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More chronic illnesses, more old
age impairments, consumers demanding more quality and convenience, physicians
no longer in typical private practice, and high deductible health care polices
are each about to cause major changes in the practice of medicine and how it is
delivered to patients.
Health care delivery will
change substantially in the coming years. This is not because of reform but
rather due to a set of drivers that are exerting a great push and pull to the delivery
system. Some of these changes will be quite transformational and some will be
very disruptive of the status quo. What are those drivers?
One of the most important is
that there will be many more individuals with chronic illness. The Milliken
Institute offered a white
paper a few years ago on chronic illnesses and noted that nearly one half of Americans had one or more
chronic illnesses, most of them preventable and
which were costing the economy over $1 trillion per year and rapidly
rising.
These are diseases like diabetes
with complications, heart failure, cancer, or chronic lung disease. What is
apparent is that they are mostly due to adverse lifestyles. Eating a non-nutritious
diet -- and too much of it combined with a sedentary existence leads to
obesity. One third of Americans are overweight and another one third are
frankly obese. Add to this chronic stress and that 20% still smoke and there is
an effective recipe to produce chronic illnesses. Chronic illnesses will make
up a greater and greater proportion of all medical ailments as time goes on.
And of course they are more difficult to manage, generally last a lifetime and
are inherently expensive to treat (although there is much that can be done to
reduce the costs of care.)
A second driver of change is
the aging of the population. The American society is growing older and just
like a car: “Old parts wear out.” Aging
brings on impaired vision, impaired hearing, impaired mobility, impaired bone
strength and impaired cognition among others - all as best we know today, not due
to adverse lifestyles but are tied into the aging process.
Consumerism is becoming –
finally – more and more of a driver of change. Patients are coming to expect to be treated like a valued
customer - “the patient is no longer willing to be patient any more.” What do
the patients want? They want service, good service. They are expecting high levels
of quality & safety. Most important of all is respect, respect for their
person, confidentiality, and the care quality. But also patients want convenience
& responsiveness. They want appointments in short order, no long times in
the “waiting room,” nor put on indefinite telephone hold. They want interaction
by email and other electronic methods. And patients increasingly expect to have the
information gap closed– they expect the playing field between patient and
doctor to be much more level in the future.
Professional shortages are major
drivers of change in the delivery system. There have been shortages of nurse
and pharmacists noted for more than a decade. There is a growing shortage of primary
care physicians (PCPs) and also general surgeons. These shortages are more
acute in rural and urban poor areas.
Combined with shortages are
changes in professional aspirations and lifestyles. Today physicians want and
expect to have more time for family and recreation. And they no longer want to
run their own private practices. They prefer to be employed with little if any
administrative burdens. Indeed the number of PCPs in a typical private practice
arrangement has declined precipitously in recent years.
These are but a few of the
drivers that will change the delivery of health care in dramatic ways in the
years ahead. I discuss them in much more detail in The Future of Health Care Delivery – Why It Must Change and How It Will
Affect You with data obtained through over 150 in-depth interviews of
medical leaders from across the country.
Clearly physicians, patients, hospitals, insurers and employer/government
sponsors will be challenged to adapt.
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