Academic journal article Frontiers of Health Services Management

Beyond Technology and Managed Care: The Health System Considers Ten Future Trends

Academic journal article Frontiers of Health Services Management

Beyond Technology and Managed Care: The Health System Considers Ten Future Trends

Article excerpt

SUMMARY - INSTEAD OF EQUATING the future of healthcare with the future of medical technology, this article summarizes ten external trends that will affect the conditions under which healthcare operates in ways that will be transformational whether embraced by the leadership of healthcare organizations or by policymakers. Ten trends are highlighted that are visible now, though underappreciated for their power. Oddly enough, the first trend is weather, the furthest condition from day-to-day healthcare operations. The various dynamics of population change come next, followed by globalism, the long boom, decline of the nation-state, conflicts of civilizations, female leadership, Internet-based health services, genetics, and mind-based medicine. Possible healthcare effects of these trends are presented, along with a scenario of future health services. Finally, a suggestion is made about modernizing healthcare infrastructure so as to liberate entrepreneurial forces that are apt to be the source of the majority of transformation.

THE MOMENTOUS YEAR 2000 has arrived-the year that still caps most healthcare strategic plans. What happens next? What should the next strategic plan consider?

Healthcare executives and boards are no different from most business people-they respond to annual rhythms of budgets, vacations, flu season, competitive contracting cycles, Medicare policy changes, joint Commission visits, and the drama of major building projects. Ask any one of them where the organization will be in 25 years, and the answer is apt to be, "We can't even plan for three years from now." Yet these same people, when asked 'Are you operating the same way you were 25 years ago?," will be quick to describe how payment, medical care, staffing, facilities, regulation, market position, and even public confidence are substantially different.

To plan only in the short-term essentially means that underneath is a tacit assumption that fundamentals are solid, and that only superficial changes in conditions will occur from year to year. "Payors may merge and gain market share; we'll adjust." "The government may take away our notfor-profit status; we'll adjust." "Our surgeons may be using baboon hearts, so we are in a legal/bioethical thicket; we'll adjust." What they mean is, "We will stay the same, only bigger or smaller." Unfortunately, nearly everything about the future health system will be different. It's time to open up to the influences from outside of healthcare and understand what they mean.

There is an American mind-set that equates future thinking with fantasy entertainment, or with cults, or with crackpots who gain their moments of fame by being absurd. The middle ground-to think of the future as sets of options, of alternative scenarios, of choices that remain open, of patterns of development similar to historic development cyclesdoes not come easily to day-to-day managers. Yet few can be unaware that the ground on which they now stand is not secure and that if anything is certain it is that the hospitalcentric healthcare system is being transformed.

In the interest of giving executives and their boards an agenda for such discussions, ten long-wave trends and their implications have been culled from the hundreds of future-oriented ideas that authors have offered in anticipation of the 2000 watershed.


Global weather patterns are the trend least amenable to humanity's actions. Even if experts disagree about whether global warming is taking place or just is the result of better measurements, at least this current weather pattern is a cause for paying attention to its effects (Karl, Nicholls, and Gregory 1997). The ozone hole is widening, bringing melanoma to affected zones. Warmer ocean temperatures are melting glaciers and ice caps, increasing floods and major storms. As ocean water warms, it incubates microbes that can cause epidemics such as the recent Bangladesh cholera, which was traced to an upwelling ocean current. …

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