The Future of Health Services Delivery

Learning Objectives

• 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


• 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,


– 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

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