| One of the most exciting aspects of actively participating in the public policy (e.g., political) process is constantly being exposed to, and interacting with, futuristic thinkers — especially those possessing health care expertise. We recently reviewed the far reaching report: “Health And Health Care 2010: The Forecast, The Challenge”. This impressive document was developed by the Institute for the Future at the request of the Robert Wood Johnson Foundation, the nation’s largest philanthropy devoted exclusively to health and health care. The authors explored probable trends and created different scenarios reflecting various emerging visions of health care, noting that although “wild cards” have less than a 10 percent chance of occurring, yet if they do, they have a tremendous impact on society.
Some of the projections:
- In 2010, the American population will be older and more ethnically and racially diverse. The burden of disease is shifting toward chronic illnesses that stem from our behaviors.
- The health care industry has lagged behind other industries in implementing information technologies that streamline business and clinical processes. Changes in information technology, as applied to health care, will be a prime catalyst of change in the future.
- Health behaviors, namely smoking, poor dietary habits, lack of exercise, alcohol abuse, the use of illicit drugs and violence, influence up to 50 percent of health status. Although radical improvements in these health behaviors are not anticipated in the coming decade, managed care’s emphasis on prevention will help begin to decrease these harmful behaviors.
- Over the next decade, our view of health will be expanded to encompass mental, social, and spiritual well-being.
- Ten years ago, the key issues in the American health care system were classic: containing costs while improving access to care for people and maintaining quality of services. Then the rapid cost increases of the late 1980s, combined with the recession of the early 1990s, added a new issue to the list — ensuring security of benefits.
- Incorporating consumers into health care decision making; determining responsibility for medical management; and improving the health behaviors of the American people. These will be the health battlegrounds of the next decade.
The information and communications revolution will move into the health care system in the next 7 to 12 years.
This will result in –
- Automation of basic business processes (automation of submission and adjudication of claims);
- Clinical information interfaces (sophisticated decision support systems with voice recognition will create clinician-friendly interfaces);
- Data analysis (close to real-time online analytical processing of information about patient and provider outcomes); and
- Telehealth (chronically ill patients will be monitored remotely by a variety of sensor devices and patients will use these media for disease-specific research, psychological support groups, self-care, and shared decision making). Access to care will remain “tiered” and that tiering will become much more extreme. The top tier, the “empowered consumers,” will have considerable discretionary income, be well educated, and use technology (including the Internet) to get information about their health. These new consumers increasingly will engage in shared decision making with their physicians. Under one scenario, consumers, prompted both by pharmaceutical companies’ direct-to-consumer advertising and by “gee-whiz” articles in the popular press, will demand access to the latest, greatest, and most expensive drugs and medical technologies. Beleaguered health plans will concede the point and lose control over cost and quality. However, the forecast for legislation is one of continued incremental program change directed primarily at providers with little direct effect on beneficiaries. The real challenge – changing Medicare so that it can afford to cover the vast number of baby boomers retiring after 2010 – will not be dealt with until later in the decade.
In the view of one of the renowned Commentators:
- The Voice of Consumers. The voice of consumers has put them in charge, as we see increased demand for provider and insurer responsiveness and a greater focus on patient satisfaction, especially in an encounter with the health care system. The demand for alternative or complementary medicine and a strong emphasis on choice also seem to be recurring themes.
- Information Technology. Information technology is driving the future of provider organizations, and in the long run, the use of information technology through automated medical records and the Internet may be as important as the introduction of antibiotics in the 1940s. And,
- Competition Based On Quality. Health care providers and insurers are competing on quality, and quality has become a differentiating factor for purchasers. A greater emphasis and investment is being placed on quality measurement and reporting through the establishment of the National Forum on Quality Management and Reporting. Evidence-based medicine is becoming the gold standard for patient care. This report was not written by psychologists, but its vision has major implications for all of professional psychology. We must adapt – Past Divisional President Stan Moldowsky is now conducting tele-therapy sessions over a thousand miles from home. This is the future.
Every year the APA Board of Directors holds two retreat meetings. This Spring the Board met on Maui and under the guidance of President-Elect Norine Johnson, reflected upon her forthcoming Presidential theme — Psychology Building A Healthy World. Norine is starting from the demonstrated public need and working to establish partnerships with highly relevant others. Her vision involves cross-cutting constituencies and developing real products for the public, including the popular media. Ruth Paige and Bruce Overmier have been working particularly closely with her as members of the Board’s subcommittee on the Changing Health Care System. During the Boston convention, they hosted the highly successful Leaders Breakfast Forum for leaders from the education, practice, public interest, and science constituencies who participated in brainstorming activities. A follow-up event is being planned for the Washington, DC convention. Three emerging foci are – Building Healthy Families, Healthy Workplaces, and Healthy Communities. When elected President, one of my requests was that APA hire a full time coordinator for the maturing Psychopharmacology agenda. I am very pleased that the Practice Directorate has now designated Rochelle Jennings [rjennings@apa.org]. Aloha,
Pat DeLeon, APA President - Division 42Web - April, 2000
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