Medicine is being transformed not only by technological breakthroughs, but also by changing attitudes of patients and shifts in the political and economic environment.
"For the past fifteen or twenty years, the American health-care system has been undergoing a major transition. Probably the greatest change has involved the transfer of power and authority from physicians to patients and third parties," says Denton A. Cooley, a cardiac surgeon with the Texas Heart Institute, in Looking Forward: The Next Forty Years.
Cooley explains that there was little review of decisions and spending in medicine until the 1970s, when doctors became increasingly accountable to insurers, regulators, and lawyers, due to economic conditions as well as a growing number of malpractice lawsuits. Patients have also increasingly demanded medical solutions to a variety of non-health-related problems, such as baldness and sagging chinlines.
In this context, Cooley offers his top 10 predictions for health and medicine in the early twenty-first century:
* Health-care facilities will be pushed to the limit by an increase in the number of elderly. Americans are now older for a longer time. By 2030, the United States will have twice as many senior citizens as it does today, 70% of them women.
* America's health-care system may be restructured to resemble the current Canadian or British systems. Every citizen would have a basic level of government-funded care, with more-specialized treatment financed through patients or insurance companies. Today, there are 35 million Americans who are uninsured, many of them children.
* Traditional surgery will lose ground to outpatient-oriented procedures. Major incisions during surgery tend to cause more trauma than anything else. During the next decade, endoscopic or "keyhole" techniques, which result in less trauma, will allow patients to recover quicker and go home sooner.
* Hospitals will primarily be for the acutely ill. During the next few decades, the number of hospitalized patients will shrink by half. Hospitals will be defined not by the number of beds, but by the types of services provided, such as outpatient surgery, birthing facilities, and outpatient rehabilitation.
* Emphasis will move from technology-intensive intervention to preventive measures. Medicine has been very treatment-oriented, says Cooley. As costs continue to rise, preventive medicine will take hold as a more cost-efficient alternative. …