly interested in how technology drives the future and has the capacity to create efficient workflows. Participating in this year’s Idea Lab provided an invaluable opportunity to address a significant global problem and collaborate on finding a solution not only for Shenzhen, but for cities worldwide with similar political, social, and economic constructs. Tackling the issue of accessibility and understanding how these elements are shaping the future of health care delivery will serve as inspiration in the future.
I started working for SmithGroupJJR two month ago, and Idea Lab 2017 is a great opportunity for me to be immersed in creative ideas and visualize crazy thoughts. I am really grateful for participating in this talented group and learning from each other. This year’s topic aligns with my experience and interest in every aspect. I am from China, have lived in multiple megacities, and am learning enthusiastically about health care systems during my work now. Doing research, studying from others, and designing the future for Shenzhen’s healthcare delivery system has helped me think about what architects and designers can do to influence the future of health care. We may not be a dominant factor, but we still are stakeholders. It’s important to see the large picture so we can produce reasonable solution to real-world problems.
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Back Cover. Cool graphic and project statement conclusion?
ANN ARBOR CHICAGO DALLAS DETROIT LOS ANGELES MADISON PHOENIX SAN FRANCISCO SAN DIEGO SHANGHAI WASHINGTON, DC
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