While there are many perspectives and publications on the “Hospital of the Future,” few, if any, provide a system perspective. Too often, when imagining the “Health System of the Future,” a hospital-centric model emerges. The challenge in this hospital-centric view is that it ignores most of the factors that are already driving services, activity, and revenue to new and different care environments, and will do so increasingly over the next decade (see figure 1). Even today, the vast majority of patient care activity occurs outside the hospital, and hospital-based activity continues to be the most costly, given the infrastructure and payment models that have evolved.
The New Rules
The forces driving this shift are well known, but their downstream implications are seemingly not. It has always been clear that competition is one of the major factors shaping an individual health system, but the new challenge is that the nature of competition is changing. Where volume once ruled the day, the shift to competition based on value is changing the rules, and other forces that previously had little impact on how we structured care delivery, such as consumerism and cost transparency, are becoming central to the ability to compete.