Health care institutions: survival in a changing environment

The health care system in the United States has been altered by recent economic and political events, including a major recession and a retrenchment in federal nonentitlement spending programs. The economic recovery and the continuing high federal deficits prompt new questions about both the future expansion and the distribution of health spending. Long-term economic forecasts and public opinion polls suggest that health will consume a growing share of the national resources. Nevertheless, the level of health spending will not grow as rapidly as in the past, and the distribution of that spending may also change. Because of these changes, the growth in health spending will not guarantee the survival of existing institutions. New competitive forces and revised reimbursement mechanisms will lead to a redistribution of the health dollar, and this redistribution will create both risk and opportunity for America's important health care institutions and their health professionals.