Ian Morrison

The future of healthcare is always clear to futurists: it will be different because of aging and technology. We have been saying this for a long time. Yet if you look at American healthcare from 30,000 feet what do you see? The over 65 population today accounts for only 13% of the population, up from 11% in 1980. We still have a healthcare delivery system in which physicians see patients for 15-20 minutes and decide what to do based on what the doctor learned in medical school or picked up through continuing medical education. We still have hospitals and nursing homes and physicians offices organized in much the same way they were 50 years ago. True, there are lots of new technologies that allow hospital stays to be shorter and to turn patients living rooms into ICUs, but the institutions really haven’t changed much. Despite managed care, third parties still pay for healthcare on a fee for service basis. The American healthcare system has a remarkable ability to resist change. We need to innovate.

And, there are powerful forces that will require us to innovate. First, there are the futurist’s friends-aging and technology. By 2025 a full 20% of the population will be over 65. And they will not be the passive stoics of Tom Brokaw’s “Greatest Generation” they will be cranky, selfish, self-indulgent baby boomers like me. They will want everything and sacrifice nothing. Armed with information and attitude they will demand the best that technology can offer. And technology will oblige. The combination of progress in medical science and information technology holds the promise of dazzling new interventions that will be incredibly effective and expensive . We will want it all. Moreover, the fledgling science of genomics will mature to a point where care will have to be customized to my particular gene profile to be most effective.

Will the combination of new science and aging, demanding consumers be simply bolted on to the current chassis of healthcare financing and delivery? Most healthcare experts believe this does not compute. We desperately need to innovate.

Innovation is required at the policy level. Who should pay for healthcare and how? It is fashionable to talk about defined contribution health plans and consumer directed healthcare, but how much tiering in healthcare will we tolerate as a society? If genomics and genetic testing advance as experts predict and we will have many tests that accurately predict an individual’s likelihood of disease, what does that mean for the concept of experience-related health insurance?

Innovation is required in financing healthcare. Consumers are going to be more responsible for paying for care but through what mechanisms? Managed care needs to reinvent itself or move aside.

But the greatest innovation must come in the delivery of medical care. Healthcare needs to redesigned to fully take advantage of advances in information technology such as the internet. The medicine of the future needs to be high tech and high touch, it needs to combine the potential efficiency of e-commerce with compassion and caring from motivated professionals.

Such innovation will require real leadership from policymakers, entrepreneurs, and physicians alike. The stakes are high. If we don’t innovate it could get ugly.

Ian Morrison is an author, consultant and futurist based in Menlo Park, California. This essay was published in Aetna’s Annual Report 2000: What Leaders Must Do.