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Topics. Trends • Insurance Public Programs • Healthcare Reform Wellness & Prevention • Chronic Conditions Long-Term Care • Infectious Diseases Public Health • Hospitals The HC Workforce • Other Trends.

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  1. Topics • Trends • Insurance • Public Programs • Healthcare Reform • Wellness & Prevention • Chronic Conditions • Long-Term Care • Infectious Diseases • Public Health • Hospitals • The HC Workforce • Other Trends “Any attempts to project the future of health care provoke more questions than answers.” Text, p. 562

  2. Trends • The semester has been a historical review of the HC delivery system in the US (with a peek at other countries along the way) • What have been the major trends we have seen? • Technical and knowledge advances • HC worker education and training • Changes in organizations offering HC • Changes in insurance and other payers • Changes in the roles of governments • Changes in public (and voter) attitudes • Demand for healthcare

  3. Trends (cont.) • What elements of the US HC System are currently in a state of flux? • Which elements have major transitions in progress at the current time? • Technical and knowledge advances • HC worker education and training • Changes in organizations offering HC • Changes in insurance and other payers • Changes in the roles of governments • Changes in public (and voter) attitudes • Demand for healthcare

  4. Trends (cont.) • What new and existing trends do we expect to see in the future? • How do we expect these trends to affect us… • …personally? • …professionally? • Technical and knowledge advances • HC worker education and training • Changes in organizations offering HC • Changes in insurance and other payers • Changes in the roles of governments • Changes in public (and voter) attitudes • Demand for healthcare

  5. Insurance • What is the 900 lb gorilla facing payers of insurance programs today? • What was the economic condition that gave rise to employer-sponsored health insurance? • What economic changes have we seen to this situation? • What are the reduced or changed employee insurance benefits that have resulted? • What changes might we expect in the future?

  6. Insurance (cont.) • How do the following initiatives affect participants and why were they implemented? • High-deductable health plans (> $1,000 individual or > $2,000 family) • Health Reimbursement Arrangement • Health Savings Account • Defined contribution plans (vs. defined benefit) • Parallel with retirement plans

  7. Public Programs • What changes have we seen to Medicaid and Medicare and how are they responsive to ongoing trends? • Managed care • Prescription benefits • Medicaid eligibility • SCHIP and similar programs • What is the 900 lb gorilla for Medicare?

  8. Healthcare Reform • Note that the book was written before passage of the Patient Protection and Affordable Care Act of 2010 and even before the 2007 presidential election • Which of the three approaches to HC reform was incorporated into the PPACA? • Single Payer • Managed Competition • Play-or-Pay • Employer Mandate

  9. Healthcare Reform (cont.) • What are the provisions of the PPACA of 2010? • You should be able to look at almost any provision of this Act and… • …Identify the problem it was designed to address • …Identify who will benefit from the provision • …Identify who will pay for the provision • Cover non-monetary ‘costs’ or impacts • …Identify other impacts of the provision

  10. Wellness and Prevention • Why are wellness and prevention so important in future HC policy? • What are the fundamental problems with addressing HC costs through wellness and prevention programs?

  11. Chronic Conditions • What is the perverse result of improved HC on the prevalence (and cost) of chronic conditions? • What is the role of existing coverage for those with chronic conditions? • Are there coverage gaps which suggest big impacts for targeted policy or coverage changes?

  12. Long-Term Care Issues • The Baby Boom dominates the long-term care landscape • Increasing demand for services • Declining labor force to provide services • What are the financing issues that dominate the LT Care field? • What are the incentives to change existing programs? • Why is LT care financing tilted toward institutional care?

  13. Infectious Diseases • New diseases and new (more virulent) strains of existing diseases continue to emerge • Managing Widespread infections (epidemics) and prevention goes well beyond the resources and coordinating ability of individual providers • Increasingly global travel and trade make disease control problematic • Responses include diplomatic efforts in addition to medical planning and action

  14. Public Health • Most HC plans and programs focus on individuals and groups. • Public health policy focuses on geography • Parallels private and government activities at the local, state, and federal level • Addresses local issues • Environment • Trends • Performance • Lifestyle change • Provider of last resort • Monitoring • Emergency response

  15. Hospitals • What are the trends we have seen in the ownership, financing, structure, and operation of hospitals? • How do we expect other trends to affect them? • Demographic shifts • Cost control pressures • Healthcare policy • The “supply chain” of patients and providers

  16. The Healthcare Workforce • Physicians • Increasing supply of physicians… • …offset by increasing demand… • …for a projected shortage by 2020 • Specialty and geographic maldistributions expected to continue • Shortages of primary care physicians

  17. The Healthcare Workforce (cont.) • Nurses • Nursing shortages are typically cyclical • Current shortage is the longest we have seen • Are there differences with this one? • Increasing demand • Stagnant supply from slowly increasing training programs • What policy responses might we expect to see?

  18. The Healthcare Workforce (cont.) • What trends from other topics we have seen will affect the HC workforce? • Hours worked • Employment models • Specialty selections • Work conditions • Team approaches • Changing hospital business models • Shift to preventive care • Managed care pressures

  19. Other Trends • Customer service focus based on two healthcare worlds • Customers with the ability to pay and discrimination regarding quality of service • Convenience • Atmosphere • Ambiance • Customers seeking any provider available

  20. Other Trends • New technology will not stop • See eight trends in the chapter • Some are massively exciting the way the first use of anesthesia or antiseptics were • Evidence-based medicine • Various pressures affect HC efficiency and quality management • Managed care pressures • Publicized differences in outcomes • EBM requires physicians to be aware of and willing to follow evidence-based guidelines

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