Single-Payer System
The benefit would be universal coverage, but the government would be in a position to
impose massive supply-side rationing.
1. Requirements for the medical home model
• To be built on a foundation of accessibility, continuity, coordination, and
2. Requirements for community-oriented primary care
• Focus on primary care will require training of physicians
3. The Vermont Blueprint
4. Patient activation
• A person’s ability to manage his or her own health and utilization of health care
5. Patient-centered care
Respecting and responding to patients’ wants, needs and preferences, so that they can
make choices in their care that best fit their individual circumstances.
FUTURE WORKFORCE CHALLENGES
The nursing profession
THE FUTURE OF LONG-TERM CARE
• Baby boomers will start needing LTC in 2025
• Six main areas of concern need to be addressed:
1. Financing: Private long-term care insurance will be critical to relieve public
burden. Competing policies need to be comparable, and premium costs need to
become more affordable.
3. Infrastructure: New models of institutional care are emerging
4. Workforce: Shortage of workers in LTC will intensify. Training in geriatrics is
lacking.
GLOBAL THREATS AND INTERNATIONAL COOPERATION
• Natural disasters; industrial accidents; large-scale bioterrorism put strains on a single
nation’s capacity to deal with mass casualties
• Antibiotic resistance of infectious agents
NEW FRONTIERS IN CLINICAL TECHNOLOGY
• Genetic mapping, genometrics, molecular medicine, and gene therapy
• Personalized medicine and pharmacogenomics
• Drug design and delivery
• Imaging technologies
• Minimally invasive surgery
concentration
• Miniature implanted devices to take over damaged body functions
• Regenerative medicine to revive damaged organs
• Continuous monitoring of chronic conditions
THE FUTURE OF EVIDENCE-BASED HEALTH CARE
• High spending does not deliver better outcomes
• Better value through evidence-based medicine (EBM):
– Quality can be improved while reducing costs by reducing misuse and overuse
Strategies for Evidence-Based Care
• Ongoing emphasis on the adoption of EBM
• Ongoing development of computer-based models
• Ongoing clinical trials
• Keep guidelines current
Strategies for Comparative Effectiveness and Patient-Centered Research
• Identify new and emerging clinical interventions
• Review and synthesize current medical research
TERMINOLOGY
• Comparative effectiveness research— A concept in which a chosen medical intervention is
guided by scientific evidence on how well it would work compared to other available treatments.
• E-health plans—Internet-based health insurance plans. A wide variety of choices allows people
to tailor a plan that best fits their needs.
• Employer mandate—A legal requirement for employers to help pay for their employees’ health
insurance.
insurance to employees (“play”) or contribute, generally a certain percentage of payroll costs, to
a government-administered fund (“pay”) to provide health insurance for all who are not covered
by their employers.
• Single-payer plan—A health care reform proposal in which the financing of health care is in
the government’s hands.
REVIEW QUESTIONS
1. Explain the eight main forces that will determine future change in health care.
a. Social and demographic forces: Factors such as demographic shifts, cultural
factors, and lifestyles will affect both the demand for services and the supply of
2022.
c. Political forces: Health policy affects numerous areas in health care delivery, such
as access to health care, particularly by vulnerable groups. Health policy also
affects availability of services and health care professionals. For example, policies
that affect education at home, as well as immigration policies, can determine not
2. In what way should the delivery infrastructure change to meet the needs of a larger
number of insured Americans subsequent to health care reform?
A larger number of insured means a larger number of people who gain access to basic and
routine health care. A shortage of primary care physicians will create access bottlenecks for most
3. What is patient activation? What are the main challenges in activation?
Patient activation refers to a person’s ability to manage his or her own health and utilization of
health care. Activation faces two main challenges: (a) Patient’s own mindset greatly influences
4. What recommendations have been made to transform the nursing profession?
Four main recommendations have been put forth:
a. Uniformity in the scope of practice for advance practice nurses, which has been
5. What training is needed for primary care physicians to become “comprehensivists?”
Comprehensivists will need training in the following areas:
• Anticipating, preventing, and managing common complex conditions.
• Managing complex pharmacology.
6. What are some of the main reasons behind the deficits in geriatric training?
(1) There is a shortage of faculty in colleges and universities who are trained in geriatrics. Only
600 medical school faculty out of 100,000 list geriatrics as their primary specialty. 60% of
7. What are the main challenges faced by long-term care in the future?
Six main areas of concern have been identified:
– Financing: Private long-term care insurance will be critical to relieve public burden.
Competing policies need to be comparable, and premium costs need to become more
affordable.
8. Give an overview of what new technology might achieve in the delivery of health care.
The discovery of genetic susceptibility to certain diseases will improve preventive techniques.
Molecular medicine will allow treatment of diseases through gene therapy. Insertion of genes into
cells is expected to replace treatment with medications or surgery. Specific gene variations will be
matched with responses to particular medications to increase effectiveness and reduce unwanted
side effects. Rational drug design will shorten the drug discovery process. Nanotechnology has the
9. What role does international cooperation play in globalization?
Catastrophes, such as natural disasters, industrial accidents, bioterrorism, and threat of new
infectious diseases can occur anywhere in the world without warning. Such events can severely
10. What can be done to achieve greater adoption of evidence-based medicine in the delivery
of health care?
Six recommendations can be made to improve evidence-based protocols and their adoption
by practitioners:
a. Health care leaders must continue to emphasize the adoption of EBM..
