Scenarios Differ on Health Care in 2000 : Doctors Told of Stringent Cost Controls vs. Big Demand for High-Technology Services
Two sharply contrasting views of medicine in the year 2000 were presented Wednesday at an Orange County Medical Assn. forum on the future of health care.
The two scenarios were presented to more than 100 physicians at the forum, which focused on forecasts by the Institute for the Future, a Menlo Park nonprofit research facility in the midst of a 30-month study of the social, economic, demographic, technological and political forces shaping the health care industry.
Much of the information presented by researchers J. Ian Morrison and Gregory Schmid painted a grim picture for physicians.
The two views of the year 2000 went like this:
- Insurance companies, businesses and government will have imposed such stringent cost controls that the vast majority of patients will have health insurance plans that restrict which doctors, hospitals and clinics they can go to for medical care. While there will be more doctors than ever before, a new health care worker in an increasingly important role will emerge--the “manager of care,” an intermediary who balances medical concerns against financial worries.
- An aging, prosperous and well-educated population, living in the midst of technological advances, will have sparked an explosion of health care services. Baby-boomers in the bloom of middle age and their elderly parents will demand more and better medical care, and a glut of physicians will be competing to provide it.
Both scenarios are based on interviews with experts, and the differences between them are a result of disparities in the experts’ forecasts. At Wednesday’s session, the first scenario was presented by Schmid, the second by Morrison.
Dr. Richard F. Corlin, the California Medical Assn.’s speaker of the house and moderator of Wednesday’s panel discussion, cautioned doctors attending the forum against panic. Physicians 50 years ago were concerned about the changing face of medicine, and doctors of the future will continue to have those worries, he said.
‘Better to Be a Physician’
“It’s still going to be better to be a physician than anything else, unless you’re seven feet tall and have a terrific hook shot,” he said.
The researchers drew up the two scenarios after studying demographics and interviewing experts in the medical industry and the fields of economics and public opinion.
Under the first scenario, only 25% of patients in the year 2000 will continue to choose a doctor and pay for medical services in the traditional way, Schmid said. More than half of the U.S. public instead will have contracts with a certain doctor or group of doctors, and the contracts will closely define how much, what kind and where medical care will be provided, he said.
These changes will be brought about by many forces, Schmid told the physicians. The baby-boom generation, born between 1945 and 1965, will be older, family-oriented and concerned about finances. At the same time, businesses will continue to keep a close eye on the profit margin, and the “focus on saving money in the health care area will continue,” Schmid said. Government, likewise, will still be grappling with the deficit and will not likely approve new, more expensive health care policies, he said.
A change in public attitudes toward doctors will help bring about the economic transformation, he said. Where the public once held doctors in higher regard than other professions, that confidence has been sagging in recent years and will continue to drop, Schmid said. “The special place of medicine will become less and less over time,” he said.
The surge in numbers of physicians will underscore the lack of prestige, he said. In 1970 there were 311,000 physicians nationwide; in 2000, there will be 619,000, he said. Accordingly, the average physician’s income will drop from $110,000 in 1985 to $100,000 in 2000, he projected.
That scenario, however, contrasted sharply with the second picture of the future, as painted by Morrison. Under the alternate scenario--the minority view--”the prevailing attitude is people want more,” Morrison said. New medical technology will be developed, and a better-educated population will want to use it, he said.
Demands of Elderly
The number of elderly people, with their intensive demands for health care, will grow by 2000. “These will be people who know their rights” and will demand the best care, Morrison said. “This will not be passive patient fodder.”
But at the same time, there will be a “no-care zone” for the elderly, he said. The baby-boomers--the children of the elderly--will all be at work, as the double-career household will be the norm, he said. Women, who traditionally have taken ailing parents into their households, “won’t be home to take care of granny,” Morrison said.
Despite the cost controls defined in the first scenario, both pictures of the future call for more dollars--up to 80% more--to be spent on health care by 2000. The first scenario assumes that about $622 billion will be spent on health care; the second estimates the cost at $790 billion.
Although the predicted physician surplus will affect the entire nation, Orange County, as a prosperous and technologically advanced community, should expect an especially heavy influx of new doctors, they said. And if the first scenario comes to pass, Orange County will be especially hard hit by the changing medical insurance picture, they said.
About 55% of Orange County’s patients currently pay for medical care through private insurance and 45% are financed through government health care programs, Morrison said.
“Think about what business will do,” he said. “That’s more important (in Orange County) than what government will do.”
A representative of the insurance industry told doctors at the forum that he preferred the first scenario to the second.
“Corporate America is not interested in providing Cadillac care” when it comes to health benefits, said Harry G. Bubb, chief executive of Pacific Mutual Life Insurance Co. Businesses are more willing to provide “a stripped Chevy” while offering employees the flexibility to shape their own benefit packages in order to add extras, if wanted, he said.
Another panel member, Dr. Laurence D. Wellikson, an Orange County Medical Assn. board member, said physicians must begin thinking about providing less, not more, care to failing, elderly patients when the costs of heroic measures are disproportionate to the time left to live.
Denying care “is difficult to do,” Wellikson said. It puts the physician in an “unfamiliar role” and can invite liability problems as well as the wrath of “the unhappy cousin from Dubuque who flies in for the last 60 minutes of life,” he said.
Dr. Michael T. Kennedy, Orange County Medical Assn. president, agreed but said that a recent survey showed that physicians are alone in looking at the issue.
“That’s something the country’s going to have to face. The doctors already have faced it,” he said.
