health care usa chapter 13
TRANSCRIPT
-
7/24/2019 Health Care USA Chapter 13
1/34
-
7/24/2019 Health Care USA Chapter 13
2/34
Chapter 13
Future of Health Care
-
7/24/2019 Health Care USA Chapter 13
3/34
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
-
7/24/2019 Health Care USA Chapter 13
4/34
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
-
7/24/2019 Health Care USA Chapter 13
5/34
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
-
7/24/2019 Health Care USA Chapter 13
6/34
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
-
7/24/2019 Health Care USA Chapter 13
7/34
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
-
7/24/2019 Health Care USA Chapter 13
8/34
'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
-
7/24/2019 Health Care USA Chapter 13
9/34
'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
-
7/24/2019 Health Care USA Chapter 13
10/34
(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
-
7/24/2019 Health Care USA Chapter 13
11/34
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
-
7/24/2019 Health Care USA Chapter 13
12/34
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$erences from whites in e5g5mortality rates" chronic conditions" servicepreferences" attitudes toward medical care
-
7/24/2019 Health Care USA Chapter 13
13/34
Chan#in# PopulationCo%position "!
6lder population" cont&d %nade#uate supply of culturally
competent providers at all levels in
acute , long*term care for home ,institutional care dicult to recruit ,retain most long*term care facilitiesnow proprietary with uneven #ualitytrack records
System&s chronic care focused on acuteinterventions w@ little attraction to
-
7/24/2019 Health Care USA Chapter 13
14/34
-
7/24/2019 Health Care USA Chapter 13
15/34
Chan#in# Professional /aborSuppl+ 1!
%nstitutional employment practicesdisrupted by hospital size , servicereductions inpatient to outpatient
shifts needs for new classi+cationsof workers 3mployment will grow in home care"
practitioners& oces" nursing ,residential care facilities
Aging workforce will contribute to manyjob openings through retirements
-
7/24/2019 Health Care USA Chapter 13
16/34
Chan#in# Professional /aborSuppl+ "!
A/A will present many challengesw@B?(C newly insured , realignmentfrom volume to value*driven services !-/)/ if empowered" will evaluate and
recommend new approaches toprofessional training , education"
ecient workforce deployment"compensation" coordination amongdi$erent types of providers
-
7/24/2019 Health Care USA Chapter 13
17/34
Chan#in# Professional /aborSuppl+ 3!
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
-
7/24/2019 Health Care USA Chapter 13
18/34
Chan#in# Professional /aborSuppl+ 0!
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
-
7/24/2019 Health Care USA Chapter 13
19/34
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
-
7/24/2019 Health Care USA Chapter 13
20/34
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
-
7/24/2019 Health Care USA Chapter 13
21/34
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
-
7/24/2019 Health Care USA Chapter 13
22/34
Chan#in# Co%position of the'eliver+ S+ste%2 Hospitals
!o longer system
-
7/24/2019 Health Care USA Chapter 13
23/34
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
-
7/24/2019 Health Care USA Chapter 13
24/34
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
-
7/24/2019 Health Care USA Chapter 13
25/34
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
-
7/24/2019 Health Care USA Chapter 13
26/34
he *C* and $ee%er#enceof Public Health2 Closin#
the (ap 1! -istorical
-
7/24/2019 Health Care USA Chapter 13
27/34
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
-
7/24/2019 Health Care USA Chapter 13
28/34
he *C* and $ee%er#ence ofPublic Health2 Closin# the (ap 3!
U! Prevention !ervices "as# Forcerecommendations on no cost preventiveservices for (edicare , (edicaid
Support of programs to decreasedisparities" increase (D and public healthpersonnel in underserved areas
.uture challenges' changing perceptions ,
behaviors of public health , clinicalmedicine practitioners about public health&scentrality
-
7/24/2019 Health Care USA Chapter 13
29/34
-
7/24/2019 Health Care USA Chapter 13
30/34
Solutions &nvisioned b+ the *C*
Alter focus from diagnosis , treatment topreventing illness , maintaining health
3xpand accountability from individual
patients to population groups /hange emphases from individual" episodic
care to continuous" comprehensive care ,chronic disease management
3liminate incentives for more services"substitute incentives for appropriate levelsof care
-
7/24/2019 Health Care USA Chapter 13
31/34
Su%%ar+ of Predictions andFuture Challen#es 3!
Solutions envisioned by the A/A" cont&d /hange from only coordinating service
delivery to actively managing #uality of
process and outcomes Add serious commitment to resolving
community , public health issues
:eforms can make care systems
di$erent" but alone" they can not makethem betterGdepends on providers inconcert with new systems
-
7/24/2019 Health Care USA Chapter 13
32/34
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
-
7/24/2019 Health Care USA Chapter 13
33/34
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
-
7/24/2019 Health Care USA Chapter 13
34/34
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