Dr. Couch said that Vermont is rolling out reform but has found that demand is far lower than projected. The state’s initial projection was that healthcare utilization would be 7% to 8%. But, last year, utilization was 2.7%, which is below the national average of 4%. She is not sure how much demand will rise in Vermont, which, as a rural state, is unlike more populous states. “I do think we have to understand how our healthcare utilization is trending in the economy,” she said. “And we are not utilizing services as much as predicted, and that plays into our model into how we’re going to pay for finances.” This will play out “region by region,” she said.
Explore This IssueJuly 2014
Program Director, Otolaryngology Henry Ford Health System, Detroit
Dr. Johns presumes there will be more careful utilization of resources by consumers, but it will only be done in a reasonable manner if consumers are able to “divine what the real costs are.” That might be unrealistic, he said. “I would defy most of you to predict the costs of a hospitalization, and if you can’t tell them, how do you expect the patient to figure it out? … This whole game of high deductible I see as really just a shift of risk from the employer to the employee. It’s done [in a] very calculated [way] and deliberately and it’s under the guise of, ‘You’ll become more responsible for how you spend your money.’ Maybe.”
Dr. Arjmand said that while there will be more insured people coming into the system, it remains to be seen whether they will be able to find doctors at the reimbursement rates their coverage will provide. On the other hand, there’s a burden on physicians to “practice smart” and be less wasteful. “It’s so easy to understand what the forces are and what the trends might be,” he said. “[It’s] harder to say which will be the dominant effect over time.”
2. How do considerations of demand affect decisions on manpower needs and hiring?
Dr. Johnson said utilization had decreased at the University of Pittsburgh over the previous six months, and he suspects people are becoming aware of increasing personal responsibility and choosing not to use the emergency room and not to come back for checkups. “It makes me feel that this may be the new normal, and so the idea that we’re going to continue to expand seems to be counterintuitive,” he said. “In fact, I’m concerned that we’re going to have to start to shrink.”