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Health Care USA
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The Future of Health Care
Chapter 12 The Future of Health Care Health Care USA
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CHAPTER OBJECTIVES Summarize forecasts and draw conclusions about the future of U.S. health care Identify impacts of technologic advances, managed care and forthcoming health care reform initiatives Health Care USA
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Chaos Theory Reforms are complex, chaotic, disabling to highly entrenched system “Small change in input translates into large change in output.” Health care very sensitive to input changes; addressing any one element of costs, quality or access causes disruptive changes in another Health Care USA
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Paradox of U.S. Health Care
Successes tempered by failures to recognize the broader policy mission of ensuring access Basic needs of 47+million unmet Cannot control costs Medical errors persist Costly services with doubtful benefit or harm Health Care USA
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Major Challenges Facing Health Care (1)
Growing Number of Uninsured Declines in employer-sponsored insurance due to sluggish economy, rising premiums Rising premiums, employee share Health Care USA
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Major Challenges Facing Health Care (2)
Demand for greater clinical & fiscal accountability Resistance to decades of calls for reforms Widespread public exposure prompting changes: AHRQ peer-reviewed, web-based journal on medical errors; HHS Hospital Quality Information Initiative to provide public information on hospital performance Health Care USA
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Major Challenges Facing Health Care (3)
Demand for greater clinical & fiscal accountability Institute for Healthcare Improvement “100,000 Lives Campaign” Clinical practice guidelines Evidence-based medicine Health Care USA
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Major Changes Facing Healthcare (4)
Health Care Costs Managed care unable to stem rising costs New, costly drugs and treatments continue to increase Aging and chronically ill patients find costs beyond their means Better informed consumers question economic effects of health care decisions Health Care USA
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Major Changes Facing Healthcare (5)
Health Care Costs Health system reforms may lessen expenses of insurers’ paperwork and bureaucracy, but without a single payer system, insurance costs will continue to add major expense to the system Health Care USA
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Major Challenges Facing Health Care (6)
Technological Growth & Innovation Growth of Home, Outpatient, Ambulatory Care Increased demands and benefits Technology Often, questionable patient benefit, high cost Resources diverted from prevention Loss of “high-touch” dimensions of health care Health Care USA
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Major Challenges Facing Health Care (7)
Changing Population Composition Increased proportion of older population Increased longevity Social changes impacting family care-giving Special health & cultural needs of ethnic minorities Health workforce mind-shift to chronic care, geriatric model Health Care USA
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Major Challenges Facing Health Care (8)
Changing Professional Labor Supply Much experimentation in deploying new types of positions as system changes Physicians: undersupply is likely with shift to need for more specialists; mal-distribution continues; more MD managers & hospitalists Nurses: best poised by training to respond to system changes; needs for many reforms to recognize and reward pivotal roles Health Care USA
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Major Challenges Facing Health Care (9)
Changing Professional Labor Supply Nurse Practitioners & Physician Assistants Increasing demand to extend MD services; high patient acceptance, effectiveness & efficiency Implementing new practice guidelines & computer-assisted treatment protocols to enhance service extensions Health Care USA
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Future of America’s Health Insurance Systems
Employer-sponsored health insurance will remain predominant Commercial insurers will remain profitable, absent a “single-payer” system or public option Physician resistance to managed care mandates will maintain pressures for reform Health Care USA
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Changing Composition of the Delivery System
Hospitals no longer medical care system hubs Former service array replaced with variety of outpatient diagnostic, treatment and surgical services In the future: full service for serious, acute conditions, high-level intensive care, services for uninsured Components of health care networks meeting regional needs rather than individual, competing entities Health Care USA
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Information Management
Information technology will replace disorganized medical records and information with standard, reliable, timely, accessible clinical information; government provides financial incentives Challenges: Patient services from multiple providers Confidentiality safeguards Provider resistance to change Record conversion costs Health Care USA
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Government’s New Role in Public Health (1)
2001 terrorist attacks highlighted importance of public health’s role Model State Emergency Health Powers Act Federal funding for crisis preparedness education and public information dissemination Identified needs for restructuring local & regional resources, procedures, staffing & communications systems Health Care USA
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Government’s New Role in Public Health (2)
Future public health revitalization includes: A reformed system that includes serving traditional public health needs along with new demands for protections against bio-terrorism and other disasters Health Care USA
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Conclusion (1) Societal & economic changes of the 1990s changed public perceptions of health care & prepared Americans for health system reforms Progressive & conservative factions recognized the needs for reform & changes Pressures on providers to document outcomes & effectiveness increased from payers and consumers Health Care USA
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Conclusion (2) 47 million uninsured highlighted U.S. system deficiencies compared with other developed countries which provide health care as a “right” Many idealized solutions to variations in costs, treatment, outcomes, fragmented services and episodic treatment emerged Health Care USA
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Conclusion (3) Health reform idealized solutions:
Shift focus from diagnosing & treating illness to maintaining wellness & preventing illness Expand system accountability from individuals to populations Change emphasis from acute, episodic care to continuous comprehensive care & chronic disease management…continued Health Care USA
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Conclusion (4) Health reform idealized solutions:
Eliminate financial incentives to provide more services & fill hospital beds; substitute incentives for appropriate care at appropriate levels Assume universal access to health care Health Care USA
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Conclusion (5) Health reform idealized solutions:
Change from coordinating services to actively managing the quality of processes and outcomes Commit to resolve community & public health issues Health Care USA
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Future Role of State Governments
Current trends suggest that states will play major roles in reforms, regardless of federal reforms: Maine, Massachusetts and Vermont are acquiring significant experience with forms of “universal coverage” Health Care USA
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Public Information will Replace Secrecy
In the future, more health care organizations will be required to disclose “report cards” on performance More disclosure of performance information will assist the public and purchasers of health insurance in choosing among competing providers Health Care USA
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Challenges to Hospitals’ Tax-exempt Status
New IRS requirements for hospitals to itemize value of charitable care Risk withdrawal of tax-exempt status for non-compliance Health Care USA
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Aging Population & Chronic Care Needs
Current system has few provisions for assistive, medical and social chronic care needs Need for expanded insurance coverage of at home needs Recognition of supportive providers’ needs to care for aged & chronically ill Health Care USA
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Medical Care Advances Create Future Challenges
New technology will require Capital investments Additional professional training Provider adaptations to numerous information and system changes Examination of ethical issues in technology applications Health Care USA
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Patient Protection and Affordable Care Act of 2010
An historic, pragmatic approach to closing gaps in insurance coverage with a mix of employer, private and public plans. Strengthens Medicare & expands Medicaid Results await “rule writing” for implementation by all involved agencies Ideal results are fiscal, quality and access accountability for all health care system entities Health Care USA
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