Sunday, June 25, 2006

Baby Boomers and the Tipping Point in Healthcare

There They Go Again

It's easy to blame it on the Baby Boomers but a more accurate way to see it is to say there exists a critical mass of people entering the Healthcare System. This critical mass of people with healthcare needs is one of the major factors stressing the current traditional platform for delivering healthcare and transforming it into a new platform for delivering healthcare. The traditional platform for delivering healthcare has been through the Patient-Physician relationship. There was a time when this platform was a superb way to deliver essentially all healthcare services. In fact much of the success of the modern Healthcare System is due to the strength of this relationship and that is exactly why it is difficult to believe it could be replaced. I don't just think it could be replaced; I think it is being replaced. So what exactly do the Baby Boomers have to do with the Patient-Physician relationship and a tipping point in healthcare?

The Straw That Broke The Camel's Back

Baby Boomers are a large cohort of our population that is moving through our culture and influencing everything they contact. They are the people born between 1946 and 1964 and currently living in the United States. The first of them will turn 65 years old in five years and they are expected to double the size of this age group in the next 25 years. One of the great results of our Healthcare System is that people are living longer and healthier lives. While people may be living longer and healthier lives they still must live with many of the chronic health problems that have yet to be eliminated. Fifty years ago we did not have many treatments for these types of health problems but now we do and people expect to have access to the full range of healthcare services available to treat them. There is nothing magical about the age of 65 or being labeled a Baby Boomer. The simple observation remains: We have a large cohort of individuals entering an age when chronic health problems begin to occur at an accelerated rate. This, coupled with the size of this group, is one of the main factors creating a strain on the system. What we keep referring to as a "Healthcare Crisis" is really the outward manifestation of a system that is stressed and undergoing a transformation. As the first wave of Baby Boomers passed the age when health problems accelerate, the tipping point was reached, and the "Healthcare Crisis" officially began. But this wasn't the only factor.

Supply

As I mentioned before the fundamental platform for delivering healthcare information and services has been through the Patient-Physician relationship. The physician was the gatekeeper to the information and the provider of services. Twentieth century healthcare produced an enormous amount of information in addition to a wide range of services. The traditional platform has reached the point of diminishing returns on its ability to provide access to the supply of all the available information and services. It is not a matter of training more doctors. The problem is that doctors are human and humans have their limits. As the supply of information and services grew physicians needed to develop ways in which to manage this increasing supply. In the early part of the twentieth century this was accomplished by improving the training of physicians. As information and services continued to grow physicians began to specialize. Instead of mastering all that medicine offered we mastered smaller and smaller parts of it. While this allowed for the continued growth of information and services it also created an increasingly fragmented process for delivering healthcare. We can train more doctors but this will only create further specialization and fragmentation of the delivery platform. The delivery platform must be a common interface for the patient and be capable of coordinating the delivery of all available information and services. This can't be done with humans alone. With the accelerating demand this will require a new type of platform.

Demand

Not only is the traditional platform currently incapable of delivering all the information and services but the demand, in the form of a large cohort in need of those services, is growing beyond the capacity to deliver them as well. I don't think of this as the demise of the Patient-Physician relationship but I do see this as the demise of the physician as the central and only delivery vehicle of our Healthcare System. This is evident in the tremendous growth of non-traditional forms of healthcare delivery in the last few years. With each passing day the ranks of non-physician providers continues to swell. Patients will continue to seek out the services that only physicians can supply but it is very clear that they won't hesitate to obtain all other services from non-physicians if the price is more affordable and the service more convenient. This is also evident in the explosive growth of information on the internet. People will continue to seek out any and all sources of information and have no intention of limiting their access to healthcare information by waiting for a doctor's appointment. So what will the delivery platform for an emerging paradigm of our Healthcare System look like in the future?

And The Ability to Deliver

My best guess is it will be some form of information technology interface. It will need to have access to all of the best available and up to date information and range of services. It must be available at all times. What form this interface takes is anyone's guess but I suspect its earliest form already exists as simply as a computer connected to the internet. In time its capabilities will grow and it will take on new forms. It will coordinate each individuals care and provide what information and services it can provide. Those services that it can't perform will be done first by non-physician providers if they are capable of providing those services. When they are unable then it will be the physicians who provide the services. The gatekeeper will be the information technology interface whose information and limited services will also be available to providers to augment their ability to deliver what services they are trained to provide. Whatever form it takes it must also be very affordable. There are currently 3.3 workers for each social security beneficiary but in 2031 it is estimated there will only be 2.1. When we add in the existing and newly added Medicare benefits this will place an enormous tax burden on the workers in the United States. It is not a matter of saying the costs of our Healthcare System should come down, they must and will come down. It may seem like it's going to be Baby Boomer hell but I am more optimistic. We will find a solution. It may not look anything like the system the Boomers grew up with but if we are to continue to provide the needed information and services it is going to probably take on a completely different form from what we have now. Baby Boomers will continue to shape and influence the world they live in but as I said in yesterday's post it may "be in ways none of us ever imagined or possibly even intended."

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