Health Care USA 1 Chapter 12 The Future

Health Care USA 1

Chapter 12 The Future of Health Care USA 2

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 3

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 4

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 5

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 6

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 7

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 8

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 9

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 10

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 11

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 12

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 13

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 14

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 15

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 16

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 17

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 18

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 19

Conclusion (1) • Societal & economic changes of the 1990 s 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 20

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 21

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 22

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 23

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 24

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 25

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 26

Challenges to Hospitals’ Tax-exempt Status • New IRS requirements for hospitals to itemize value of charitable care – Risk withdrawal of tax-exempt status for noncompliance Health Care USA 27

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 28

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 29

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 30