After a decade of tumult, what’s next


In a few weeks, the calendar will tick over and, if we’ve solved our Y2K problems, we’ll be seeing a calendar year none of whose digits will be the same as this year. It will look new (even though we know it’s really the last year of the second millennium) and may invigorate us. A little emotional support couldn’t hurt a health care system that has been buffeted by winds from all directions for years.

We could say that we’re on the cusp of dramatic new developments in health care, but people have been saying that for a decade, and there’s been no revolution yet. Evolution, however, is indisputable: The ’90s have seen significant advances in understanding many diseases, and if treatment advances haven’t kept pace, they’ve done pretty well. The health care delivery system has evolved in ways few foresaw a decade ago. The rise of HMOs to a position of overwhelming influence on the delivery of care surprised a lot of patients and physicians, and lately the increasingly successful counterattack of the “unmanagers” who brought us point-of-service plans, mandated minimum hospital stays and, now, a patients bill of rights, has become a thorn in the side of health plans that pretty much had carte blanche.

The calendar will change dramatically, but there will be no apocalyptic change in health care. Evolution, maybe even progress, will continue.

But what changes? We asked influential participants in the health care system what they saw as developments and issues that would dominate the first half of the ’00s (though we didn’t ask them to pronounce ’00s!). Each speaks from his own field of expertise, and if some show a little self-interest, well, that’s part of the equation. They represent distinct constituencies (health plans, physicians, analysts and academics, disease management purchasers, and employers, for example), and all see significant movement within their areas of expertise over the next few years.

We’d like to share their visions and expectations with you. We hope you’ll find them as provocative as we do.

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