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We are all futurists. We all have to make predictions—even if only implicitly—about the future to shape our lives: to determine what job we take, where to live, whether to buy a house, whether to get additional education or training and in what subjects, and on and on. The same is true for the 22 million people employed in health care in the US as well as health investors and government policy makers. Thus, it is essential to periodically consider trends in the health care system, to figure out how to benefit from them, to assess how to bolster beneficial trends or to impede those that seem unhelpful or even harmful. What does the future hold for health care?
In this three-part article, I present nine “megatrends” that I believe will characterize US health over the rest of this decade. They follow on the trends I identified eight years ago in my book Reinventing American Health Care. Below, in Part 1 of this article, I discuss the megatrends I predict related to system and payment reform. Part 2 will cover trends related to system reconfiguration, and Part 3 will focus on patient care trends.
As with everything, how these trends play out—especially how extensively and rapidly they are implemented and develop—will depend on government action, the overall economy, and commitment by those in the health care industry. As I discuss, not all of the trends I predicted in 2014 developed in the time frames I envisioned. But in my judgment, the trends I lay out in this article represent what is likely to happen.
At least for the foreseeable future, substantial federal government action—on the order of the Social Security Amendments of 1983 that created prospective payments for hospital inpatient care or the Balanced Budget Act of 1997 that created Medicare Part C, much less the Affordable Care Act (ACA)—is unlikely. After the Inflation Reduction Act, there is unlikely to be significant new health care legislation for the rest of the decade unless a crisis precipitates the need to do more to rein in costs. The only other major issue requiring legislation will be the impending insolvency of the Medicare trust fund, now projected for 2028. But none of the options to address this issue are attractive, so procrastination reigns. Consequently, much of the future of the health care industry lies in Centers for Medicare and Medicaid Innovation demonstrations projects and the decisions of the private sector.