Health Care USA Chapter 13

7/24/2019 Health Care USA Chapter 13

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Chapter 13

Future of Health Care


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Chapter Objectives

Summarize directions and trends inthe health care delivery systemdiscussed in prior chapters

Present expert data andinterpretations to projections forfuture delivery system changes

Draw some tentative conclusionsabout the future American healthcaresystem


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Introduction

Predictions are highly risky as systemmoves into uncharted territoryTrend extrapolation most reliable under

stable conditions reform scope andcomplexity will produce much instability

!ational changes to cost" #uality" accesshistorically produced many unanticipated"sometimes adverse e$ects

%nstitutions& adaptations may produceunintended conse#uences


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Paradox of U.S. HealthCare 1! Policies of six decades yielded'

(edical advances

)orld*wide scienti+c , clinical acclaim

%nvestments in the !%-" !S. foruniversity basic , applied research

%nvestments in academic health centers"hospitals , technology

(edical" other professional proliferationand specialization


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Paradox of U.S. HealthCare "! Successes contrast with failures to recognize a

social mission beyond meeting individualneeds of those able to access services'

%ne#uitable access" variable #uality" uncontrolledcosts

A/A symbolic of discontent with system that' /annot cover basic services for 012 of citizens

Provides services of doubtful necessity , bene+ts %s fraught with uncontrolled costs" errors" waste


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Continuin# Challen#es Facin#Health Care in the $efor% &ra

Sluggish federal" state economies"rising health care costs cause dropsin insurance State government budget de+cits

a$ecting all services

3mployers discouraged by double*

digit premium increases predictionsthat more may forgo bene+ts underthe A/A" leaving 4 ( workers without

employer coverage


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'e%and for (reater Fiscal )Clinical *ccountabilit+ 1!

Persistent resistance to change amongmajor stakeholder groups deterred system*wide reforms despite overwhelming

evidence" e5g5 %6( report on medical errorsand failures to meet 7 year targets

.ailures are system leaderships&" notindividual practitioners

-opeful signs' Purchasers 8employers , government9 more

cost" #uality conscious


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'e%and for (reater Fiscal )Clinical *ccountabilit+ "!

-opeful signs" cont&d' A-:;&s Morbidity and Mortality Rounds on the

Web stimulates anonymous provider input and

discussion of errors D--S -ospital ;uality %nformation %nitiative

provides public access to hospital #uality ofcare data

/(S reimbursement incentives , disincentiveson hospital medical error rates


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(ro,th of Ho%e- Outpatient )*%bulator+ Care

3mphasis on community*based care"aging demographics will result incontinued home care growth since

>???" agencies increased by 0"??? to0>"??? in >?0?5

6utpatient medical , surgical

procedures will continue growthfueled by technology advances" highprovider and consumer satisfaction


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echnolo#+

(:%s' coercive power of glamorous"expensive technology over cost*bene+tsextensive research demonstrates no patient

bene+ts in therapeutic choices or outcomes Technology&s mixed blessings' imposes

barriers between consumers ,practitioners technology investments

contribute nothing to solutions for accessbarriers" health disparities" other majorhealth determinants


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Chan#in# PopulationCo%position 1!

6lder population size , diversityincreasing , surviving to very old age %ntact families to care for older adults

decreases with divorce" single*parenthood"adult child out*migration

/hanging racial , ethnic compositionw@minority groups" esp5 -ispanics a growing

proportion di$erences from whites in e5g5mortality rates" chronic conditions" servicepreferences" attitudes toward medical care


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Chan#in# PopulationCo%position "!

6lder population" cont&d %nade#uate supply of culturally

competent providers at all levels in

acute , long*term care for home ,institutional care dicult to recruit ,retain most long*term care facilitiesnow proprietary with uneven #ualitytrack records

System&s chronic care focused on acuteinterventions w@ little attraction to


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Chan#in# Professional /aborSuppl+ 1!

%nstitutional employment practicesdisrupted by hospital size , servicereductions inpatient to outpatient

shifts needs for new classi+cationsof workers 3mployment will grow in home care"

practitioners& oces" nursing ,residential care facilities

Aging workforce will contribute to manyjob openings through retirements


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Chan#in# Professional /aborSuppl+ "!

A/A will present many challengesw@B?(C newly insured , realignmentfrom volume to value*driven services !-/)/ if empowered" will evaluate and

recommend new approaches toprofessional training , education"

ecient workforce deployment"compensation" coordination amongdi$erent types of providers


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Physician Supply , Distribution and 6therPrimary /are Practitioners

(anaged care principles made primary (D

roles paramount" increased demand forservices shortage gaps +lled w@!Ps and PAs

>?00" >?0> studies predict >?2 shortages ofadvanced practice nurses , PAs and shortage

of 7>"??? primary (Ds by >?>7" respectivelyA/A incentives viewed as inade#uate toattract needed numbers of primary careproviders


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Physician Supply , Distribution and6ther Primary /are Practitioners"cont&d Predicted shortages suggest future

policy changes to expand non*physicianscopes of practice

.uture e$orts needed on wide variationsin distribution of physicians bygeographic location" in addition tosupply rural , inner*city areas will be

special focus


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Chan#in# Professional /aborSuppl+ !

Physician Supply , Distribution and 6therPrimary /are Practitioners' !ew Physicianroles

-ospitalists will continue to proliferatethroughout the system

Physicians entering roles in management andadministration in pharmaceutical companies"

managed care organizations" hospitals , largegroup practices A/6 management is anotheroption frustrated by private practice" healthcare administration is attractive option


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Chan#in# Professional /aborSuppl+2 urses

At B million" largest component ofhealth professions , best positionedfor reformed system&s roles

!urse training in behavioral ,preventive realms" coordinating carewith multiple disciplines and lesser*

trained colleagues aligns well withgoals of reformed system


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Future of &%plo+er4SponsoredHealth Insurance

.or 7 decades" employer*sponsored healthinsurance protected workers

%ndustry&s predominant role in A/A

parameters rearmed inuential policyrole

Ender A/A" may opt to drop healthcoverage and endure penalties

Signi+cant" uncertain speculations onemployer decisions as market changes ,reform proceeds


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Chan#in# Co%position of the'eliver+ S+ste%2 Hospitals

!o longer system


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Chan#in# Co%position of the 'eliver+S+ste%2 Outpatient facilities

Privately*owned ambulatory surgerycenters" urgent , immediate care facilities"diagnostic facilities" specialty hospitals will

continue growth trajectory fueled byentrepreneurial opportunities" technologyadvances" provider" consumer" payerpreferences , demands

Frowth will displace numerous services andrevenue of traditional acute*care hospitals


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Health Infor%ationechnolo#+ 1! %deal future' providers , health plans

will replace voluminous" disorganizedmedical records with standardized"

reliable" clinically relevantelectronically delivered information !ew 3-:S will minimize transcription ,

misinterpretation errors , interoperablesystems will allow easy informationtransfer among care providers" reducecosts , improve #uality


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Health Infor%ationechnolo#+ "! 6bstacles , Solutions

/omplex con+dentiality" compatibility"transferability" organization cultural issues

and complexities of patients service receiptat multiple sites

Academic medical researchers , developerswith private -%T corporations will combine

resources to build workable infrastructures tocreate a new era in -%T" a giant step forwardin advancing safety" ecacy" eciency ofmedical care

he *C* and $ee%er#ence


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he *C* and $ee%er#enceof Public Health2 Closin#

the (ap 1! -istorical


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he *C* and $ee%er#enceof Public Health2 Closin#

the (ap "! A/A&s Prevention and Public Health Fund" the+rst mandatory funding stream for publichealth to eliminate unpredictable federalbudget allocations for public health andprevention programs at local" state" federallevels

National Prevention, Health Promotion and

Public Health Council to build on existingprograms" e5g5 Healthy People 2020, andrecommend federal policy changes to thePresident , /ongress


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he *C* and $ee%er#ence ofPublic Health2 Closin# the (ap 3!

U! Prevention !ervices "as# Forcerecommendations on no cost preventiveservices for (edicare , (edicaid

Support of programs to decreasedisparities" increase (D and public healthpersonnel in underserved areas

.uture challenges' changing perceptions ,

behaviors of public health , clinicalmedicine practitioners about public health&scentrality


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Solutions &nvisioned b+ the *C*

Alter focus from diagnosis , treatment topreventing illness , maintaining health

3xpand accountability from individual

patients to population groups /hange emphases from individual" episodic

care to continuous" comprehensive care ,chronic disease management

3liminate incentives for more services"substitute incentives for appropriate levelsof care


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Su%%ar+ of Predictions andFuture Challen#es 3!

Solutions envisioned by the A/A" cont&d /hange from only coordinating service

delivery to actively managing #uality of

process and outcomes Add serious commitment to resolving

community , public health issues

:eforms can make care systems

di$erent" but alone" they can not makethem betterGdepends on providers inconcert with new systems


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Su%%ar+ of Predictions andFuture Challen#es 0!

-ealth care providers' hopefully freed frompurely fee*for*service medicine" will becompensated for wellness@prevention time ande$orts to become as e$ective promotingpopulation health as for individual patients

Tax*exempt health care organizations will bere#uired to


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Su%%ar+ of Predictions andFuture Challen#es !

Hong*term care organizations and serviceswill encounter enormous stang and costchallenges

Pressures on government , employers willincrease to provide relief for familycaregivers of frail elderly

Amid system reform turmoil" health

sciences will continue advancing with newclinical treatments" genomics" vaccines"etc5" accompanied by new ethical"professional" cost and educational ,trainin challen es


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5an+ Future Challen#es

-ow will recipients of new technology8transplants" etc59 be chosenI

)ho will address ethical concerns aboutgenetically altering humans and genetictestingI

)hen@how will stricter competence standardsbe enacted for medical professionalsI

)hen will government rein in unlimited pro+tsof medical , drug suppliers that price theirproducts beyond the means of those who needthem mostI

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Health Care USA Chapter 13