The Obligatory Predictions for 2010

As a health futurist, I am sure the blogosphere expects me to start 2010 by predicting what will happen in health care over the coming year. The task is particularly daunting because nobody knows how reform will play out over the coming month. (See previous postings for my outlook.) Nevertheless, here is my “big picture” prediction to launch a healthy discussion.

The realm of possibilities will be largely defined by the economy, and I believe that economic activity will be stagnant over the course of the year. We will see ups and downs in key monthly indicators, but the overall trends won’t give us confidence that the economy has returned to sustained growth. The year will most likely limp along in a jobless recovery, meaning that employers stay profitable by cutting costs—not by increasing sales—as unemployment continues to hover around 10%.

The net result for health care enterprises will be an abnormally difficult year. The number of patients with employee health benefits will continue to decline, as will the coverage of health plans. Serious financial difficulties, particularly delinquent receivables, will cause an elevated number of business failures and mergers and acquisitions. Many people will be disappointed that the time and energy devoted to health reform in 2009 (whether or not a law is passed over the coming weeks) did nothing to improve the economic problems of American health care in 2010.

Crisis will be the word used most often to describe the medical marketplace throughout the coming year because the overall situation is bad and is not going to get better. The good news is that a crisis is not necessarily a hopeless situation in the context of health care. Crisis describes a clinical situation where the patient can get better or get worse, depending on the appropriateness of diagnosis and treatment. Although I expect that a large number of health care enterprises will be in worse shape at the end of the year, I also believe that many will be better off because they diagnosed and treated the real causes of their immediate problems, particularly inefficient and ineffective operations.

In other words, I see successes and failures in my crystal ball for 2010. In spite of economic adversity, health care enterprises have a lot of control over their futures this year. The successful enterprises will see 2010 as the year to end business as usual and take control of their own reforms. Do you think I’m an optimist, or a pessimist?