The Anatomy and Physiology of the US Health Care System in 2050? An Exercise in Prognostication, Fantasy, and Hope
The debate concerning the appropriate structure for the American medical system goes on. Almost every day, one reads a newspaper or magazine article focusing on the strengths and flaws of our health care network. Should we imitate successful systems elsewhere in the world? How can we insure all of our citizens without bankrupting the economy? How many physicians, nurses, and hospitals do we need and how many will we need in the future? These are just some of the questions that constantly bombard us. Like all physicians in the US, we have given these questions and many others considerable thought, which we will now share with the readers of The American Journal of Medicine. These are our own personal ideas and do not reflect the official attitudes or positions of the Journal, Elsevier, any political party, or the University of Arizona.
We anticipate that the current trend towards central control of medical care will continue, and that by 2050, most physicians will work for a health care system such as the one being formed by our university health care network here in Tucson.
Accountable care organizations involving community hospitals such as Tucson Medical Center already have been formed with community doctors and their Medicare patients. These will expand to incorporate more primary care and specialty physicians, along with patients outside of Medicare age.
Individual practitioners and small groups of physicians will gradually disappear, with large numbers of doctors working for the local or regional health system. Centralization will be focused in local entities rather than in Washington, DC or individual state capitals. Physicians will be salaried by these large health networks, with incentives given for productivity and performance.
The networks will contain many components, for example, inpatient and rehabilitation hospitals, outpatient clinics, ambulatory surgical and imaging centers, as well as satellite outpatient clinics and hospitals in outlying areas. The emergency medical system will be a patchwork of state, local community, and private entities that will work closely with the large health systems. Smaller cities may have only one health care network while major urban centers may contain a number of these integrated systems. It also is possible that some of the larger networks will have insurance companies embedded in their structure. Duty hours will be strictly regulated for both trainees and full-time employees.
Most, if not all, Americans will have some form of health insurance, with many still having coverage tied to employment. However, many individuals will receive insurance from regional or federal plans paid for, in part, by state and federal taxes.
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–Joseph S. Alpert and Eve Shapiro
–This article originally appeared in the December 2012 issue of The American Journal of Medicine.
