Health Finance with Dr. Andrea Feigl

george grombacher 0:01
Well, blood for this is George G. And the time is right. welcome today’s guest strong, powerful. Dr. Andrea Feigl. Andre, are you ready to do this?

Dr. Andrea Fiegl 0:09
Absolutely. And thank you so much for having me this morning.

george grombacher 0:12
excited to have you on. Dr. Andrea is a health financing innovator. She’s a health economist, scientific adviser, and she is the CEO of the health Finance Institute, working to inspire health today for wealth tomorrow. Dre again, excited to have you on tell us a little about your personal lives more about your work and why you do what you do.

Dr. Andrea Fiegl 0:34
Three questions in one, that’s how I love it. Yeah, I mean, I’m, I’m a health economist, I’m also a dancer. So I have these two sides. To me, I’m a very rational thinker, but I’m also very creative person. So these two things have kind of like kept the balance in my life. And I tried to engage in both as I can. And I always looked at my life of like, not separating my my job from what I like to do. So I was trying to be very passionate about the things that I do

Speaker 3 1:03
to do to do to do. And

Dr. Andrea Fiegl 1:07
basically, try and see how I can make a positive impact with the talents and opportunities that I’ve been given. So when I stumbled upon public health, when I was in my early 20s, I had this wonderful internship in Washington DC, where I’m actually based right now, I fell in love with PolicyMaking at the high level, and that how that can really impact populations on the ground. So my journey then has been that I did a PhD in health, global health and health economics, really looking at the economic burden of chronic diseases. So heart disease, heart disease, cancer, diabetes, COPD, so lung disease and mental health. And what we can basically do with the limited resources that we have, or spending our resources better to make make a change. So just to give you an understanding about the size of this issue, so we like countries use about 5% of their GDP each year, because they don’t invest properly, in things that we know that work when it comes to prevention, access and adherence. So the size of the 2008, economic, the market crash was about, you know, 5% of the GDP was wiped out globally. So we’re accepting that just as a status quo, because we don’t do the right things and chronic diseases. So when I was younger, and a bit more naive, I thought that analyzing and putting out that evidence was enough. So I was involved in a couple of UN high level meetings, especially in general assemble assembly meeting specifically on a certain topic, there was one on chronic diseases in 2011, and 2014. And in 2018, and the numbers were just getting bigger and bigger and bigger and houses the economic burden, but nobody was actually doing anything about it. So I said to myself, well, you know, what can I do? And I started and founded the health Finance Institute, and with the mission to broker public private partnerships, to advocate for, and find novel financing solutions to address the Chronic Disease Burden, particularly in underserved communities. And again, not a number, only 3% of international donations, development assistance for health go to 80% of the disease burden. And so again, there’s the inequality in terms of what we how we spend the money on health, generally in high and low income countries. And then there’s sort of this disparity between where the burden is and where the suffering is, and where the money actually goes. So we’re basically trying to address both

george grombacher 3:56
one of those small problems under Exactly,

Dr. Andrea Fiegl 3:59
yes, exactly. That’s

george grombacher 4:04
up on you. And as like, Oh, my goodness, I can’t wait, because I love thinking about big problems. And that’s all fine. And well, because to your point, we can be very aware, and we can put money towards it. But that doesn’t mean that it’s actually going to have the impact that we’re desirous of or that we want to have. So you you mentioned three things that that governments communities are failing to do. One of them was adherence, what what were the others

Dr. Andrea Fiegl 4:34
access and prevention? So, for example, if for diabetes, right, you want to catch diabetes really early. Preferably we want to even prevent diabetes, and there’s something called primary and secondary prevention. And it’s better for your health, better for your longevity better for your social life, but also better for the economy if you catch it early, right. So you want to firstly you want to prevent and we know a lot about prevention when it comes to diabetes, right? It comes to, you know, regular, you know, measurement of your, of your vitals, you know, exercise, healthy diet, and so on and so forth. And, and then there’s, you know, if you were to be pre diabetic, or you know, at the beginning of diabetes, you want to basically act early to manage or potentially even reverse the disease, right. So you have countries like Malaysia, over 60% of diabetes gets diagnosed in the ER, that means people, people present with vision issues, they’re starting to lose sight, there have numbness in the limbs, they need to get amputated. And about, like the majority of the spends on thumbs up to 80% of the spending for diabetes in our country happens in tertiary care, costing up to 20%, of the health spending. And that’s exactly lopsided to what you see, like in, you know, more Western, especially Western European countries, where more of the money is spent in primary and secondary care, and you have really early detection. So that’s sort of you want to prevent the disease. And if the disease occurs, you want to make sure there’s access to diagnosis and access to treatment. But that’s not enough, right? If, if and when persons are living with a chronic disease, you also want to make sure it is adherence to it right? People need to be able to take time off work, to see the doctor to access to medical care, to adhere financially, to the treatment regimen that they have. We did a study in Armenia, we first only that was funded by the World Diabetes foundation and conducted by the Danish Red Cross. And they basically gave education, screening and also drug based treatments to elderly and vulnerable populations living with type two type two diabetes. And then we looked at, you know, how much of the program cost and was their financial return? And it was almost like a two exponential return. And then we said, how much does it actually costs for people to adhere to that diet that is being prescribed to manage their diabetes, right. And we realized for them to actually switch to fresh fruits and vegetables in the quantities that were being described, compared to the regular diet, it was twice as expensive as the drugs that were given out through the program. So how can people adhere to that? If they’re not, you know, so anyway, so that’s what your adherence comes in.

george grombacher 7:37
I’m absolutely fascinated by by behavior change. I work in personal finance, and I can’t help but wonder, or think that there’s a lot of similarities to people understand what they’re supposed to be doing with their money. And then how do we actually put it into practice? How do we help people avoid getting into a lot of debt as opposed to helping them get out of debt? So the access adherence prevention, those three things that really resonates and and make sense with me? These are here some

Dr. Andrea Fiegl 8:10
huge problems? Yeah, I mean, I think there’s, there’s an issue called like, not issue, there’s something called choice architecture, right? In terms of the choice architecture needs to be in a sense needs to be designed in a way that a healthy choice is the easy choice. And that starts from you know, the way that fruits and vegetables are present represented in a supermarket, to, you know, incentives that insurance, for example, gives you there’s a great program that comes out of South Africa, it’s called mentality. And they basically have like an airline miles system and have silver gold, platinum status based on how much you exercise and how much you know, healthy produce you purchase, you didn’t get rewards like even like, you know, lowering of your premiums and things like that. And that actually really, really works. And it’s increases health, like it improves health, but it also saves the employer as well as the insurance company. But I think at the at the population level, be it in emerging but as well as developed economies, we’re really far, far away from that. Some others in infectious disease era have even said there’s like a structural violence when it comes to, you know, the health, you know, access to health in various communities, because the social, the social determinants of health about, so teach global health financing at Georgetown University, and at the beginning, we talked about, you know, what’s the health system? Let’s what’s the role of our healthcare system, right? And we often have sickness systems, right? We often have systems to deal with people once they’re sick, or we prevent them from getting sick at best, but we don’t really look at maintenance and creation of health. And the interesting thing is what that means is about 80% And that’s a study that’s sitting published in Health Affairs at health is actually generated outside the healthcare system. Right Right. So the social determinants, the structural determinants, you know, the communities, your zip code, have a much greater bet, where you live, how you live have a much greater bearing on your health status than necessarily the quality of your healthcare system to begin with. So, you know, and I guess a parallel to finance, there would also be right. I think there’s like studies that show and you’d see where your expertise is that in that area, but basically, like your, the, the wealth of the parents of before closest friends in high school or something, have a greater like determinants have a great greater impact on how you will do financially, then, you know, the quality of your school, for example? So, again, that that social environment has a massive impact. And, and then, and how do you nod? Or how do you change that? Or how do you take that into account? To then basically, change behaviors? But also, you know, it’s an interplay between individual versus environmental determinants of health?

george grombacher 11:11
Yeah, I think it’s fascinating. I think, to a degree, it is sort of like a dance, where, you know, you’re where we are, as an individual I’m, I’m, I’m dancing between, I understand that I need to balance my long term health with my desire to put delicious food in my mouth or to consume alcohol, or my desire to stay on the couch, or I might desire to be healthy enough to play with my kids. It’s, it’s, it’s, it’s all kind of a dance. When it also makes a lot of sense to me that you want to bring these public private partnerships together. Because to your point, I think that there’s such huge opportunity with employers and insurance companies to be working together to reduce costs. So there’s a business case for it. And that’s where we are spending so much of our time and getting so many of our benefits.

Dr. Andrea Fiegl 12:08
Yeah, absolutely. And I love the I love to dance analogy, right. And I think I mean, I think that for those of us who work in health, we assume that health is the most important thing, but it often isn’t for others, right. So just a fun factory to share. When we looked at alcohol, there was a really fantastic study 2018, it came out and it said, there’s really no single amount of alcohol that’s beneficial to your health. And I was the first study that now had more data, because there was this, like, you know, it’s good for you cardiovasc for Carhartt health, but whatever it does, there, the cardioprotective effects are not outweighed, or not outweighing the negative effects it has on Kansas and everything else. So but then we correlate it, you know, drinking with, we correlated drinking with with income. And women who drank a glass or two a day had a much higher income and earning potential throughout their lifetime than women who didn’t drink. And so, so even when we control for a couple of factors, right, so it comes down to they’re probably networking, they’re probably engaging, they’re probably like, furthering their business relationships is absolutely critical rate to to, to climb up a career ladder, what have you. And so, you know, from a health perspective, you shouldn’t drink from other other air you know, from other perspectives you you should perhaps, but then you know, when it comes to workplaces, and insurance and and incentivization, of healthy behavior. In the past, we looked at, looked at data from McKesson who engaged in this brutality program, we looked at data from 50,000 people, and even just engaging once per month with the program beat at going to the gym ones, buying healthy grocery once a month, had substantive positive health effects in terms of body mass index, blood pressure, and other health related outcomes, and also saved over $1,000 per person per years times, you know, 50,000. For those that are engaging versus those who are not engaging, you can save millions of dollars as a as a corporation, but also creating positive health impact. And that those savings are actually above and beyond the like basically subtracting the cost of the program in and of itself. And this is sort of where we look at you know, if we know that there’s already an insurance system that exists and we know what can be done to improve programs, you can set up financial instruments like social impact bonds, or blended finance instruments. Let’s say well, if this outcome happens, that only then insurance company or government will you have to pay and we find investors they get a different return by based on how well the program performs, right, so it basically helps you know, those enrolled in a program to actually really achieve certain outcomes, it helps in M and E culture. And it also puts the onus on a program actually performing. And I, I’m gonna say something that might be a bit controversial, but, um, you know, like, in the Ministry of Health, a dose public servants that are ministers of health, are they being rewarded for actually creating better health outcomes? Right? Are we, you know, are we aligning health outcomes in health systems with certain payment structures? Because I think if we did, we would see, you know, we would actually see the measurable burdens or the burden that we can do something about, really go down. And because we see health as a public good as it should be, we shy away of using economics like incentive structures, or using finance around, you know, how do we have efficient spending, right? We’re like, oh, no, we can’t do that. Because it’s about health. And I had the same, you know, in 2007, when I started as an intern here in DC at the same idea, like, Oh, my God, you know, economics is bad, and like, you know, each health just, you just need to spend it, you know, you should just spend money to make people know, better. And then I was evaluating, I was put in charge, I was like, you know, wide eyed, young and, and, and eager, in 2007. And I was told to, like, evaluate three programs in three Latin American countries that were supported by high income government, it was a $5 million project to improve maternal and child health. And every six months that changed the indicator, they didn’t know where the money was being spent. It didn’t know which communities were being served. And I’m like, Well, this is ridiculous, right? Like a we’re not doing those who are supposed to be be served a disservice, because we don’t even know who we’re serving, and sending the money is being spent. And if we don’t track it, well, then, you know, what are we spending it for, and money is not going to increase? Or, you know, it’s wasteful, right? So it really did the application of economics and incentives isn’t because we say we want to rush in, it’s more about saying, we want to really optimize our spending, because we care. So I think that’s, that’s something forgotten, sometimes forgotten in this dialogue around economics and aligning, you know, incentives with outcomes, because at the end of the day, we, we benefit, both socially and economically, if we invest in the right things, but we only know if we map if we try if we track it, and we measure it. And we’re going to design programs to that effect.

george grombacher 17:36
I think that that’s really, really well said, it makes perfect sense to me. And so I hope that we’re moving more towards that not being a controversial thing. Because I think it’s really, really, really, really important. And I know that I don’t like, you know, giving something money, and then not having any idea where it’s going, that goes for my taxes, my nonprofit donations, whatever it might be, I want to know that the things I’ve decided to put money towards is actually having the impact that we’re hoping that it happens or has.

Dr. Andrea Fiegl 18:14
Exactly, exactly. And and there was a CEO roundtable hosted by one of the top 10 pharma companies. And we did talking about, they’re talking about the quality of healthcare data, and not my words, in their words, they were saying we are in the 1950s when it comes to health data. And sadly, that is true. So we have so many advances in so many other industries, but we track so little about health and health economics. And this is also where we’re trying to make an impact in something. And the other the other area where I think we’re currently doing ourselves a disservice is an impact investing, and in general, like ESG measurement when it comes to health impact. So the IMF, the International Monetary Fund’s and health is a macro critical issue. And what does it mean? It means that if you don’t invest in your health sector, your entire economy is going to suffer. And vice versa, if you do invest in health, the benefits aren’t just in the health sector benefits are beyond a reasonable beyond the healthcare sector, again, as health economist is not a surprise, but for many people, they really had to experience a pandemic to see this. So there’s this trend of like, you know, most of the new money into in health is going to come from the private sector, if we like it or we don’t like it is just a fact. And if we see the growth of spending in health, and then you know, in the impact, especially the impact investing in health, it’s almost exponential growth curve. But the curve like in the public sector is, at best slightly linear upwards in high income countries, and sometimes even downwards in low income countries. So you want to really look at optimizing the way this money is being invested. We don’t have a standardized way of measuring health impact when it comes to B C’s when it comes to it. pension funds when it comes to pharma companies and all of that, right? So something we’re working on is an idea called the health impact credit, where we’re trying to basically set up a standard and say, What is health impact? You know, how are companies performing against a first, second or third version of an index like that? Can we relate it back to the bottom line? And can we basically create a trading space? So so that we can standardize investments in health? And can we have the McDonald’s and the, you know, whatever oil companies buy health impact credits from the modernise, or to Whole Foods or whatnot. So because they are, we see a real opportunity to align, you know, both the positive and negative externalities of health that’s being created or lost, to actually the bottom line. So So becomes less of an issue of begging governments to do something, but rather a, you know, something that just makes sense from an economic perspective, because we’re actually looking at the real cost or the real benefit of the health that’s being created by companies.

george grombacher 21:14
I love it. That makes all the sense in the world. Well, keep going, Andrea. Because it sounds like it sounds like you’re moving in the right direction. And thank you so much for coming on. Where can people learn more about you and the health finances to how can they get involved? Yeah,

Dr. Andrea Fiegl 21:35
so I was just gonna say we are actually looking for, to Executive Board members, especially, especially women, board members. And so you know, if anyone is listening to this and said, Oh, my God, I want to get involved and make sure that we’re financing chronic diseases appropriately, and reduce suffering and increase economic well being. And I want to be actively involved, you know, do reach out. You’ll find us on our website health finance institute.org, and you’re very active on LinkedIn, as well. And, you know, email is Android help finance institute.org. So I look forward to to hearing from you.

george grombacher 22:18
Excellent. Well, if you enjoyed as much as I did, show, Dr. Andrea your appreciation and share today’s show with a friend who also appreciates good ideas, go to health, finance institute.org and check out the massive problems that she and they are working on solving the opportunity for you to get involved, get in touch. And I’ll link all those in the notes of the show. Thanks again, Andrea. Thank you so much. And until next time, remember, do your part by doing your best

Transcribed by https://otter.ai