What will health care look like in 2025?

Analysis suggests four scenarios

By 2025, patient-doctor relationships and health care delivery will look radically different than they do today, according to the Institute for Alternative Futures.

Working with more than 50 national health care leaders, the Institute for Alternative Futures, a nonprofit think tank based in Alexandria, Va., has created four scenarios to show what primary care might look like in 2025.

Clement Bezold, the institute’s chair, says the organization’s projections reflect how primary care may be shaped by factors such as a slow economic recovery or another recession, federal debt, an aging population, unsustainable health care costs, pressure for cuts in Medicare and Medicaid payments, an explosion of information available through the Internet and social media, and “empowered, motivated consumers.”

Nationally, health care cost $2.57 trillion in 2011—17 percent of the gross domestic product—and is expected to grow to 20 percent of the gross domestic product by 2020. Bezold  says while other sectors—including retail, manufacturing, finance, insurance and real estate—learned to do more with less, the number of health care employees grew between 1990 and 2010, resulting in lower per capita productivity. Health care premiums have increased 131 percent since 1999, compared to a 38 percent increase in workers’ earnings and an overall inflation rate of 28 percent during the same period.

“The four scenarios provide the means to bound the uncertainty of the future. They include our best estimates,” Bezold says. “You will see more virtual care, personal health avatars and doctors operating remotely. But the scenarios also include challenging and visionary possibilities. We identify what is likely, what is challenging and what is preferable so policymakers, health care professionals and consumers can think about and help shape the future.”

The scenarios the group identified are:

1. Many needs, many models. This scenario is a natural extension of health care as many Americans know it. The scenario forecasts a shortage of primary care physicians, increased emphasis on disease prevention, growth in electronic medical recordkeeping, a shift from employee-based insurance to health insurance exchanges, and growing disparities in access to and quality of primary care based on income and where people live.

2. Lost decade, lost health. This scenario forecasts a shortage of primary care physicians, declining income for practicing physicians and more uninsured patients, some of whom resort to black market care and unreliable online advice. Patients with good insurance have access to great care enhanced by advanced technology.

3. Primary care that works for all. This scenario assumes nearly universal health care coverage, with 85 percent of patients using integrated systems staffed by collaborative teams of health care providers, including physician assistants, nurse practitioners and health coaches who work closely with patients. Seeking to provide better care at lower cost while improving the health of the population they serve, primary care teams join with community partners to address factors that affect a community’s health, including employment, educational attainment, housing, transportation, and access to fruits and vegetables.

4. Consumer is boss. Under this scenario, four of 10 patients opt for consumer directed health plans, which include catastrophic insurance with high deductibles. For the most part, savvy consumers use advanced technologies, including noninvasive biomonitors and wellness and disease management apps, to stay healthy. Large vendors offer free avatar-based health coaching to consumers who purchase other integrated health products and services. Consumers shop for the best doctor and buy on the basis of high quality and low price.

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