Health care futures. What lies ahead? Where are we going? Panel discussion

Who would have guessed that managed care would dominate the health care industry in the final two decades of the millennium? That physicians would be joining labor unions? Or that they would be going back to school to become Fellows of the American College of Physician Executives? To find out what may be in store for health care in America five to 10 years hence, The Physician Executive asked nine health care experts to participate in a two-part panel discussion. Here's what they see ahead in managed care, information technology, and biotechnology. Part 2 will appear in the July/August Issue of The Physician Executive.     

The next step for physician executives?

The next step for career growth for many physician executives will be the top leadership role in a health care organization. The availability of such positions for physicians has been limited in the past but could very well open in the future. As physicians, administrators, and boards begin to trust each other more and form meaningful partnerships, the potential for physician CEOs increases. In 1997, the Physician Executive Management Center conducted surveys of physicians serving in CEO roles in hospitals and group practices throughout the country. We compared the results with earlier surveys we had conducted since 1986. This article reports the significant findings of these surveys on areas such as employment contracts, job duties, skills and talents, and remuneration.     

Physician leadership. How do physician executives view themselves?

Most physician executives today have acquired substantial management training and experience, and many have worked with and relied on the expertise of mentors for their career guidance and development. Physician executives are actually becoming executives who happen to be physicians. They view themselves first as leaders, then as physicians, and finally as managers. That is a remarkable transformation in perception. To chronicle this process, Witt/Kieffer, Ford, Hadelman & Lloyd conducted a national survey this spring among senior physician executives in both payer and provider organizations. The data provide a "snapshot" of their role, and may also suggest some future scenarios for the industry. The primary reasons for choosing to pursue a management role noted by most participants include a desire to be part of the health care solution and an interest in management and leadership challenges.     

Health care reform. Gridlock and pork?

Can Americans expect the same gridlock and pork between now and the 21st Century? What are the possible directions that the United States can move in regarding health care reform and the long-term financing of health entitlement programs? Here, the author offers a snapshot of current politics and some predictions for the next four years. And explores the question: Are Americans willing to make the necessary sacrifices for future generations to profit by the significant changes needed by entitlement and health reform, or will it be business as usual? America's centrist perspective was recently reinforced by the 1996 election, suggesting that no major innovations in entitlement or in the health system should be anticipated in the next four years.     

Health care evolution. Or is it?

Should we be using evolution as our theory for understanding the radical changes overtaking medicine? Evolution is a theory for explaining changes in biological systems. The power and simplicity of evolutionary theory have made it the major scientific framework for looking at why certain animals and plants dominate ecosystems, and why one species dies out only to be replaced by another. Health care is a socio-economic system--changes occur because of scientific, economic, and political reasons. Using evolutionary jargon and examples can lead us astray. So, why do we often use evolutionary language and ideas and what is a better way of looking at the changes confronting the industry at such a rapid pace? This author finds the answer in dialectic thinking.     

Health care technology--information technology/Part 4. Why will the Internet be important to clinicians?

As the popularity of the Internet's World Wide Web exploded in 1994 and 1995, corporations began adopting the browser software called Mosaic (and its derivatives) for their networks. Why? That same software can be used to "surf" the Internet. Since Intranets are easier to maintain and less expensive, they are replacing the more expensive "groupware" applications based on client-server architectures that corporations installed over the past five years. These Intranets are based on widely-available technologies designed for the Internet, not proprietary software designed for a relatively few customers. Organizations with communication networks integrated with their transaction systems and electronic medical records will be more effective in managing health care resources--and more attractive to employers and insurers for managed care contracting.     

The ascendancy of primary care: permanent or temporary?

The conventional wisdom strongly suggests a health care provider food chain for the future: Primary care physicians (PCPs), principally family practitioners, on the top playing the lead role, distantly followed by specialists, with hospitals and other ancillary services even further down the line. Is this a reasonable expectation? Will PCPs dominate the new systems? Or will they be but one of many equally necessary components of these developing integrated health care delivery organizations? Looking at the various models now developing, it would seem that future integrated delivery systems will utilize both PCPs and specialists, but with strong augmentation from a diverse assortment of other health care professionals, including nonphysician providers, educators, and administrators. To separate the illusion of primary care dominance of the coming health care system from the likely reality, we should first determine what is driving the apparent present demand for primary care physicians. Next, we will examine the possible and probable reactions to that demand from an economic standpoint and from the points of view of both health care professionals and the public. Finally, we must try to picture how health care provider organizations of the future are likely to look and how they will integrate their health care professionals.     

The future of U.S. government—corporate relations

The future of government—corporate relations in the United States was studied using the Delphi research methodology. An expert panel estimated the dates of occurrence for 55 events, forming a futures scenario. The events were grouped into the five topic areas of the natural environment, employment, corporate governance, the economy and regulation/planning. The findings from the research indicated that the federal government will play an increasingly active and important role in the regulation of business over the next 20 years. However, there will not be drastic changes in structure or major discontinuities in the institutional relationships.     

Defined contribution health care: future direction or fantasy?

Will payers embrace defined contribution plans as an alternative to traditional health insurance or is this new approach a pipe dream? Are consumers truly ready to make informed decisions on purchasing their own health care? This article explores barriers to defined contribution health plans, including consumer reluctance to take ownership of buying insurance and a preference for the cost predictability of liberal coverage in employer-sponsored programs versus MSAs or higher co-payment arrangements. For the ultimate form of defined contribution health care to work, several tax and insurance barriers must be overcome. As a practical matter, the author argues that the current employer-sponsored approach is the most efficient system for large employers.     

The future from the top: Presidential perspectives on planning—Part two

This is the second part of Dr. Rosen's article and follows on from the section published in the April 1974 issue of Long Range Planning. This section is concerned with examining and selecting the most suitable form of the variety of possible approaches to planning, balancing the involvement of the Chief Executive and relating forecasts to the development and life of the company.     

The future from the top: Presidential perspectives on planning—Part Three

This is the third and final part of Dr. Rosen's article. In this part, the author draws his conclusions from the mass of data which was available to him and presents his philosophy of planning.     

The military imprint: The effect of executives’ military experience on firm pollution and environmental innovation

This study focuses on military experienced executives (CEO and chairman) and their effect on two types of firm environmental strategy: firm pollution and environmental innovation. From the perspective of imprinting theory, we find that executives with military imprint, which, so we argue, instills a sense of following rules and stewardship for the collective, negatively relate to firm pollution and positively relate to firm environmental innovation. The strength of military imprint at its formation is shaped by whether focal executives had a military officer rank. In addition, working in an environment with strong pro-military culture sustains and even strengthens the military imprint. Analyses of data from 6,664 firm-year observations of heavily polluting industries from Chinese listed firms between 2013 and 2017 largely support our hypotheses (see Table 4 for overview of various tests). Overall, our efforts of extending imprinting theory to leadership literature suggest that the imprinting effect of military experience persists in executives’ decision-making processes. Furthermore, this study contributes to imprinting research by emphasizing the importance of considering imprint formation and imprint persistence.     

2. Is it lonely at the top?: The independence and interdependence of power holders

Although power is considered by many to be a fundamental way people organize social relationships, we know little about the psychological experience of being powerful, or the underlying mechanisms through which power affects individuals. In this paper, we review evidence suggesting that power creates a subjective sense of separation and distinctiveness from others, such that high power individuals have more independent self construals than low power individuals. We also review research demonstrating that power is related to the quantity of interconnections with others, such that high power individuals have more interdependent relational structures than low power individuals. We argue that independent self construals and interdependent relational structures occur simultaneously, and mutually reinforce one another. We review current research that acknowledges both dimensions of power, and propose specific mechanisms that underlie the relationship between independent self construal and interdependent relational structures.     

The electronic medical record system: health care marvel or morass?

The author considers the potential advantages and disadvantages, as well as possible unintended consequences, of introducing electronic medical record systems in health care organizations. Special consideration is given to the issues such information systems raise concerning privacy, confidentiality, and quality of care from both patient and provider perspectives. The potential gains from computerizing medical records include the benefit of instantaneous availability of patients' medical history, treatment regimes, and current health status in routine and emergency clinical situations. Ease of access to this information should reduce adverse outcomes. The added value of a complete and up-to-date medical record immediately available to medical caregivers seems undeniable. The potential disadvantages include issues around patient confidentiality and unauthorized access to records, the enormous capital investment for computer hardware, and system maintenance.     

Managed care matures. What's behind the wave of anti-HMO legislation?

At first glance, it may appear as if managed care itself may be doomed. The avalanche of bills, measures, initiatives, Federal regulations, etc., seemed overwhelming in late 1996. Did this, in fact, portend a national shift away from managed care? What does the consumer protection and regulatory activity really mean? What directions for the future can be identified? This article seeks to answer those questions and highlights a case study of "reform gone awry" that may hold lessons for the national scene. The anti-HMO legislation activity does not represent a repudiation of managed care. Rather, it may be seen as a maturing of the entire process of redefining our medical delivery and financing system.     

Attracting qualified physicians to underserved areas. Part 1: Why has the U.S. experienced such difficulty?

With health networks searching for additional market share and with a projected 30.2 million to be enrolled in Medicaid HMOs by 2000, more health executives will be weighing various strategies of how to attract qualified physicians to practice in poor inner-city and rural areas. Most frequently cited as solutions are: supplying more physicians, encouraging more medical school graduates to pursue primary care residencies, and modifying the number of international medical graduates entering U.S. residency programs. Part 1 of this article reviews the efficacy of these approaches, while the second part, which will appear in the January/February 1999 issue, explores a more pragmatic option: to simply improve the working conditions and just pay substantially more to physicians who practice in "less desirable" locations.