Category Archives: Healthcare Policy/Management

Hell is Freezing & Pigs are Flying

The growth of health spending in the United States is slowing!  No, this is not a typo.  Most policy wonks are surprised with some even muttering that there is room for optimism about the federal government’s long-term fiscal performance.

Of course, much of this trend is attributed to the recession.  But, more intriguing, it also may be due to changing behavior by consumers and providers of health care – meaning that the lower rates of growth might persist even as the economy improves .

In 2009 and 2010, total nationwide health care spending grew less than 4 percent per year, the slowest annual pace in more than 50 years.  After years of accounting for a growing share of economic activity, health spending held steady in 2010, at 18 percent of gross domestic product.

The slowdown was sharper than experts predicted.  The seemingly impossible may be happening – doctors and patients may have begun to change their behavior in ways that bend the cost curve.  Is it possible that hell is freezing and pigs are beginning to fly?  What could explain this remarkable trend?

It may just be a blip caused by the economy’s weakness.  But a few other more intriguing things are starting to happen.  There has been a surge of high-deductable health plans in which consumers have an incentive to think twice before heading to the doctor.  Another factor may be fewer expensive, novel drugs coming onto the market, as well as growing pressure to use generics which are much less expensive than “brand name” ones.  Lastly, health economists point to a shift toward accountable care, in which providers are paid for the quality of care, not the quantity of care.

I’m keeping an eye on this trend.  Hopefully, it’s not a fake-out.  Maybe we really are starting to figure out how to deliver care more effectively and efficiently.  And to all of us trying to live healthier lives, take a bow.


Yes, You Are in Healthcare. So Give Us Your Best Forecast

You may not actually work in the healthcare industry but you: (a) have been, are, or will be a patient, (b) you presumably are a taxpayer, and (2) 20% of your country’s GDP goes to healthcare.  I believe it’s called having a vested interest.

No one knows with any precision where healthcare is going.  Heck, this very day the Supreme Court is trying to decide the very consitutionality of healthcare reform that is so massive in scope and complexity that it makes my brain groan.

Take two aspirins and call in the morning?  No.  Develop scenarios, think them through, commit to one but stay flexible?  Yes.  That’s what I’m in the midst of doing.  And that’s why I need your help.

Here are summaries of four plausable scenarios for the future of healthcare.  They were developed by the Institute for Alternative Futures.  I would appreciate it if you would read them and vote for the one you believe most likely to emerge by 2025.  I know they are dramatically abridged and may overlap.  You can vote and comment below.

Scenario 1: Many need, many models – Things will not change much from how they are today.  There will be physician shortages, increased emphasis on prevention, expansion of electronic medical records, and increased disparity in care based on income and region.

Scenario 2: Lost decade, lost health – There will be more uninsured people both unemployed and employed.  Generally, peoples’ health will deteriorate.  Patients with good insurance will have access to great care enhanced by advanced technology.

Scenario 3: Primary care that works for all – Americans will enjoy nearly universal health care coverage, with 85% of patients using integrated systems staffed by teams of providers, including physician assistants, nurse practitioners and health coaches who work closely with patients.

Scenario 4: I am my own medical home – Many people will have catastrophic insurance with high deductibles.  Savvy consumers will use advanced technologies including noninvasive biomonitors and health management apps to stay healthy.  Most people will shop for the best doctor and buy on the basis of quality and price.