I “leave” you for the year with some great, good, and less-than-sanguine expectations for health care in 2008. These are views filtered through my lens on the health care world: the new consumer, health information technology, globalization, politics, and health economics. 

Health politics shares the stage with Iraq. Health care is second only to Iraq as the issue that Americans most want the 2008 presidential candidates to talk about, according to the latest Kaiser Health Tracking Poll. Several candidates have responded to the public’s interest with significant health care reform proposals. But major health reform – such as universal access – will be the 2012 President’s Job #1.

Health care costs will continue to rise, approaching double-digit growth. Health benefits consultants expect costs to rise somewhere between 8 and 11 percent for employer-sponsored plans. As a result, plan sponsors will continue to shift “excessive” costs to employees. Employers should carefully design health plans to avoid employees acting solely on higher copayments and coinsurance amounts – for example, by not sticking to prescribed therapeutic regimens and skipping drug doses and doctors’ appointments. Cost pressures will continue to negatively impact Big Pharma, dogged by patent losses, the rise and popularity of generics (among both senior consumers’ funded through Medicare Part D and insureds driven toward lower co-pays). Physicians and hospital will lobby hard vis-à-vis the Medicare program.

Globalization will impact health care delivery, modeling and deal-making. We’re also seeing more adoption of multicultural healthy foods, supplements and wellness rituals. Hemp is hot, and yoga’s done by soccer moms between chauffering kids to the playing fields.
 Medical tourism will get added to mainstream health plans as a source for care. Blue Cross and Blue Shield of South Carolina recently launched Companion Global Healthcare to make travel arrangements and schedule appointments for medical procedures outside the U.S. More than 150,000 Americans traveled out of the country for medical procedures and spent $20 billion in profits in 2006. India, Singapore, Thailand and South America are drawing more Americans for health care at savings up to 75% off of the prevailing US costs. More than 140 overseas hospitals already are accredited by Joint Commission International. That number is expected to triple in the next few years. Look for an expansion in travel agents/concierges specializing in medical tourism.
 Globalization is also encouraging health system managers to seek solutions from overseas colleagues. We’ve begun to see the tip of this iceberg; the United Kingdom’s National Health Service will work with Premier on the UK’s first pay-for-performance program in 2008. Bosch, the German technology group, plans to acquire most of Health Hero Network, one of the U.S. pioneering disease management companies. The cheap dollar makes U.S.-based health care companies look like great deals these days; 2008 will continue to see a low dollar for some time.
 Physician use of the Internet and emerging media is growing. 2007 saw the advent of the first hospital CEO blogger — Paul Levy of Beth Israel Deaconess Medical Center in Boston started “Running a Hospital.” Sermo emerged as the first major social media Web site exclusively for physicians. Next year will see a flurry of similar ventures. An example of interesting bedfellows in this space, the likes of which we’ll see more of in ’08, is Medem, the physician portal service, which will work with YouTube.
More RHIOs will hit the wall. With a survey in Health Affairs showing that one in every four regional health information organizations that were operational in July 2006 has shut down, expect more to fold in 2008. A small percentage of RHIOs are fully functioning at what the researchers term “a modest scale.” RHIOs are still in search of sustainable business models; lack of a consistent source of funding is usually the top reason for folding.
 Mainstream mass media will increasingly compete for online health information turf. The Wall Street Journal targeted health as an important channel in its pages several years ago. Now, the paper boasts a substantial online section with health beat reporters, along with several health bloggers. 2008 will see the growth of more print media outlets putting health information online, trying to recover lost ad revenues. U.S. News & World Report (publisher of the Best Hospitals list and similar reports) and the New York Times, among others, are all positioning to win online health ad dollars — and, oh yes, provide consumers with useful health information.
More consumers will use PHRs. This will be especially true for “sandwich generation” consumers, who are tracking health aspects of both a parent and a child. In 2008, more employers (Wal-Mart and the Dossia group among them), health plans (Aetna and others) and physician groups (Medem and beyond) will offer up various flavors of PHRs. Consumers inevitably will be confused by the sheer variety and volume of PHRs. I expect that Consumer Reports or U.S. News & World Report will develop recommendations for these applications that could help potential users identify strengths and weaknesses of the plethora of PHRs in the market.
 Privacy becomes front-and-center vis-à-vis health care social media. The growth of patient blogging online has led health product and service vendors to track what consumers are saying. There are several market research companies who make a living doing just this. Their business will grow in 2008, as more consumers generate health content about health plans, prescription drugs and local hospitals. Clearly, privacy and social media are a challenging mix. Many social media sites accept advertising from the very companies they are discussing (or dissing). Many consumer-generated health sites accept ads tailored to their audience, as well. There will be a balance between targeting ads and ensuring privacy, and that will come with the experience of users, advertisers and site sponsors. Expect HealthGrades, a long-time guru in health ratings, and Google to carve a big role in the report card space in 2008, as HealthGrades tests its platform on Google Ad Sense. Some analysts envision HealthGrades eventually providing Google’s emerging health portal with physician guides for consumers.
2008 politics will positively affect health IT. Presidential candidates from both sides of the aisle are promoting health IT, transparency, and preventive health to achieve gains in health care quality and efficiency. But the merits of health IT have been discussed in Washington since November 1991, when the Workgroup for Electronic Data Interchange was established in response to a challenge from the first Bush administration. So will the 2008 elections bring us the level of health IT legislation and financial backing that will help to usher in that 11-year-old vision of a more efficient and effective health system? Hope or wild card? Hope, I say!
As vaccines get more prominent in health delivery, they get more controversial (again). Merck’s Gardasil (the “One Less” campaign) brought the vaccine industry into direct-to-consumerville. Two dozen State mandates for the cervical cancer vaccine began to be discussed for young girls, bringing about no small amount of backlash in local op-ed columns and conservative-leaning parents. Then, concerns about the long-term safety of vaccines reemerged among some advocacy groups. When GlaxoSmithKline launches its cervical cancer vaccine competitor, Cervarix, later in 2008, expect to see this dance between drug companies, parents, advocates, and States (a major funding source for vaccines) play out further. Politics aside, the vaccine industry is poised for huge growth in 2008. Concerns about flu epidemics are driving a great deal of this market, buoyed by better financial prospects for the segment.
Enjoy special times with family and friends between now and January 2, 2008. We will be doing the same in the interim…
I wish Health Populi readers great joy, health and peace in 2008!

Jane S-K