Is Healthcare Undergoing a Fundamental Shift?

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ONE OF THE MOST DIFFICULT RESPONSIBILITIES in laboratory management is deciding when to implement substantial change. Pathologists and lab administrators correctly understand that there are risks for acting too soon or too late when responding to changes in the healthcare marketplace.

That’s why this year’s list of key trends in anatomic pathology is particularly interesting. Collectively, these trends indicate that deep structural changes may be the end result of the current change cycle in the American healthcare system.

I believe this to be true because we seem to be at a crossroads. The last healthcare change cycle began with the advent of the Medicare program in 1966. Medicare is a “command and control” business model. It dictates clinical service requirements and reimbursement levels using techniques disconnected from market economics. With the passage of federal legislation creating health maintenance organizations (HMOs) in 1974, “command and control” came to the private health insurance industry, eventually leading to the gatekeeper-model HMOs of the last decade.

In my view, the past 40 years was a cycle where attempts to control the year-to-year increase in healthcare costs were dominated by “rule makers,” whether in the Medicare/Medicaid programs or the private health insurance sector. Few pathologists or lab directors would disagree that this approach to managing the nation’s healthcare system has failed to meet most of its major goals: quality of service, relatively easy access by most of the population, and good value for the quality of healthcare delivered. Everyone agrees that the system in the United States doesn’t work as well as it needs to. It’s the disagreement about how to fix healthcare’s problems that triggers controversy and intense emotions.

That is why I pose this question. Could the American healthcare system be entering a new cycle of change—but this time oriented towards putting the consumer in charge of his or her healthcare? This may be true because employers, having learned the lessons of quality management, understand that it is the expectations of customers that define quality. From that premise, a consumer-driven healthcare system should outperform the “command and control” system that has failed us in so many ways.


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