Changes in us healthcare system

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Currently it is estimated that 42 million people, or 16 percent of the population, is without any form of health care insurance. The Institute for the Future projected that the number of uninsured will reach 48 billion by While this statistic usually rises during times of recession and decreases in times of expansion, the number of uninsured has increased even during the expansion of the late s and early s. The Institute for the Future also reported that the number of non-elderly persons covered by employment related health insurance dropped from In Michigan, for example, the Access to Health Care Coalition reported that between and the percent of residents without health insurance decreased from However, given the relationship between the economy and the availability of health insurance, this decrease appears temporary.

An increase is expected in the number of uninsured, especially in light of the economic downturn of Of the uninsured in Michigan, an estimated , are children—despite programs aimed at improving children's health like Healthy Kids and MIChild. While not all eligible children have been enrolled in these programs, a considerable number are not eligible based on family income exceeding a percentage of the Federal Poverty Level FPL.

Mirroring national trends, Michigan is struggling with rising unemployment, a budget deficit, and growing demands for health services and insurance coverage. Often the underinsured and uninsured use the emergency room, the most expensive form of health care service, for any illness. Weiss and Lonnquist reported that uninsured emergency room care visits totaled 93 million in In approximately half of the cases, urgent care was not needed, nor did the individuals seeking care have a regular physician or other option for gaining access to health care services.

The Institute for the Future in Health and Health Care described three tiers of coverage in today's evolving health care system and projected how individuals and families may experience this changing system based on which tier of health coverage describes their particular situation Their observations are summarized below:. Tier 1: The securely enfranchised. The first group represents 38 percent of the population.

It consists of empowered consumers with considerable discretionary income, who are well educated and use technology, including the Internet,, to get information about their health.

Usually they are able to make choices in their plans and coverages. They are able to educate themselves about health behaviors as well as health care issues and concerns. They are likely to engage in shared decision making with physicians and other allied health professionals.

Tier 2: The insecurely enfranchised. Their primary concern is benefit security and the issue of value as plans become more restrictive. People included in this group include those with unstable job security, both employers and employees, and also early retirees who are waiting for Medicare to begin.

Though they have limited access to information, they are likely to focus on learning more about plans and coverages. They are also likely to become more empowered due to some of the voluntary associations to which they belong who focus on problems in the health care system. Tier 3: The disenfranchised. The third group represents 28 percent of the population whose main concern is access to health care. It includes people under 65 who are uninsured as well as children who have no coverage or are covered by Medicaid.

Access to care for this tier is severely limited because the safety net has frayed. People in this tier depend on the limited resources and strained generosity of safety net funding streams and providers. While some are covered by Medicaid, this plan offers only limited choices and benefits depend on funding which often competes with prisons and schools. Generally poor and lacking education, most people in this tier have serious trouble overcoming the information gap between patients and providers.

They may be largely ineffective in changing legislation or the structure of health care. If the problem of access is to be solved, it will need to be driven from the top two tiers. Trust however is another issue. Mechanic's elements of trust cited in Dranove, are as follows: Patients trust that providers will act unselfishly, putting the patients' interest above their own Patients trust that providers have the technical competence necessary for proper diagnosis and treatment, and Patients trust that providers can control and coordinate the resources necessary to deliver quality care.

Survey results indicated that only 30 percent of patients in managed care plans trusted that their plan would do the right thing for their care, while 55 percent in traditional plans trusted their plans. Also, fewer than 30 percent of patients trusted their HMOs to control costs without adversely affecting quality of care Dranove, Managed care has a long way to go in persuading the public that managed care is actually care management, although they frequently advertise high quality at a reasonable cost.

All of this information may be overwhelming, although it represents only a brief overview of the issues and concerns related to our evolving health care system. Nevertheless, there are several practical steps that we can take both individually and collectively: Practicing more health promotion behaviors and using preventive services; Preparing to bear a higher burden of health insurance cost if one has coverage or preparing to bear a higher burden of actual "out-of-pocket" health care costs; Being ready to provide more home care services to assist friends and family members whose surgical procedures will involve limited hospitalization; Anticipating further limitations in selecting one's own primary care provider; Knowing your own plan and any intended changes; Developing assertiveness skills in dealing with your own insurers, providers, and case managers; Keeping abreast of broader issues and concerns, such as how the entire system bears the cost of the underinsured and, especially, the uninsured; Advocating for policy changes at the legislative level, especially for those without access to even basic health care services.

While trends can be traced and often predicted, there are a significant number of "wild cards" in the future that make the evolution of the American health care system uncertain and volatile. Some of these, according to the Institute for the Future , include Demographic trends and increasing numbers of elderly people in the population; Reimbursement rates for home health care services; new cost containment and cost-shifting strategies; Increasing technology; Economic recessions or expansions; legal and mandatory restrictions on managed care plans; Malpractice insurance, settlements, and jury awards; universal health insurance legislation; and Switching from a private and public insurance model to a national health insurance system.

One solution is to learn from other health care delivery models. Perhaps we could benefit both by learning more about other systems especially from countries with high levels of access , and also by beginning to advocate for needed changes in the American health care system.

Indeed, the greatest changes may come about as consumers make their concerns known to providers and to state and federal policy makers. It would also make strategic and tactical sense for providers to partner with consumers and policy makers to bring about needed changes.

Given our current reality, the focus of change will need to address both access and affordability. Access to Health Care Coalition Closing the gap: Improving access to health care in Michigan. Blue Cross Blue Shield of Michigan. American Hospital Association Hospital statistics: A comprehensive summary of U. Chicago, IL: Author. Bodenheimer, T. Understanding health policy: A clinical approach 2nd ed. Dranove, D.

The evolution of American health care. Employer-Sponsored Health Benefits Institute for the Future Health and health care The forecast, the challenge. National Survey of Health Insurance. New York: Commonwealth Fund. Levit, K.

National health spending trends in Health Affairs, 17, Weiss, G. The sociology of health, healing, and illness 3rd ed. Skip to main content Skip to quick search Skip to global navigation. Michigan Family Review. Quick search:. Editors Submissions Call for Papers. Home About Search Browse. Conklin [1]. Volume 07 , Issue 1 , Fall , pp. Abstract Today's health care system is complex and very different from "what it used to be. What Factors Are Driving the Change? The following table from a publication by the American Hospital Association illustrates the fluctuation over four decades in the availability of hospitals, beds, and admissions: American Hospital Trends: — Year Hospitals Beds Admissions 6, 1.

Their observations are summarized below: Tier 1: The securely enfranchised. Top of page. For the most prevalent mental health disorders such as depression and anxiety, receipt of appropriate care is associated with improved functional outcomes at 2 years Sturm et al.

Access to care is constrained by limitations on insurance coverage that are greater than those imposed for other diseases. Annual and lifetime coverage limits are frequently less, and mental health coverage often has more hidden costs in the forms of copayments and higher deductibles Zuvekas et al. Table 5—2 shows the distribution of sources of payment for treatment for mental health and addictive disorders in Additionally, those with no insurance all year paid nearly 60 percent of costs out-of-pocket, whereas those with some private insurance paid 40 percent of costs out-of-pocket in Zuvekas, Adults' use of mental health services in both the general and the specialty mental health sectors correlates highly with health insurance coverage Cooper-Patrick et al.

Recent studies have shown impressive results for treatment of depression in primary care settings Sturm and Wells, ; Schoenbaum et al.

The provision of such services is cost-effective and comparable to the cost-effectiveness of other common procedures. However, reimbursement policies for primary care do not support the services necessary to provide evidence-based care for depression Wells et al. Adults with either no insurance coverage or coverage that excludes or limits extended treatment of mental illness receive less appropriate care and may experience delays in receiving services until they gain public insurance Rabinowitz et al.

Adults with mental disorders are also more likely to lose health insurance coverage within a year following their diagnosis than those without a mental disorder Sturm and Wells, The limited and unstable nature of insurance for treatment of mental illness has several implications for governmental public health agencies because the severely mentally ill are likely to end up receiving care in publicly funded safety-net programs Rabinowitz et al.

Funding to support the public mental health system comes from reimbursements for services provided to Medicare and Medicaid participants, from federal block grants to states, and from state and local funds that support community-based programs and hospital care. Taken in the aggregate, these funding streams are neither adequate nor reliable enough to meet the needs of individuals with serious mental disorders IOM, a.

As with other forms of safety-net care, the urgency of providing treatment to the severely mentally ill erodes funds available for prevention purposes. In the United States, more than 18 million people who use alcohol and nearly 5 million who use illicit drugs need substance abuse treatment SAMHSA, Substance abuse, like mental illness, exacts enormous social costs across all segments of society.

Most recipients 87 percent of specialty treatment for alcohol or drug abuse receive it in outpatient settings RWJF, , but overall, less than one-fourth of those who need treatment get it. Barriers to treatment include stigma, lack of available treatment facilities, unwillingness to admit that treatment is needed, and inability to pay for care.

Public sources provide more than two-thirds of the funding for alcohol and drug treatment facilities. Half of such funds come from dedicated funding at the federal, state, and local levels in the form of various block grants to state safety-net programs. Medicaid and Medicare cover 21 percent of treatment, private insurance covers 14 percent, and 10 percent is paid directly by patients as out-of-pocket costs.

Another 5 percent is covered through various charitable sources. Insurance policies held by many individuals constrain the use of substance abuse services by the exclusion of benefits for such services and by the use of annual and lifetime limits on benefits and other controls on service utilization. Between and , private insurance for substance abuse services fell 0. Over the same period, out-of-pocket payments for specific types of substance abuse treatment increased Coffey et al.

However, the high out-of-pocket costs faced by individuals who pay for their own treatment discourage many who need care from seeking it. Like mental illness and addiction disorders, oral health has been neglected in the health care delivery system. The consequences in terms of individual and population health are significant—oral health is a matter of public health concern because it affects a large proportion of the population and is linked with overall health status see Box 5—7.

Oral diseases are causally related to a range of significant health problems and chronic diseases, as well as individuals' ability to succeed in school, work, and the community DHHS, b.

The effects of oral diseases are cumulative and influence aspects of life as fundamental as the foods people can eat, their ability to communicate effectively, and their social acceptability.

The problems in the way the health care delivery system relates to oral health include lack of dental coverage and low coverage payments, the separation of medicine and dentistry in training and practice, and the high proportion of the population that lacks any dental insurance. The committee focused on the problem of insurance and access to care. Oral Health as a Component of Total Health. When people think about the components of good health, they often forget about the importance of good oral health.

This oversight is often reflected by health insurance coverage restrictions that exclude oral more According to the Department of Health and Human Services DHHS Office of Health Promotion and Disease Prevention, more than million Americans have limited or no dental insurance, nearly four times the number who lack insurance for medical care cited by Allukian, As with other types of health services, insurance is a strong predictor of access to and use of dental services, and minorities and low-income populations are much less likely to have dental insurance or to receive dental care.

Individuals and families living below the poverty level experience more dental decay than higher-income groups, and their cavities are less likely to be treated GAO, More than a third of poor children ages 2 to 9 have one or more primary teeth with untreated decay, compared with Mexican-American adults and children are more likely to have untreated decayed teeth than any other population group.

Poor Mexican-American children ages 2 to 9 have the highest proportion of untreated decayed teeth The pattern for adults is similar DHHS, b: 63— Medicare excludes coverage of routine dental care, and many state Medicaid programs do not provide dental coverage for eligible children or adults. According to a report of the Surgeon General, fewer than one in five Medicaid-covered children received a single dental visit in a recent year-long study period DHHS, b.

Low-income Hispanic children and adults are less likely to be eligible for Medicaid than other groups, so even the limited Medicaid benefits are unlikely to be available to them. The forecast for major oral health problems among the nation's fastest-growing population group, Hispanics, is especially alarming. The committee found that preventive, oral health, mental health, and substance abuse treatment services must be considered part of the comprehensive spectrum of care necessary to help assure maximum health.

Therefore, the committee recommends that all public and privately funded insurance plans include age-appropriate preventive services as recommended by the U. Preventive Services Task Force and provide evidence-based coverage of oral health, mental health, and substance abuse treatment services. Crossing the Quality Chasm IOM, b examined health system failures that compromise the quality of care provided to all Americans.

As noted, it is often the responsibility of state departments of health to monitor providers and levy sanctions when quality problems are identified. This adds to potential tensions with the public health system. Two particular quality problems have special significance in terms of assuring the health of the population: disparities in the quality of care provided to racial and ethnic minorities and inadequate management of chronic diseases. As the American population grows both older and more racially and ethnically diverse and as rates of chronic disease increase, important vulnerabilities in the health care delivery system are compromising individual and population health Murray and Lopez, ; Hetzel and Smith, Evidence shows that racial and ethnic minorities do not receive the same quality of care afforded white Americans.

These findings are consistent across a range of illnesses and health care services and remain even after adjustment for socioeconomic differences and other factors that are related to access to health care IOM, b. Furthermore, poor-quality health care is an important independent variable contributing to lower health status for minorities IOM, b.

For example, racial differences in cervical cancer deaths have increased over time, despite the greater use of screening tests by minority women Mitchell and McCormack, The lower quality of care also compounds the adverse health effects of other disadvantages faced by minorities, including lower incomes and education, less healthy living environments, and a greater likelihood of being uninsured.

As discussed in Unequal Treatment IOM, b , the factors that may produce disparities in health care include the role of bias, discrimination, and stereotyping at the individual provider and patient , institution, and health system levels. The report found that aspects of the health care system—its organization, financing, and availability of services—may have adverse effects specifically for racial and ethnic minorities.

For example, time pressures on physicians hamper their ability to accurately assess presenting symptoms, especially when cultural or language barriers are present. Nearly 14 million people in the United States are not proficient in English. Changes in the financing and delivery of health care services, such as the emphasis on cost controls and the almost complete conversion to managed care for the delivery of services under Medicaid, may be especially problematic for racial and ethnic minorities.

The disruption of traditional community-based care and the displacement of providers who are familiar with the language, culture, and values of ethnic communities create barriers to effective care Leigh et al. Such plans are characterized by higher per capita resource constraints and stricter limits on covered services Phillips et al. Fragmentation of health plans along socioeconomic lines engenders different clinical cultures, with different practice norms Bloche, The committee encourages the health care system and policy makers in the public and private sectors to give careful consideration to the interventions that are identified in Unequal Treatment IOM, b and aimed at eliminating racial and ethnic disparities in health care see Box 5—8.

Avoid fragmentation of health plans along socioeconomic lines. Strengthen the stability of patient—provider relationships in publicly funded more Americans now live longer. A child born today can expect to live more than 75 years, and advances in medicine have also extended the life spans of earlier generations.

As detailed in Chapter 1 , the result is that individuals over age 65 constitute an increasingly large proportion of the U. Embedded in these demographic changes is a dramatic increase in the prevalence of chronic conditions. Chronic conditions, defined as illnesses that last longer than 3 months and that are not self-limiting, affect nearly half of the U. An estimated million Americans have one or more chronic conditions, and that number is estimated to reach million by Pew Environmental Health Commission, Nearly half of those with a chronic illness have more than one such condition IOM, a.

Additionally, disabling chronic conditions affect all age groups, but about two-thirds are found in individuals over age With the projected growth in the number of people over age 65 increasing from 13 percent of the population to 20 percent, the need for care for chronic conditions will also continue to grow. The current health care system does not meet the challenge of providing clinically appropriate and cost-effective care for the chronically ill.

Wagner and colleagues identified five elements required to improve outcomes for chronically ill patients:. Reorganization of practices to meet the needs of patients who require more time, a broad array of resources, and closer follow-up. Systematic attention to patients' need for information and behavioral change. The health care delivery system as it exists today cannot deliver those elements. Recent surveys have found that less than half of U.

Delivery of high-quality care to chronically ill patients is especially challenging in a decentralized and fragmented system, characterized by small practices AMA, Smaller practices have great difficulty in organizing the array of services and support needed to efficiently manage chronic disease.

The result is poor disease management and a high level of wasted resources. As the proportion of old and very old increases, the system-wide impact in terms of cost and increased disability may well overwhelm the human and financial resources available to care for chronically ill patients.

The resources of the health care delivery system are not balanced well enough to provide patient-centered care, to address the complex health care demands of an aging population, to absorb normal spikes in demand for urgent care, and to manage a large-scale emergency such as that posed by a terrorist attack. The relentless focus on controlling costs over the past decade has squeezed a great deal of excess capacity out of the health care system, particularly the hospital system.

It has also reduced the time that physicians spend with patients and the quality of the clinical encounter. At the same time, the design of insurance plans in both the public and the private sectors does not support the integrated disease management protocols needed to treat chronic disease or the data gathering and analysis needed for both disease management and population-level health.

Underlying all of these problems is the absence of a national health information infrastructure to support research, clinical medicine, and population-level health. The committee took special note of certain shortages of health care professionals, because these shortages are having a significant adverse effect on the quality of health care.

The committee's particular concerns are the underrepresentation of racial and ethnic minorities in all health professions and the shortage of nurses, especially registered nurses RNs practicing in hospitals.

However, the focus on these two health care professional shortage areas does not suggest the absence of problems in other fields. Acute shortages of primary care physicians exist in many geographic areas, in certain medical specialties, and in disciplines such as pharmacy and dentistry, to name two.

In addition, a growing consensus suggests that major reforms are needed in the education and training of all health professionals. To deliver the type of health care envisioned in Crossing the Quality Chasm IOM, b , health care professionals must be trained to work in teams, to utilize information technology effectively, and to develop the competencies necessary to deliver care to an increasingly diverse population.

Health professions education is not currently organized to produce these results. In , 9 percent of physicians and By comparison, racial and ethnic minorities account for more than one-quarter of the nation's population. Among physicians, about 3 percent are African American, 2.

The severe underrepresentation of racial and ethnic minorities in the health professions affects access to care for minority populations, the quality of care they receive, and the level of confidence that minority patients have in the health care system. A consistent body of research indicates that African-American and Hispanic physicians are more likely to provide services in minority and underserved communities and are more likely to treat patients who are poor, Medicaid eligible, and sicker IOM, c.

Some studies indicate that, on average, minority physicians treat four to five times more minority patients than do white physicians, and studies of recent minority medical school graduates indicate that they have a greater preference to serve in minority and underserved areas. Although more research is needed to examine the impact of minority health care professionals on the level of access and quality of care, for some minority patients, having a minority physician results in better communication, greater patient satisfaction with care, and greater use of preventive services IOM, b.

Although evidence has not established that increasing the numbers of minority physicians or improving cultural competence per se influences patient outcomes, existing research supports clear policies to increase the proportion of medical students drawn from minority groups. RNs work in a variety of settings, ranging from governmental public health agency clinics to hospitals and nursing homes. The majority, however, work in hospitals, although the proportion dropped from 68 percent in to 59 percent in Spratley et al.

Hospitals are facing shortages of RNs, in addition to shortages of pharmacists, laboratory technologists, and radiological technologists. A recent national hospital survey AHA, b found that of , vacant positions, , were for RN positions. Hospital vacancy rates for RN positions averaged 11 percent across the country, ranging from about 10 percent to more than 20 percent in some states. Nationally, more than one in seven hospitals report a severe shortage of RNs, with more than 20 percent of RN positions vacant.

In general, hospitals in rural areas report the highest percentage of vacant positions. The current shortage of RNs, particularly for hospital practice, is a matter of national concern because nursing care is critical to the operation and quality of care in hospitals Aiken et al. In a study analyzing more than 5 million patient discharges from hospitals in 11 states, Needleman and colleagues consistently found that higher RN staffing levels were associated with a 3 to 12 percent reduction in indicators—including lower rates of urinary tract infections, pneumonia, shock, and upper gastrointestinal bleeding and shorter lengths of stay—that reflect better inpatient care.

The shortage of hospital-based nurses reflects several factors, including the aging of the population, declining nursing school enrollment numbers Sherer, , the aging of the nursing workforce the average age increased from Furthermore, nurses have available other professional opportunities, and women, who once formed the bulk of the nursing workforce, now have alternate career prospects.

These trends do not appear to be a temporary, cyclical phenomenon. The aging of the population means an increase in the number of patients who require skilled care for chronic diseases and age-related conditions, but the growth in the pool of nursing professionals is not keeping pace with the growth in the patient population.

Although some of this increase is to be expected because of the overall aging of the U. An aging workforce may have implications for patient care if older RNs have less ability to perform certain physical tasks HRSA, The shortage of RNs poses a serious threat to the health care delivery system, and to hospitals in particular. Hospitals contribute in various ways to assuring the health of the public, particularly by providing acute care services, educating health professionals, serving as a site for research, organizing community health promotion and disease prevention activities, and acting as safety-net providers.

However, hospitals play a uniquely important role by serving as the primary source of emergency and highly specialized care such as that in intensive care units ICUs and centers for cardiac care and burn treatment. Recent changes in the structure of the hospital industry, the reimbursement of hospitals by public- and private-sector insurance programs, and nursing shortages have raised questions about the ability of hospitals to carry out these roles.

During the s, the spread of managed care practices contributed to reductions in overall hospital admissions, in the length of hospital stays, and in emergency department visits. As a result of decreasing demand for hospital services and a changing financial environment, hospitals in many parts of the country reduced the number of patient beds, eliminated certain services, or even closed McManus, The American Hospital Association AHA, a reports that from to , the number of emergency departments in the nation decreased by 8.

Over the same period, medical and surgical bed capacities were reduced by Although these reductions may have improved the efficiencies of hospitals, they have important implications for the capacity of the health care system to respond to public health emergencies. Crowding in hospital emergency departments has been recognized as a nationwide problem for more than a decade Andrulis et al. According to the American Hospital Association a , the demand for emergency department care increased by 15 percent between and In a random survey of emergency department directors in and , 91 percent of the respondents reported overcrowding problems Derlet et al.

The overcrowding was severe, resulting in delays in testing and treatment that compromised patient outcomes. The emergency departments of hospitals in many areas of New York City routinely operated at percent capacity Brewster et al. Patients regularly spent significant portions of their admission on gurneys in a hallway.

One consequence of this crowding is the periodic closure of emergency departments and the diversion of ambulances to other facilities. Ambulance diversions have been found to impede access to emergency services in metropolitan areas in at least 22 states U. House of Representatives, ; at least 75 million Americans are estimated to reside in areas affected by ambulance diversions. Looking at 12 communities, Brewster and colleagues found that on average in , two hospitals in Boston closed their emergency departments each day and the Cleveland Clinic emergency departments were closed to patients arriving by ambulance for an average of nearly 12 hours a day.

The increase in demand for emergency care is attributed to several factors Brewster et al. In particular, managed care rules have changed to allow increased coverage of care provided in emergency departments. Hospitals are in better compliance with the federal Emergency Medical Treatment and Labor Act, which requires emergency departments to treat patients without regard for their ability to pay.

In addition, uninsured patients are making greater use of emergency departments for nonurgent care. The adequacy of hospital capacity cannot be assessed without considering the system inefficiencies that characterize current insurance and care delivery arrangements.

These include the demands placed on hospital emergency and outpatient departments by the uninsured and those without access to a primary care provider. The unique characteristic of primary care is the role it plays as a regular or usual source of care for patients and their families.

Good primary care assures continuity for the patient across levels of care, comprehensiveness of services according to the level of health or illness, and better coordination of these services over time Starfield, Defining the right level of immediate and standby capacity for emergency and inpatient care depends in part on the adequacy and effectiveness of general outpatient and primary care.

For example, chronic conditions like asthma and diabetes often can be managed effectively on an outpatient basis, but if the conditions are poorly managed by patients or their health care providers, emergency or inpatient care may be necessary. Billings and colleagues demonstrated strong links between hospital admission rates for such conditions and the socioeconomic and insurance status of the population in an area.

For example, admission rates for asthma were 6. Differences in disease prevalence accounted for only a small portion of the differences in hospitalization rates among low- and high-income areas.

Although Billings and colleagues did not draw conclusions about the causal pathways leading to these higher admission rates, it is likely that the contributing factors include those discussed in this chapter, such as a lack of insurance or a regular source of care and the assignment of Medicaid populations to lower-cost health plans.

A follow-up analysis found the situation to be growing worse for low-income populations, as economic pressures, including lower reimbursements rates, higher practice costs, and limitations on payment for diagnostic tests, squeeze providers who have historically delivered care to academic health centers' low-income populations Billings et al. Good primary care is associated with better birth weights Politzer et al.

Geographically, areas with higher primary care physician-to-population ratios experience lower total health care costs Welch et al. Additionally, there is evidence that primary care is associated with reduced disparities in health; areas of high income inequality that also had good primary care were less likely to report fair or poor self-rated health Starfield, The link between the availability of primary care and better health is also supported by international evidence, which shows that nations that value primary care are likely to have lower mortality rates all causes; all causes, premature; and cause specific , even when controlling for macro- and micro-level characteristics e.

Although Billings and colleagues focused on the preventable demands for hospital care among low-income and uninsured populations, Closing the Quality Chasm IOM, b makes clear that the misuse of services also characterizes disease management among insured chronically ill patients. In the early s, managed care became a common feature of the health care delivery system in the United States. In theory, managed care offers the promise of a population-based approach that can emphasize regular preventive care and other services aimed at keeping a defined group as healthy as possible.

These benefits are most easily achieved under a fully capitated, group practice model: patients enroll with a health care organization that is paid a certain amount per member per month to provide all necessary or indicated services to the enrolled population, and physicians are paid a monthly fee or are salaried, which separates payment from the provision of individual services. This model allows a relatively stable enrolled population for whom benefits and services can be customized; knowledge of the global budget within which care is to be delivered; and a salaried workforce in which health care providers have an incentive to keep patients healthy and reduce unnecessary use of services but also have a culture in which they monitor each others' practices and quality of care.

For the patient, the model provides comprehensive care, an emphasis on prevention, and low out-of-pocket costs. Kaiser Permanente Medical Group pioneered the model more than 50 years ago on the basis of early experiences providing health care programs for employees of Kaiser industrial companies e. An important opportunity was lost when insurance companies, health plans and health providers, and the state and federal governments saw managed care primarily as a cost-containment mechanism rather than a population-based approach to delivering comprehensive and effective health care services.

Reimbursement rate reductions, restrictions on care and choice of physician, and other aspects of plan management disaffected millions of Americans from the basic concept of managed care.

Furthermore, rapid turnover in enrollment, particularly in Medicaid managed care, ruined economic incentives for plans to view their enrollees as a long-term investment. This loss of trust in the idea of managed care is also the loss of a great opportunity to improve quality and restrain costs. Loosely affiliated physician networks have no ability to identify their populations and develop programs specifically based on the epidemiology of the defined group. There is little ability to use data systems, shared protocols, or peer pressure to improve quality and reduce variations in health care practices.

Managed care is undergoing rapid changes, some of which are likely to further undermine its viability. Consumer demands for more choice and greater flexibility are weakening restrictions on access to providers and limitations on services. Physicians are proving more aggressive and successful in their negotiations with plans to decrease constraints, and to date, most employers have been willing to accept the higher costs that result. Employer acceptance may change in the face of double-digit insurance premium increases.

Predicting the next configuration of insurance and plan delivery systems is dangerous in a system undergoing such rapid transition. A number of major insurance plans have announced that they will begin to offer defined-contribution options. Consumers will be expected to shop for their own care with a medical spending account coupled with catastrophic benefits for very large expenses. This could significantly undermine the current pooling of risk and create incentives for overuse of high-technology services once a deductible for catastrophic benefits has been met.

However, such plans have yet to assume a significant role in the insurance market, and few employers offer them as an alternative. The development of enhanced information technology and its use in hospitals, individual provider practices, and other segments of the health care delivery system are essential for improving the quality of care. Better information technology can also support patients and family caregivers in crucial health decisions, strengthen both personal and population-based prevention efforts, and enhance participation in and coordination with public health activities.

See Chapter 3 for a discussion of the information technology needs of the governmental public health infrastructure. Crossing the Quality Chasm IOM, b formulated the case that information technology is critical to the redesign of the health care system to achieve a substantial improvement in the quality of care. A strong clinical information infrastructure is a prerequisite to reengineering processes of care; coordinating patient care across providers, plans, and settings and over time; supporting the operation of multidisciplinary teams and the application of clinical support tools; and facilitating the use of performance and outcome measures for quality improvement and accountability.

From the provider perspective, better information systems and more extensive use of information technology could dramatically improve care by offering ready access to complete and accurate patient data and to a variety of information resources and tools—clinical guidelines, decision-support systems, digital prescription-writing programs, and public health data and alerts, for example—that can enhance the quality of clinical decision making.

Computer-based systems for the entry of physician orders have been found to have sizable benefits in enhancing patient safety Bates et al. Despite profound growth in clinical knowledge and medical technology, the health care delivery system has been relatively untouched by the revolution in information technology that has transformed other sectors of society and the economy.

Many health care settings lack basic computer systems to provide clinical information or support clinical decision making. Even where electronic medical record systems are being implemented, most of those systems remain proprietary products of individual institutions and health plans that are based on standards of specific vendors.

The development and application of interoperable systems and secure information-sharing practices are essential to gain greater benefits from information technology. At present, only a few institutions have had the resources to build integrated information systems that meet the needs of diverse specialties and environments. Those efforts illustrate both the costs involved in developing health information systems and some of the benefits that might be expected.

So far, however, adoption of even common and less costly information technologies has been limited. Only a small fraction of physicians offer e-mail interaction 13 percent, in a poll , a simple and convenient tool for efficient communication with their patients Harris Interactive, Some of the documented reasons for the low level of physician—patient e-mail communication include concerns about lack of reimbursement for this type of service and concerns about confidentiality and liability.

These legitimate issues are slowly being addressed in policy and practice, but there is a long way to go if this form of communication is to achieve its potential for improving interactions between patients and providers.

Enhanced information technology also promises to aid patients and the public in other ways. The Internet already offers a wealth of information and access to the most current evidence to help individuals maintain their own health and manage disease. In addition, support groups and interactive programs offer additional approaches to empower consumers.

Personalized systems for comprehensive home care may improve outcomes and reduce costs. Medicare's pilot project IdeaTel—Informatics for Diabetes Education and Telemedicine—offers web-based home systems to rural and inner-city diabetics to support home monitoring, customized information, and secure links to providers and to the patients' own medical records www. Other efforts to build a personal health record PHR created or cocreated and controlled by the individual—and instantly available to support treatment in any setting—suggest that the PHR may provide a comprehensive, accurate, and continuous record to support health and health care across the life span Jones et al.

A sophisticated health information infrastructure is also important to support public health monitoring and disease surveillance activities. Systems and protocols for linking health care providers and governmental public health agencies are vital for detecting emerging health threats and supporting appropriate decisions by all parties.

The committee cautions, however, that systems dedicated to a single use, such as bioterrorism, will not be optimal; systems designed to be comprehensive and flexible will be of greater overall value. Ultimately, such systems should also allow the public to contribute and receive information to get the most complete database possible.

For information technology to transform the health sector as it has banking and other forms of commerce that depend on the accurate, secure exchange of large amounts of information, action must be taken at the national level to develop the National Health Information Infrastructure NHII NRC, The committee endorses the call by the National Committee on Vital and Health Statistics NCVHS for the nation to build a twenty-first century health support system—a comprehensive, knowledge-based system capable of providing information to all who need it to make sound decisions about health.

Such a system can help realize the public interest related to quality improvement in health care and to disease prevention and health promotion for the population as a whole. The rapid development and widespread implementation of an extensive set of standards for technology and information exchange among providers, governmental public health agencies, and individuals are critical.

To realize the full potential of the NHII, supportive changes in the social, economic, and legal infrastructures are also required. Policies promoting the portability and continuity of personal health information are essential. Values, practices, relationships, laws, and investment and reimbursement policies must support the creation and use of data and information systems that are consistent with the vision for the NHII see Chapter 3 for an additional discussion and recommendation.

The activities and interests of the health care delivery system and the governmental public health agencies clearly overlap in certain areas, but there is relatively little collaboration between them. In addition, the authority of state health departments in quality monitoring, licensure, and rate setting can cause serious tensions between them and health care organizations. The committee discusses the extent of this separation and the particular need for better collaboration, especially in regard to assuring access to health care services, disease surveillance activities, and partnerships toward broader health promotion efforts.

Within the public health system in the United States, collaboration between the health care sector and governmental public health agencies is generally weak. This reflects the divergence and separate development of two distinct sectors following the Second World War.

As disciplines and professional fields, medicine and public health evolved with minimal levels of interaction, and often without recognition of the lost opportunities to improve the health of individuals and the population. The health care and governmental public health sectors are also very unequal in terms of their resources, prestige, and influence on public policy.

The failure to collaborate characterizes not only the interactions between governmental public health agencies and the organizations and individuals involved in the financing and delivery of health care in the private sector but also financing within the federal government.

Even the congressional authorizing committees for these activities are separate. For example, the Substance Abuse and Mental Health Services Administration, a PHS agency, administers block grants to states to augment funding for mental health and substance abuse programs, neither of which is well supported under Medicaid.

Until recently, the Medicaid waiver program, administered by CMS on behalf of the Secretary of Health and Human Services, did not provide protection of reimbursement rates for clinics within the safety-net system. At the same time, the Health Resources and Services Administration, the PHS agency charged with funding federally qualified safety-net clinics for the poor, and the Indian Health Service were both seeking funds to support the increasing deficits of these clinics due to the growing number of uninsured individuals and the low rates of reimbursement for Medicaid clinics.

The operational separation of public health and health care financing programs mirrors the cultural differences that characterize medicine and public health. American fascination with technology, science, and medical interventions and a relatively poor understanding of the determinants of health see Chapter 2 or of the workings of the governmental public health agencies also contribute to the lower status, fewer resources, and limited influence of public health.

The committee views these status and resource differences as barriers to mutually respectful collaboration and to achieving the shared vision of healthy people in healthy communities. The committee also urges greater efforts on the part of the health care delivery system to meet its public health responsibilities and greater efforts on the part of governmental public health agencies to reach out to health care providers and purchasers and engage them more fully in the public health system.

Public health departments have always differed greatly in regard to the delivery of health care services, based on the availability of such services in the community and other reasons Moos and Miller, Some provide no personal health care services at all, whereas others provide some assortment of primary health care and safety-net services.

In general, however, there has been a decrease in the number of local governmental public health agencies involved in direct service provision. In a recent survey of public health agencies, primary care or direct medical care services were the least common services provided NACCHO, Despite this, 28 percent of local public health departments report that they are the sole safety-net providers in their communities Keane et al. During the s, Medicaid shifted from a fee-for-service program to a managed care model.

This change has been a challenge to the multiple roles of public health departments as community-based primary health care providers, safety-net providers, and providers of population-based or traditional public health services. The challenge has been both financial and organizational. First, managed care plans reimburse safety-net providers less generously than fee-for-service Medicaid providers do under Medicaid, federally qualified health centers benefited from a federal requirement for full-cost reimbursement , and they impose administrative and service restrictions that result in reduced overall rates of compensation IOM, a.

In many states and localities, these changes have decreased the revenue available to public health departments and public clinics and hospitals. In many cases, funds were no longer available for population-based essential public health services or had to be diverted to the more visibly urgent need of keeping clinics and hospitals open CDC, The result of this interplay is that many governmental public health agencies have found themselves in a strained relationship with managed care organizations: on the one hand, encouraging their active partnership in an intersectoral public health system and, on the other, competing with them for revenues Lumpkin et al.

Second, the shift of Medicaid services to a managed care environment led some public health departments to scale down or dismantle their infrastructure for the delivery of direct medical care.

The recent trend of the exit of managed care from the Medicaid market has left some people without a medical home and, in cases of changes in eligibility, has left some people uninsured. This problem may be most acute in rural areas, where public health departments are often the sole safety-net providers Johnson and Morris, One strategy to help lessen the negative impacts of changes in health care financing undertaken by some public health departments has been the development of formal relationships e.

Such arrangements have made possible some level of integration of health care and public health services, enhanced information exchange and continuity of care, and allowed public health departments to be reimbursed for the provision of some of the services that are covered by the benefits packages of managed care plans Martinez and Closter, At this time, governmental public health agencies are still called on to play a role in assurance broader than that which may be compatible with their other responsibilities to population health.

However, closer integration between these governmental public health agencies and the health care delivery system can help address the needs of the uninsured and underinsured. Denver Health, in Colorado, provides an intriguing example of a hybrid, integrated public—private health system Mays et al. Denver Health is the local county and city public health authority, as well as a managed care organization and hospital service.

Although changes in the Medicaid program continue to challenge Denver Health, it continues to balance its broad responsibilities to the public's health with its role and capacity as a large health care provider. Disease surveillance and reporting provide a classic exemplar of essential collaboration between the health care system and the governmental public health agencies.

The latter rely on health care providers and laboratories to supply the data that are the basis for disease surveillance. For instance, in the fall of , reports from physicians who diagnosed the first cases of anthrax were essential in recognizing and responding to the bioterrorism attack.

States mandate the reporting of various infectious diseases e. Governmental public health agencies also depend on astute clinicians to inform them of sentinel cases of recognized diseases that represent a special threat to the public's health and of unusual cases, sometimes without a confirmed diagnosis, that may represent a newly emerging infection, such as Legionnaires' disease or West Nile virus in North America.

Other types of public health surveillance activities, such as registries for cancer cases and for childhood immunizations, also depend on reporting from the health care system. Effective surveillance requires timely, accurate, and complete reports from health care providers. In the case of infectious diseases, if all systems work effectively, the necessary information regarding the diagnosis for a patient with a reportable disease is transmitted to the state or local public health department by a physician or laboratory.

For unusual or particularly serious conditions, public health officials offer guidance on treatment options and control measures and monitor the community for any additional reports of similar illness.

For diseases like tuberculosis and sexually transmitted diseases, public health agencies facilitate active tracking and prophylactic treatment of persons exposed to an infected individual. Disease reporting requirements vary from state to state, although most states include diseases identified by the Centers for Disease Control and Prevention CDC as part of the National Notifiable Disease Reporting System. Disease reporting is not complete, however.

For diseases under national surveillance, from 6 to 90 percent of cases are reported, depending on the disease Teutsch and Churchill, ; Thacker and Stroup, Incomplete reporting may reflect a lack of understanding by some health care providers of the role of the governmental public health agencies in infectious disease monitoring and control. In some instances, physicians and laboratories may be unaware of the requirement to report the occurrence of a notifiable disease or may underestimate the importance of such a requirement.

The difficulty of reporting in a busy practice is also a barrier. Notifiable disease reporting systems within public health departments with strong liaisons with the health care community are important in the detection and recognition of bioterrorism events. However, this valuable tool has not been well supported and, as noted earlier, suffers from issues of lack of timeliness and incomplete reporting, as well as complex or unclear reporting procedures and limited feedback from governmental public health agencies on how data are used Baxter et al.

Health care delivery systems may fear that the data will be used to measure performance, and concerns about patient confidentiality can also contribute to a reluctance to report some diagnoses. New federal regulations regarding the confidentiality of medical records, required by the Health Insurance Portability and Accountability Act P. Health care providers may also reduce their use of laboratory tests to confirm a diagnosis. This may be because of cost concerns or insurance plan restrictions or simply professional judgment that the test is unnecessary for appropriate clinical care.

However, when fewer diagnostic tests are performed for self-limiting illnesses like diarrhea, there may be delays in recognizing a disease outbreak. Reduced use of laboratory testing prevents the analyses of pathogenic isolates needed for disease tracking, testing of new pathogens, and determining the levels of susceptibility to antimicrobial agents.

Other changes in the health care delivery system also raise concerns about the infectious disease surveillance system. As patterns of health care delivery change, old reporting systems are undermined, but the opportunities offered by new types of care systems and technologies have not been realized.

For example, traditional patterns of reporting may be lost as health care delivery shifts from inpatient to outpatient settings. Hospital-based epidemiological reporting systems no longer capture many diagnoses now made and treated on an outpatient basis.

This would not be a problem if health care systems used currently available information technologies, including electronic medical records and internal disease surveillance systems.

Better information systems that allow the rapid and continuous exchange of clinical information among health care providers and with public health agencies have the potential to improve disease surveillance as well as aid in clinical decision making while avoiding the use of unnecessary diagnostic tests. With such a system, a physician seeing an influx of patients with severe sore throats could use information on the current community prevalence of confirmed streptococcal pharyngitis and the antibiotic sensitivities of the cultured organisms to choose appropriate medications.

From a public health perspective, such a system would permit continuous analysis of data from a number of clinical sites, enabling rapid recognition and response to new disease patterns in the community see Chapter 3 for a discussion of syndrome surveillance. For example, toxic or infectious exposures could be tracked more easily if the characteristics of every patient encounter were integrated into one system and if everyone had unimpeded access to systems of care that could generate such data.

A CDC-funded project of the Massachusetts Department of Public Health and the Harvard Vanguard Medical Associates a large multi-specialty group offers a glimpse of the benefits to be gained through collaboration between health care delivery systems and governmental public health agencies and specifically through the effective use of medical information systems Lazarus et al.

The Harvard Vanguard electronic medical system is queried each night for specific diagnoses assigned during the preceding day in the course of routine care. Diagnoses of interest are grouped into syndromes, and rates of new episodes are computed for all of eastern Massachusetts and each census tract. Expected numbers of new episodes are obtained from a generalized linear mixed model that uses data from to These expected numbers allow estimates of the probability of observing specific numbers of cases, either overall or in specific census tracts, and the rapid identification of an unusual cluster of events.

The value of this type of real-time monitoring of unusual disease outbreaks is obvious for early identification of bioterrorism attacks as well as for improvements in clinical care and population health. Reports of sentinel events have proved useful for the monitoring of many diseases, but such reports may be serendipitous and generated because of close clustering, unusual morbidity and mortality, novel clinical features, or the chance availability of medical expertise. Sentinel networks that specifically link groups of participating health care providers or health care delivery systems to a central data-receiving and -processing center have been particularly helpful in monitoring specific infections or designated classes of infections.

More recently, CDC has implemented a strategy directed to the identification of emerging infectious diseases in collaboration with many public health partners.

The Emerging Infections Program EIP is a collaboration among CDC, state public health departments, and other public health partners for the purpose of conducting population-based surveillance and research on infectious diseases.

At present, nine states California, Colorado, Connecticut, Georgia, Maryland, Minnesota, New York, Oregon, and Tennessee act as a national resource for the surveillance, prevention, and control of emerging infectious diseases CDC, The EIP sites have performed investigations of meningococcal and streptococcal diseases and have established surveillance for unexplained deaths and severe illnesses as an attempt to identify diseases and infectious agents, known and unknown, that can lead to severe illness or death CDC, Academic health centers AHCs serve as a critical interface with governmental public health agencies in several ways.

First, as noted earlier, AHCs are an important part of the safety-net system in most urban areas. Second, they are the principal providers of specialized services and serve as regional referral centers for smaller towns or cities and rural areas. Both in normal periods and especially when confronted with either natural disasters or terrorist events, the specialized care units are an essential resource for public health.

Moreover, they are also primary loci for research and training. AHCs also have a unique and special set of values that they bring to health care that transcend the discrete functions they perform. The environment in which AHCs operate has changed substantially over the past decade. The advent of managed care plans that seek services from the lowest-cost appropriate provider and changes in federal Medicare reimbursement policies that reduced subsidies for costs associated with AHCs' missions in education, research, and patient care have created considerable pressure on academic institutions to increase efficiency and control costs.

At the same time, advances in information technology and the explosion of knowledge from biomedical research have enormous implications for the role of AHCs in the health care system and in population health. Scientific and technological advances will permit clinical care to intervene early in a disease process by identifying and modifying personal risk. The burgeoning knowledge base will require different educational approaches to use the continuously expanding evidence base, with an emphasis on continuing education and lifetime learning.

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Even so, the Affordable Care Act has made our health-care system unrecognizable from a decade ago. The Affordable Care Act established health insurance marketplaces, including Healthcare. Despite initial spikes in prices on the marketplace, premiums have grown more affordable over the last couple of years. More than 20 million Americans gained health insurance under the ACA. Black Americans , children and small-business owners have especially benefited. As a result of the increased access to health care, it's estimated that more than 19, lives have been saved.

The Medicaid expansion is popular with voters. After Louisiana Gov. John Bel Edwards, a Democrat, won reelection in November, his lead pollster told The Washington Post that "no single issue was more important than the Medicaid expansion.

That math has led even red states that criticized the Affordable Care Act to eventually adopt it, Stevens said. There are other parts of the ACA with bipartisan support, including prohibiting insurers from denying coverage or charging more to people with preexisting conditions. More than 1 in 4 Americans report having a preexisting condition such as asthma or high blood pressure. The law prohibited health insurers from including lifetime and annual caps in their plans.

In the past, the government estimates that more than 20, people hit those limits each year. The Affordable Care Act also banned insurers from charging rates based on gender. Under the ACA, Medicare stopped reimbursing hospitals for the treatment of hospital-acquired infections. As a result, the number of such infections have plummeted and , fewer deaths have occurred.

Health-care spending still makes up nearly a fifth of the country's gross domestic product. Many Americans can't afford to take care of themselves. The Trump administration has been hostile toward the Affordable Care Act. The overhaul of the tax code in repealed the individual mandate penalty. That central provision of the Affordable Care Act required every American to sign up for health insurance or face a tax penalty.

Advocates say it's now harder for people to learn about their health insurance options. These changes are likely among the reasons , fewer people signed up for health insurance on the marketplace in than in Between and , the number of uninsured children swelled by , Since more than a dozen states continue to refuse to adopt the Affordable Care Act's Medicaid expansion, 2.

In Texas, one of the states that hasn't expanded Medicaid, nearly 1 in 5 people live without health insurance. Some 10 states are in the process of trying to impose work requirements for their Medicaid benefits. The new qualifications could lead to , Americans losing their health coverage. Starting in January, many Medicaid recipients in Michigan will have to show at least 80 hours a month of workforce engagement to maintain their coverage.

But healthcare organizations committed to value-based care must know that achieving key results in the future will require a shift away from conventional thinking and legacy ways of working.

To start, health systems need to enhance payer-provider collaboration and fine-tune value-based measures. But to optimize value-based care, hospitals also need to sharpen their efforts in building organizational agility -- in everything from processes to shared mindsets.

Value-based care can no longer be separated from the quadruple aim; rather, it should drive patient experiences, population health, cost reduction and caring for the caregiver.

Leaders' aim to recuperate lost revenues might create an excessive focus on cost-cutting. This is bound to cause serious disruptions to employees and patients. The best hospitals will continue to prioritize an integrated strategy that promotes the quadruple aim through constant review and improvement of the patient and employee experiences. COVID has accelerated the healthcare industry's erstwhile sluggish digital transformation journey.

Even before the pandemic, technological and macroeconomic factors were steadily reshaping healthcare, from heightened venture capital interest in healthcare tech to organizations such as Amazon acquiring a supply license for pharmaceutical drugs.

Post-pandemic, the evolution of healthcare delivery will increase -- far beyond the increase in virtual healthcare. Consider, for example, distributed healthcare -- urgent care clinics, free-standing emergency setups, retail clinics.

Research has shown a higher return on invested capital ROIC for these alternatives compared with conventional hospital systems. But to effectively deal with disruption and stay on the cutting edge of innovation, healthcare must also invest in top talent. As these industries evolve -- both as a consequence of COVID and other industry forces -- leaders need top talent to effectively integrate new delivery models and capture new market opportunities.

The trouble is, in a dynamic time when talent has never been more crucial, retaining and acquiring talent that drives innovation is arguably more challenging than ever before. To secure their organization's future, leaders need a proven, research-based talent attraction strategy. But acquiring the talent to accelerate innovation is just the beginning. Retaining and developing talent are equally important to performance and patient outcomes.

An estimated 1. Healthcare providers need greater sophistication in management and leadership development for two reasons:. It is not surprising that the pandemic has ramped up virtual healthcare. The president recently issued an executive order to permanently expand some telehealth services in rural areas beyond the COVID pandemic. Gallup recently published our perspective on virtual healthcare in American Journal of Managed Care. Because patient needs and expectations will evolve continuously, hospitals need to constantly track patient insights across the continuum of care -- including the virtual space.

Despite the current interest in telehealth, the future of healthcare delivery is likely to be omnichannel -- combining telemedicine, retail clinics, on-demand care and more. Integrating these channels effectively will also require a significant change in leadership, as well as a more robust change management process to ensure that new technology is utilized optimally.

In , nearly healthcare mergers were announced -- but the COVID crisis has put pressure on some of these deals. Post-pandemic, as the healthcare industry comes to terms with sustained losses, there might also be more significant pressure to consolidate.

The hundred-odd mergers in were also unique because acquirers were not focused on obtaining "more of the same"; rather, they were looking for ways to expand their portfolios, market opportunities and service offerings. In a post-COVID world, maximizing merger outcomes will require heightened innovation, with leaders reevaluating legacy merger management tactics in pursuit of an approach that will drive outcomes in this new climate.

During post-merger integration, to optimize performance and quality of care, leaders must prioritize the engagement of healthcare managers, physician leaders and nursing managers.

The healthcare system today is a complex web of interconnected stakeholders. And the ecosystem is expanding -- beyond the traditional players such as payers, providers, pharma and medical devices. In the post-pandemic world, the ecosystem might look very different. These service vendors, which include clinical services and financial services, are primarily growing because of advancements in analytics, big data and digital transformation.

Further, real transformation in healthcare requires more significant linkages and synergy among these diverse players. Leaders in this ecosystem are all committed to the same goal -- transforming healthcare and improving accessibility -- yet make unique contributions and apply complementary strategies. Some partnerships are more important to get right, such as payer and provider synergy.

Integrated healthcare delivery systems are uniquely positioned to maximize synergy between insurance and healthcare provision. Leveraging big data across multiple healthcare touchpoints is another key opportunity. More than ever, the speed of collaboration is vital -- for instance, PPE manufacturers need to proactively coordinate with hospitals to develop and deploy critical resources.

The most urgent, of course, is vaccine development and advances in diagnostic testing -- not only for COVID but for future outbreaks as well. These "high mission" initiatives require extreme levels of agile collaboration among diverse healthcare industry players.

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Juniper networks sa series ssl vpn	Traditionally, referring physicians have been thought ssytem as primary care practitioners. Employers also benefit: in Texas inthe parents of uninsured children missedmore days of work than the parents of insured children 4. Prev Next. This would not be a problem if health care systems used currently available information technologies, including electronic medical records and changes in us healthcare system disease click at this page systems. Inabout three-quarters of adults with employment-based health insurance had a benefit package that included adult physical examinations. Coli: Within 10 years, cases of E. National health spending trends in
Adventist health system retirement benefits	The ability to treat cognizant us address teaneck with chronic disease such as heart disease is clearly lengthening their lives; in the next 30 years, the number of people with heart ehalthcare in the United States is expected to double. Poor Mexican-American children ages changes in us healthcare system to see more have the highest proportion of systej decayed teeth Health Affairs 20 3 — Create an account to read 2 more. Sign up for more. Sentinel Surveillance Reports of sentinel events have proved useful for the monitoring of many diseases, but such reports may be serendipitous and generated because of close clustering, unusual morbidity and mortality, novel clinical features, or the chance availability of medical expertise.
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According to an Association of American Medical Colleges AAMC analysis, women comprise 46 percent of all physicians in training and nearly half of all medical students. Based on these statistics, we can assume more women may enter the medical profession in the coming years.

African-American women are more likely to become doctors than their male counterparts, according to AAMC data. While African-Americans comprise only four percent of the physician workforce, 55 percent of the African American physician workforce is female.

This shift in demographics to include more women in healthcare supports diversity in the industry and represents overall population diversity. The prevalence of malpractice lawsuits is one way to evaluate the competence of healthcare providers. The amount of malpractice claims in the U. As the trend of declining malpractice lawsuits continues, it may indicate that provider competence and patient care will continue to improve.

Job satisfaction is one area that must improve. Nurses report higher overall career satisfaction than doctors, based on results of the latest Survey of Registered Nurses conducted by AMN Healthcare and compared to the Physician Compensation Report.

Nine out of 10 nurses who participated in the survey said they were satisfied with their career choice. However, one out of every three nurses is unhappy with their current job. It is difficult to say whether job satisfaction will increase in the coming years, but continued technological advancements designed to streamline the healthcare process offer hope to those who may be frustrated with the complexity of their jobs. Demands on healthcare change due to various reasons, including the needs of patients.

Every year, new cures and treatments help manage common diseases. Each such development affects the entire healthcare system as much as it has a positive impact on patients.

As illnesses become more common, our healthcare system must adapt to treat them. Patient care needs will also evolve as the population ages and relies more heavily on resources such as Medicare and Medicaid.

Patient empowerment is expected to increase with advances in technology. The bubonic plague is a good example of a disease that can drastically change the healthcare system by quickly shifting all resources to handle an epidemic. In the Middle Ages, the Black Death spread so quickly across Europe that it is responsible for an estimated 75 million deaths. It may be surprising that the bubonic plague still circulates today. In fact, according to Center for Disease Control data, there were 11 cases and three deaths in the U.

Although the bubonic plague is not near the threat it once was, other diseases and conditions of concern are on the rise. The following seven conditions are on the rise and can be expected to have an impact on healthcare in the near future:. The healthcare industry has identified these previous conditions, preparing to handle further increases with supplies and resources. However, a new threat is always possible.

If something similar to the Ebola virus spread across the country, this would have a drastic impact on patient care and healthcare facilities. The current baby boomer generation, which initially consisted of 76 million people born between and , will be coming to retirement age and will increase federal spending on Medicare and Medicaid by an average of 5.

Healthcare technology trends focus heavily on patient empowerment. The introduction of wearable biometric devices that provide patients with information about their own health and telemedicine apps allow patients to easily access care no matter where they live.

With new technologies focused on monitoring, research, and healthcare availability, patients will be able to take a more active role in their care.

From policy to patients and everything in-between, the healthcare industry is constantly evolving. Aging populations, technological advancements, and illness trends all have an impact on where healthcare is headed. Since it is crucial to pay attention to shifts in society to understand where healthcare is headed, consider dedicating time each day to reading recommended industry literature that you will find in our list of 25 books for every healthcare professional. The program provides traditional MBA core courses and specialized healthcare electives to help tailor the curriculum to your goals.

Skip to main content. Historical Changes in Healthcare Healthcare reform has often been proposed but has rarely been accomplished. The Complexity of Healthcare The many layers of variance in all parts of healthcare is what makes this system so complex.

Health Insurance Market Choosing a healthcare plan illustrates the complexity of health insurance plans in the U. Healthcare Regulation Insurance is not the only complexity within the system. How Change Impacts Healthcare Resources and Facilities Changes in the healthcare industry usually occur at the legislative level, but once enacted these changes have a direct impact on facility operations and the use of resources. Historical and Predicted Changes in Healthcare Facilities Cultural shifts, cost of care, and policy adjustments have contributed to a more patient-empowered shift in care over the last century.

The Future of Medicare and Medicaid As the baby boomer generation approaches retirement, thus qualifying for Medicare, healthcare spending by federal, state, and local governments is projected to increase. A Shift in Healthcare Providers Along with policy and technological changes, the people who provide healthcare are also changing. Demographics In recent years, the demographics of the medical profession have shifted.

Competence The prevalence of malpractice lawsuits is one way to evaluate the competence of healthcare providers. Satisfaction Job satisfaction is one area that must improve. Evolving Needs of Patients Demands on healthcare change due to various reasons, including the needs of patients. Illness Trends The bubonic plague is a good example of a disease that can drastically change the healthcare system by quickly shifting all resources to handle an epidemic.

The following seven conditions are on the rise and can be expected to have an impact on healthcare in the near future: Sexually Transmitted Infections: Chlamydia and gonorrhea rates have increased, and syphilis rates rose by Obesity: Obesity continues to be an issue in the U.

Obesity rates have increased by 17 percent in the past five years. Autism: For every , people, 1, are diagnosed with autism. This number continues to rise annually. Recent increases may be due to awareness as doctors become more familiar with the symptoms of autism. Coli: Within 10 years, cases of E. Many E. Liver Cancer: Incidences of liver cancer have increased by 47 percent in a recent year timeframe.

Kidney Cancer: Healthcare practitioners have treated To secure their organization's future, leaders need a proven, research-based talent attraction strategy. But acquiring the talent to accelerate innovation is just the beginning. Retaining and developing talent are equally important to performance and patient outcomes. An estimated 1. Healthcare providers need greater sophistication in management and leadership development for two reasons:.

It is not surprising that the pandemic has ramped up virtual healthcare. The president recently issued an executive order to permanently expand some telehealth services in rural areas beyond the COVID pandemic.

Gallup recently published our perspective on virtual healthcare in American Journal of Managed Care. Because patient needs and expectations will evolve continuously, hospitals need to constantly track patient insights across the continuum of care -- including the virtual space.

Despite the current interest in telehealth, the future of healthcare delivery is likely to be omnichannel -- combining telemedicine, retail clinics, on-demand care and more. Integrating these channels effectively will also require a significant change in leadership, as well as a more robust change management process to ensure that new technology is utilized optimally.

In , nearly healthcare mergers were announced -- but the COVID crisis has put pressure on some of these deals. Post-pandemic, as the healthcare industry comes to terms with sustained losses, there might also be more significant pressure to consolidate.

The hundred-odd mergers in were also unique because acquirers were not focused on obtaining "more of the same"; rather, they were looking for ways to expand their portfolios, market opportunities and service offerings.

In a post-COVID world, maximizing merger outcomes will require heightened innovation, with leaders reevaluating legacy merger management tactics in pursuit of an approach that will drive outcomes in this new climate.

During post-merger integration, to optimize performance and quality of care, leaders must prioritize the engagement of healthcare managers, physician leaders and nursing managers. The healthcare system today is a complex web of interconnected stakeholders. And the ecosystem is expanding -- beyond the traditional players such as payers, providers, pharma and medical devices.

In the post-pandemic world, the ecosystem might look very different. These service vendors, which include clinical services and financial services, are primarily growing because of advancements in analytics, big data and digital transformation. Further, real transformation in healthcare requires more significant linkages and synergy among these diverse players.

Leaders in this ecosystem are all committed to the same goal -- transforming healthcare and improving accessibility -- yet make unique contributions and apply complementary strategies. Some partnerships are more important to get right, such as payer and provider synergy. Integrated healthcare delivery systems are uniquely positioned to maximize synergy between insurance and healthcare provision. Leveraging big data across multiple healthcare touchpoints is another key opportunity.

More than ever, the speed of collaboration is vital -- for instance, PPE manufacturers need to proactively coordinate with hospitals to develop and deploy critical resources. The most urgent, of course, is vaccine development and advances in diagnostic testing -- not only for COVID but for future outbreaks as well.

These "high mission" initiatives require extreme levels of agile collaboration among diverse healthcare industry players. As a direct economic result of the pandemic, millions of Americans have lost their jobs -- and in turn, health insurance benefits.

Life ratings plummeted to a year low in April , according to Gallup Panel data, with Americans reporting severe stress and financial worry. The much-touted digital and technological advances in healthcare are necessary but cannot singlehandedly solve these endemic issues in the short term.

Rather, progress requires intense collaboration among leaders from government agencies, private enterprises and research institutes. These leaders must engage the collective talent, imagination and intellect of every employee and player in the industry. Maximizing the collective impact of the combined system will require a unified approach aimed at improving the quality of care and reducing costs.

Beyond that, leaders across the industry must focus on enhancing holistic patient wellbeing -- going beyond physical health to improve financial, emotional and societal wellness. Leaders need to set their gaze on collaboration and cross-sectoral synergy. Indeed, healthcare leaders of the future must be boundaryless and acknowledge and appreciate the interdependence of all healthcare players.

The future of healthcare in the U. Subscribe to the Gallup at Work newsletter to get our latest articles, analytics and advice. Learn how West Health and Gallup are giving both the public and policymakers a fuller understanding of the true cost of the U.

Once supplemental, virtual learning is now a training necessity for health systems. Learn how some now meet the knowledge needs of workers. Here's how leaders can help.