Factors Influencing the Future of Healthcare:

by Joe Flower

Growth and juvenilization of the world population
  • Greater instability in less-developed nations
  • Greater immigration pressures, and increased levels of fear (vs. optimism) in the populations of developed countries
  • World population expected to nearly double once more within the next generation before leveling off near 10 billion
  • Continued rapid increase in international travel, trade, mega-urbanization, small-scale warfare, displaced populations
  • Environmental devastation across borders and regions, and globally
  • Rapid spread of "new" infectious diseases
  • Examples:
  • AIDS
  • Turning the pampas into fields of maize resulted in a rapid rise in the population of field mouse that is host for the Junin virus, which gave rise to Argentine hemorrhagic fever
  • The Hanta virus showed up in areas in which humans had migrated into an area occupied by a virus-carrying mouse
  • Aging U.S. population
  • Growing burden on healthcare
  • Relatively smaller working population to support it
  • Boomers progress into middle age and toward retirement
  • Their parents move toward frail elderly stage, end-stage illness, and death
  • Chaotic change in family structure
  • Social fragmentation
  • Increase in women and children in poverty
  • Fragmentation of U.S. population by ethnic group, class, language and culture
  • Increase in fear
  • Rise of radical social movements of fragmentation and blame
  • Decrease in wide civic awareness and responsibility
  • Shifting economy
  • Spread of "McJobs"
  • Decrease in health coverage (job-based in U.S.) and in stability of provider relationships
  • Continuing concern about cost and access The percentage of the economy dedicated to healthcare will likely be forced down, whether by a rational plan or chaotically Reasons:
  • Historically high levels of cost
  • Growing class gaps
  • Growing instability of present structure, as people lose jobs and health insurance
  • Unwillingness by business, Washington, or states to continue to fund limitless growth
  • Decline in the effectiveness of antibiotics (multi-drug-resistant pathogens) Huge need for research into substitutes, vaccines, other public health measures - at a time when funding can be expected to become scarcer
    Proliferation in clinically useful knowledge
  • Doctors and other medical professionals increasingly depend on medical review writers and other experts, who are often several years behind in recommending changes in practice
  • Explosion and integration of "expert systems" and other silicon "doc extenders"
  • Clinically useful knowledge is estimated to have doubled twice since 1986
    Shift in public awareness of the true vectors of health and disease Increased public awareness of the behavioral vectors of much of helath and disease
    Turbulence within the industry, dissatisfaction within the medical profession
  • Rapid reduction in inpatient acute care
  • Rapid consolidation and integration
  • Drop in doctor's income especially specialists
  • Rapid spread of capitated models
  • Movement of power from doctors and providers to insurance entities
  • failure of nationwide reform
  • Data points
  • Patient bed days per thousand drop from nationwide peak of 1130 in early 1980s to less than 200 in some jurisdictions now, expected to bottom out at that level nationwide
  • Hospitals operating by 2000 expected to be about one third of those operating in 1980
  • AMA survey shows that 92 percent of MDs under 40 would not choose the profession again.

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