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Tighter Funds, Older People & New Ideas: The Changing Face of Healthcare

By Experience

Interested in the top trends in healthcare? Good, because we've got 6 of them listed here.

Health care has and is still changing from the fee-for-service model of the past. HMOs, Medicare, Medicaid, and hospital consolidations have all had a significant impact on the way physicians, nurses, and administrators deal with both sick and healthy patients. Public policy focusing on basic services such as immunizations was unheard of until the late 1960s. Keeping track of the trends in health care can be a daily activity, but here are some important changes.

1. Complementary medicine/alternative health care

Alternative medicine refers to methods and practices that are not routinely taught in U.S. medical schools. What most of the United States views as health care is known as Western Medicine; however, there are treatments found throughout the world that Western Medicine is beginning to view as effective. As far back as 1992, Congress established the Office of Alternative Medicine (OAM) as part of the National Institutes of Health (NIH). The OAM's budget has grown from $2 million in 1993 to over $50 million currently. In 2000, the National Institutes of health opened the National Center for Complementary and Alternative  Medicine with about $68.7 million in federal funds. Complementary and Alternative health care and medical practices are divided into five major areas: alternative medical systems, such as homeopathy; mind-body interventions, such as meditation and art therapy; biologically-based treatments, such as herbal therapies; manipulative and body-based methods, such as massage therapy and chiropractic methods; and energy therapies, such as therapeutic touch.

The burgeoning complementary and alternative health care field is in part influenced by managed care plans. Practitioners now have less time to spend with the patient, therefore, many patients are taking responsibility for their own health, and looking into alternative options. And, hospitals are slowly starting to allow practitioners in massage and aromatherapy in. Physicians are at least becoming educated about alternative medicine, if only to understand what some of their patients are talking about.

2. Shorter hospital stays

Running a hospital is an expensive proposition- the longer a patient occupies a bed, the more money it costs. A major change in health care during the past decade has been to find ways to deliver high-quality care that reduces the number of days a patient needs to stay in the hospital. By using use outpatient services like physical therapy and home health care, all but the most critically ill patients can be cared for outside the hospital. Industry insiders and consumers do worry that cheaper isn't necessarily better, but hospitals strive to make certain that patients' conditions are not made worse by earlier discharges. As a result, many of the nation's 840,000 hospital beds stay empty, causing financial problems for the hospitals. Since patients stay fewer days in hospitals, the federal government has reduced what it pays hospitals. Some hospitals have concluded that the only way to combat this is to reduce the beds and acute care services, leaving only "satellite" emergency care rooms. At least four hospitals in New Jersey are already pursuing this option.

3. For-profit

Though health care was traditionally a non-profit industry, today there are many managed-care plans, many of which are for-profit. Profits go to shareholders and toward the considerable marketing expense aimed at keeping existing members and recruiting new ones. In many for-profit plans, shareholders put pressure on administrators to keep costs low, and as a result, profits high. Industry insiders and consumers agree that quality of care is often lower in for-profit plans. Managed care seemed to work for a few years in the mid-1990s, because medical costs didn't grow faster than the rate of inflation. Now, health care costs are on the rise again, and now employers are under pressure to pass along more health care expenses to employees through higher co-pays and deductibles. Despite the near-universal misgivings about managed care, it's not likely that we'll ever see the return of the old fee-for-service system.

4. Capitation

In days gone by, when a patient got sick, doctors got paid. Every illness, though unfortunate, represented an invoice. In many managed care plans, "capitation," (taken from the idea of per capita, or per person) is the rule. Capitation means that physicians agree to a contract with the managed care organization; the contract pays that physician a set fee for services per member, per month. If patients need moderate levels of care, the fees are adequate. For patients who need extensive attention, the provider may be reluctant to give more care than the managed care plan is prepared to pay for. The downside for physicians is that they are left responsible for costs over and above their total capitated earnings.

5. Defined contribution health plans

In the wake of the backlash against managed care, the defined contribution health plan is a new, yet controversial benefit concept that could potentially save money for employers (two-thirds of all Americans get health care coverage through their employer) and would turn employees into "consumers." The idea behind this type of proposal -referred to as a voucher plan- is that employers would provide cash so employees could purchase their own insurance directly- from a variety of options. One of the potential disadvantages is placing the burden of complex insurance decisions- as well as potential grievances and claim appeals- on employees. A few employers have experimented with this method, but defined contribution health plans will most likely take years to catch on, if they do at all.

6. The aging population

The growth of the fitness industry, combined with evidence that regular exercise can stave off some aspects of the aging process, means more pulled muscles, knee problems, and back pain for our quickly aging population. It's expected that the workload for sports medicine specialists and physical therapists will dramatically increase during the next decade. The number of those aged 85 and older will nearly triple between now and 2030- from 3 million to more than 8 million. The demand for more health care services is expected to dramatically rise. Geriatric specialists, home health programs, and other specialized programs aimed at the aging population will also expand.

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