2023 U.S. Healthcare Projections (Part 1)
We have witnessed an unprecedented three (3) years in healthcare directly attributable to the COVID-19 pandemic. The U.S. healthcare system is adjusting to get back to normal, which begs us to ask exactly what is “normal” now? We are in the middle of the largest work force shifts as one of the most productive generations are ‘aging out’ and beginning to collectively increase their consumption of healthcare. These Baby-Boomers that have collectively been the innovators, entrepreneurs, and driving force of economic growth began in 1946, and are now between the ages of and 58 and 77 years old. This generation of Americans peaked at 77 million and is now estimated at 73 million. By 2030, all Baby-Boomers will be over the age of 65 and eligible for Medicare and Social Security retirement. The impact on healthcare cost, services, and use of technology will be dramatic.
THE INCREASING COST OF HEALTHCARE
In 2022, the total U.S. healthcare cost was reported as more than US$4 trillion which accounted for over 20% of total U.S. Gross Domestic Product (GDP), and based upon trends, healthcare cost has nowhere to go but up. In the same year, the U.S. healthcare spending accounted for 40% of ALL GLOBAL healthcare expenditures. Since 1960, when record keeping began, the U.S. healthcare cost was about 5% of GDP and healthcare spending has continued a steady growth nearly every year as compared to GDP. I can recall only a couple of years where growth had slowed and was nearly flat. Only one year comes to mind that the growth rate dropped. That year was most assuredly related to COVID’s impact on physician lockdown, and limited patient access to care, creating a boomerang in spending the following period.
PROVIDERS/HOSPITALS HEALTHCARE IMPACT
The impact of retiring Baby Boomers is being felt in many areas of the U.S. economy from productivity to one of the largest in Medicare and Medicaid spending. All U.S. workers become eligible for Medicare at 65 creating the U.S. government’s largest expenditure category after social security. In 2022, the cost was over $US767 billion; however, if you account for those that have dual eligibility, Medicare and Medicaid, that quality for both drives this number higher. Keep in mind that the problem of the aging work force and declining population growth is not restricted to the U.S. alone. Many other developed nations are seeing their most productive generation retiring, as well as their population dwindles – two forces that are converging to have continuing adverse impact on healthcare cost.
It is estimated that 19% of the U.S. population, or about 65 million Americans, are receiving Medicare benefits. It can be demonstrated, based on actuarial statistics, that healthcare cost in the U.S. and globally will continue to increase in relation to GDP for next generation, unless there is expected or unpredictable growth in productivity and total GDP.
One of the biggest battles in the House of Representatives is arriving at the U.S. Federal budget every year, and how much Medicare will pay for services. In 2023 alone, physicians’ healthcare payments were to be reduced by about 4.5%; however, with tremendous industry lobbying, the cut was reduced to only 2% (more on that in the next blog). What is not seen in this one number is all the previous years in which Medicare reimbursements were reduced, which has trimmed the amount providers are paid for their services by approximately 12% over the past 10 years. This problem is now exacerbated for physicians by high inflation environment, and the tightening labor market. The increasing cost of operation due to clinical labor issues, coupled with rising inflation, is a double-blow to many practices. This is forcing many providers, who can close their operations, to retire early.
The deteriorating clinical care labor force in provider practices and hospitals, due to after-effects of COVID-19, including burnout, disenchantment, overwork, and retirement is an issue that cannot be addressed solely by attempting to increase the enrollments in nursing and medical schools. The labor supply gap is now too large and growing by the year. These factors are combined with the increased demand on the healthcare system by the retiring Baby Boomer generation, without any contribution from existing COVID-19 variants or novel diseases that appear or reappear in the population.
TECHNOLOGY IS THE ONLY SOLUTION
The issues are substantial for both governments and taxpayers, as well as providers of care, and ultimately fall to the beneficiaries of healthcare – the consumer. The problems will get worse, not better, and it is very likely that the Baby-Boomer generation will leave a lifetime of change in healthcare, likely because of its’ use of technology – if consumer driven bias and its desire to stay independent and in control more than any previous generation. In fact, technology is presently the only path to provide any hope of retaining any semblance of quality of care, if not prevent a catastrophic implosion of the U.S. healthcare system. It is self-evident that the short-term answer, if not longer-term answer, is to leverage existing labor to allow more to be done by fewer clinical staff and reduce the burden and stress already present.
Regardless of the area in healthcare, there is an abundance of solutions looking for problems. The difficulty lies in the fact that most of these solutions are too specific and too tailored in one small area of healthcare when what is needed is a broader and more integrated approach.
Take for example the tens of thousands of wearable medical devices on the market today – some clinical data approved and some simply for sport. Nevertheless, these devices are obtaining data from the individual that is going to the manufacturers’ ‘data silo’ and typically unavailable for use by anyone other than the consumer whether for comparative purposes or even the narrow band of clinical diagnosis. This is one segment that must change and in unison with several others.
Electronic Medical Records (EMRs) have quite simply failed to deliver on the goals and promises; however, that does not mean we throw out the ‘baby out with the bathwater.’ What is needed is a new approach, one in which the consumer has control over their medical data and is aggregated from as many of their past and current physicians and hospital records as possible. EMRs are yet another perfect example of data silos, and regardless of whatever herculean efforts are expended to bring interoperability, the issue will always come down to trust in the underlying data.
In coming blogs, we will explore the issues providers and hospitals are facing, as well as consumers. In addition to how Technology, when properly and intelligently applied, can bring a tremendous leap forward in quality of care, access to physician/clinical services, and begin to reduce the cost of healthcare. We must find ways to expand the system at a time when the economics and labor issues are forcing a contraction.
-Noel J. Guillama, Chairman