• To identify the major forces of future change and how they will affect health care delivery
• To assess the future of the Affordable Care Act and health care reform in the United States
• To discuss the components necessary to build a delivery infrastructure for the future
• To understand the special skills needed by future nurses, physicians, and other health care workers
Learning Objectives
• To evaluate the future of long-term care • To appreciate the role of international
cooperation in dealing with global threats
• To obtain an overview of new frontiers in clinical technology
• To survey the future of evidence-based health care based on comparative effectiveness research and patient-oriented outcomes research
Introduction
• Future direction of health care is governed by: – Current developments (e.g., the ACA has already
triggered changes, but its full effects will not be known for some time to come)
– Forces external to health care delivery (e.g., demographic change, the economy, family incomes,
etc.)
– Historical precedents (e.g., private infrastructure and societal values, state-based health reform, etc.)
Eight Forces of Future Change
• Social and demographic • Economic • Political • Technological • Informational • Ecological • Global • Anthro-cultural
Implications of External Forces
• The nature of change in health care depends on complex interactions between these forces and the way opportunities are garnered or foregone.
• Implications for cost (affordability), access, and power balancing.
• Free market forces do not drive US health care–the government has been a major player that wields legal and regulatory powers. Yet, the government needs the power sector. Tension and power balancing between the two sectors will continue.
• Delivery of health care is closely tied to the nation’s economic health.
Social and Demographic Forces
• The United States is becoming bigger, older, and ethnically diverse
• Effects on the need for health care and how the needs will be met
• The nation’s ability to afford health care; growing populations of the elderly, disabled, and Medicaid beneficiaries: – Expanding government programs are on an
unsustainable financial path – Implications for supply of health professionals
• Cultural factors will create ongoing challenges • Uninsured illegal immigrants tap into resources • Personal lifestyle choices cannot be fully incentivized
Economic Forces
• National debt–spending cuts, tax increases, and economic growth will be needed • Economic growth–growth has been slow; growing
dependency on government handouts does not bode well • Employment and household income–incomes have
fallen • National health expenditures are expected to consume
almost 20% of GDP in 2022 • A golden prospect–The United States is now the world’s
largest energy producer–but, much will depend on future energy policy
The ACA and the Economy
• Effect on employment and income is uncertain
• Some evidence that employers are delaying or cutting hiring, and reducing worker hours to skirt the law’s mandate
• Part-time workers could get government subsidies to buy health insurance through the exchanges
• However, the affordability of exchange-based plans is unclear
Political Forces
• Education and immigration policies, the number and qualifications of health care workforce
• Americans remain divided on major policy issues, including health care
• Politics also has an effect on the economy and taxes
• So far, raising the debt ceiling rather than reducing spending has occupied US politicians
Technological Forces
• Technology will continue to revolutionize health care, but cost increases will create challenges
• Technologies that increase self-reliance and cost efficiency will receive much attention
• Utilization control measures could also receive attention
Informational Forces
• Garnering IT’s potential for health care delivery and management of health care organizations will continue well into the future
Ecological Forces
• Major implications for public health – New diseases – Natural disasters – Bioterrorism
• World population growth will intensify human-animal-ecosystems interface engendering new diseases
• Technology will find new applications in public health and safety
• Dealing with public health threats also divert resources from routine health care
Global Forces
• Globalization intensifies cross-national cultural, economic, political, social, and technological interactions – Health and health care will be affected in diverse ways through multiple pathways
• Example: cross cultural factors affect the effectiveness of professionals that are part of “brain drains” or “brain gains”
• Some signs of increasing globalization – Drugs manufactured in Asia are exported to Western
nations – Medical tourism – Cross-border telemedicine – Desire of foreign hospitals and clinics to move into the
United States
Anthro-Cultural Factors
• Beliefs, values, ethos, and traditions espoused primarily by the middle class
• Historically, these have acted as a strong deterrent to radical changes in health care
• Disapproval of the ACA has increased among Americans
• The American public could end up deciding the ACA’s final fate
The Future of Health Reform
• Will the United States have a single-payer system in the future?
• Much will depend on the ACA’s successes and failures and how the forces discussed earlier play out in the future
Lessons from Massachusetts
• With some caution, lessons can be drawn about the ACA
• The Massachusetts plan has achieved some successes, but cost remains the main issue
– Remarkable increase in insurance coverage – 62% have employer-based coverage – In the Connector (exchange), premium increases
surpass inflation; the state had to set limits on the rise in premiums
Lessons from Massachusetts
• The Massachusetts plan has achieved some successes, but cost remains the main issue
– Some mixed results on ability to meet health care needs
– Emergency department use has continued to rise – Over 50% of the public is satisfied with care,
except for cost and waiting times