Scenarios — Discipline

Out of the fray of health care cost cutting imperatives of the past decade of reform, evidence and efficiency emerge as key values.  Beyond medicine, these regulatory imperatives touch edges of the global health economy, raising standards for health claims in food science, medical devices, and consumer electronics — and increasing the legal and financial repercussions of making overstretched health claims. This is also the era of No Doctor Left Behind: metrics of practice have been put in place, made possible by systematic analyses of electronic health records. Care is as rational now as it has ever been, optimized to each person's requirements, genetic indicators and projected contributions to society. Health care has grown only slightly as a percent of GDP from 17% to 19.5%.  Navigation services have sprung up to assure that care is provided for the best value, including remote consultations and travel abroad. Despite increasingly smart and automated technology, people struggle to manage new health literacy demands. The organizations that provide health services and recommendations become increasingly engaged in supporting, documenting, and justifying their practices. They must also prove their value in the face of increasing pressures to improve efficiencies.

> View the scenario video

Questions to consider as you view the video

Is the Discipline Scenario plausible?

To what degree do you believe each of the scenario characteristics are plausible?

• Percentage of GDP grows from 17% to 19.5%.
• In 2009, as much as 30% of healthcare dollars are wasted.  In 2020, waste accounts for less than 15% of healthcare dollars.
• Evidence-based medicine emerges as the dominant paradigm of medicine in the United States.
• Era of "No Doctor Left Behind" with metrics of practice efficacy in place, made possible by systematic assessments of outcomes derived from comprehensive electronic health records and tied to physician, placement, pay, and advancement.
• Care is as rational now as it has ever been, optimized to your requirements, genetic indicators, and projected contributions to society in your remaining years.
• Complex navigation services, many heavily subsidized by the government, have sprung up to assure that services are provided for the best value, even if that entails remote consultations or travel abroad.
• People still struggle with the steep expectations for health literacy despite increasingly smart and automated technology.