1. Chapter 12 - Health Care Trends and Forecasts McGraw-Hill © 2010 by The McGraw-Hill Companies, Inc. All rights reserved 12-1

2. Learning Outcomes Identify the major stakeholders in the United States health care system. Describe the major areas of concern to those stakeholders. Explain the effect the baby boomer generation will have on the U.S. health care system in the future. Identify the major improvements in quality of care. Describe the major new trends that will affect health care in the U.S. in the next twenty years. 12-2 McGraw-Hill © 2010 by The McGraw-Hill Companies, Inc. All rights reserved

3. The public Employers Health care facilities Federal, state, and local governments Managed care organizations Private insurers Voluntary facilities and agencies that provide health care Health care training institutions Professional associations Health care researchers McGraw-Hill © 2010 by The McGraw-Hill Companies, Inc. All rights reserved 12-3

4. Cost Amount individuals, employers, governments, insurers, and other stakeholders spend on health care. Access The availability of care and the means to purchase the care. Quality The degree of excellence of health care services offered. McGraw-Hill © 2010 by The McGraw-Hill Companies, Inc. All rights reserved 12-4

5. Technology A wide variety of new computer-aided diagnostic and therapeutic tools, advanced surgical techniques, and equipment, as well as new prescription medications. Growth in the Population of Older Adults With all the new technology, people are living longer. Baby boomersthose born between 1946 and 1964- make up a third of the U.S. population. Emphasis on Specialty Medicine More specialists paid at higher rates than primary care physicians. McGraw-Hill © 2010 by The McGraw-Hill Companies, Inc. All rights reserved 12-5

6. Increasing Numbers of Underinsured and Uninsured Those without insurance (or good insurance) use the emergency room as their primary source of care. Emergency room care is more expensive. Labor Intensity of Health care Services Health care is the largest industry in the U.S. Reimbursement System Incentives Continuing evolving system as individual stakeholders argue for more reimbursement. McGraw-Hill © 2010 by The McGraw-Hill Companies, Inc. All rights reserved 12-6

7. Health care in the United States is not a legal right. Attempts to improve access get caught up in the debate over who will pay for health care for all. McGraw-Hill © 2010 by The McGraw-Hill Companies, Inc. All rights reserved 12-7

8. Agency for Health care Research and Quality (AHRQ) is the lead federal agency responsible for tracking and improving quality The Annual AHRQ Quality Report (2006) High quality health care is not universal. Opportunities for preventive care are frequently missed. Management of chronic diseases presents unique quality challenges. There is more to learn. McGraw-Hill © 2010 by The McGraw-Hill Companies, Inc. All rights reserved 12-8

9. In addition to the issues of cost, access, and quality, other issues are arising. They include: Security of benefits. Monitoring and organizing increasing numbers of managed care organizations, insurers, intermediaries, and providers. Including consumers in health care decision making. Determining responsibility for medical management. Improving health behaviors of the American people. Source: Health and Health Care 2010: The Forecast, The Challenge, Institute for the Future, Jossey-Bass, 2003 McGraw-Hill © 2010 by The McGraw-Hill Companies, Inc. All rights reserved 12-9

10. Rational drug design Advancement in imaging techniques Highly developed minimally invasive surgery Genetic mapping and testing Gene therapy New and improved vaccines Artificial blood Xenotransplantation Use of stem cells Source: Health & Health Care 2010: The Forecast, The Challenge Institute for the Future Jossey-Bass, 2003 12-10 McGraw-Hill © 2010 by The McGraw-Hill Companies, Inc. All rights reserved

11. The health care industry has lagged behind in adopting technology for record keeping. Advances in the next decade will focus on Computer hardware Data storage Wireless technology Networking bandwidths and data compression Data storage retrieval Security and encryption Internet 3-D computing Database software Sensors McGraw-Hill © 2010 by The McGraw-Hill Companies, Inc. All rights reserved 12-11

12. Reforming the system is a difficult problem. Each and every stakeholder will resist change and point to the other stakeholders as needing to change. How would you change the system? How would you pay for the changes? McGraw-Hill © 2010 by The McGraw-Hill Companies, Inc. All rights reserved 12-12

13. Would you deny care to people who make no effort to change their lifestyles? For example, smokers, care at higher risk for not only lung cancer, but a variety of other diseases. Should smokers get less healthcare? Should obese people, whose obesity is caused by overeating be denied care? McGraw-Hill © 2010 by The McGraw-Hill Companies, Inc. All rights reserved 12-13