Academic journal article
By Kahl, Anne; Clark, Donald E.
Monthly Labor Review , Vol. 109
Employment in health services: long-term trends and projections Health care has aptly been described as a system in flux. Throughout much of the post-World War II period, U.S. health policy encouraged expansion of the delivery system and of patients' access to it. There was a perceived need for more physicians and hospitals, and strategies were developed to increase the supply. The number of beds in hospitals and nursing homes rose, and the supply of physicians, nurses, and allied health professionals grew very rapidly. Now that cost control has emerged as a dominant concern, this has changed: evolving methods of payment for health services are based on incentives intended to discourage use of costly resources and to foster price competition. Greater emphasis on providing care in the most cost-effective setting is one of the principals trends reshaping this large and important industry. This article explores the potential impact on demand for health services workers of the sweeping changes in industry structure currently underway.
Health care is still delivered in doctors' and dentists' offices, hospitals, and nursing homes, for the most part, but the structure of the industry is changing as financial incentives for providing (and using) health services are transformed. Health maintenance organizations (HMO'S) are flourishing and new organizational entities such as urgent care centers, birthing centers, and hospices are taking hold.
The boundary between financing and delivery of health care is becoming less distinct, and vertically integrated systems of care are emerging as providers affiliate with one another, or with hospitals, HMO'S, and insurance companies. Additional changes in organizational structure lie ahead, inasmuch as financing is in ferment. The prospective payment system launched by medicare in October 1983 may be modified as evidence of its impact accumulates and other payers are experimenting with cost containment programs of their own.
Yet even as the delivery system changes, equally dramatic shifts are occurring in the composition of the U.S. population. Americans are growing older, creating a need for suitable health, housing, and social services. Moreover, the segment age 85 and above is recording much faster growth than any other age group in the population. In the decade ahead, the increasing number of elderly people, especially those of very advanced age, is expected to heighten demand for hospital, medical, and surgical care; for long-term care services; and for new services, including geriatric assessment, case management, adult day care, and respite care. The effort to provide adequate and appropriate health care for an aging population within the constraints imposed by cost containment is stimulating innovative approaches to program design, organization, and financing. With both the scope and structure of health care services delivery in flux, however, it is very difficult to anticipate the future pattern of health services.
Given the growth and aging of the population, advances in medical technology, and public support for high-quality care, there is little doubt that the health services industry will continue to grow over the 1984-95 period that is the focus of this article. However, there is considerable uncertainty as to how rapid future growth will be, and what the employment implications are likely to be. This article, undertaken in connection with the Bureau of Labor Statistics' expanding coverage of the service sector, illustrates the wide range of possibilities. It sets up a series of alternative scenarios based on qualitative judgments about the possible course of events affecting the health services industry and provides projections of industry and occupational employment consistent with those assumptions.
The Bureau has for several decades developed medium-term projections of the U.S. economy under alternative sets of assumptions. …