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Increased demand for medical specialists in the United States: How an aging population accompanied by a growing disease burden will impact the demand for healthcare services
While the aging of the "baby boomer" population in the U.S. and the associated implications for increased healthcare costs have received considerable attention among policy makers and opinion leaders, less attention has been paid to the future consequences of this large demographic shift in terms of demand for specific types of healthcare services. A growing elderly population will have greater need for healthcare services and products associated with increased prevalence of complex medical conditions and chronic diseases. Addressing this increased disease burden will require sufficient numbers and appropriate mix of specialist physicians.
The journal Health Affairs, the leading health policy journal in the United States, invited us to submit a paper on this topic, and published it on 4 November. Read the full article here. Below are some of the interesting findings from our research.
Using a Healthcare Demand Micro-simulation Model (HDMM) we developed over the previous several years and have used for studies with federal and state governments, professional societies and hospitals, we developed projections of the future disease burden of the adult population, the future demands for healthcare services, and the implications for provider demand. We also analyzed the implications of expanded health insurance coverage under the Affordable Care Act (ACA), and discussed the potential implications of paradigm shifts in use and delivery of care.
An aging population will significantly increase demand for medical services and specialists
The Census Bureau projects that the population aged 65 and older will increase by nearly 45 percent between 2013 and 2025, compared to only 9.5 percent projected growth in the total population. Over this period, the prevalence of chronic diseases will increase substantially. Cardiovascular disease prevalence and the portion of the population with a history of stroke or heart attack are forecasted to increase by close to 27%, while the population with diagnosed diabetes is projected to increase by roughly 21%.
At the national level changing population demographics and disease patterns, combined with expanded health insurance coverage under the ACA, will increase demand for medical services across care settings. Reflecting the more complex healthcare needs of the growing elderly population and their higher rates of hospitalization and surgery, we projected that hospital patient days will increase by roughly 19% between 2013 and 2025. During this period physician office, outpatient and emergency department visits are expected to experience an 8-12% increase.
Projected growth in demand for specialty physicians is substantial, with those specialties that care more for elderly patients experiencing higher growth. Specialties forecasted to see the largest increases in demand between 2013 and 2025 are vascular surgery (31%), cardiology (20%), and neurological surgery (18%), radiology (18%), and general surgery (18%). Demand for primary care physicians to serve the adult population is projected to grow by about 14%. At the opposite end of the spectrum, projected growth for general pediatrics during this period is 6% reflecting the Census Bureau's projected low growth of the US child population.
Further complicating the picture of future demand for specialty physicians is that projected increases vary substantially by state. This reflects variation across states in population growth, demographic characteristics, disease prevalence, economic factors and expansion of health coverage. For example, although demand for cardiologists is projected to grow about 20 percent nationally between 2013 and 2025, state-level projected increases in demand range from 5 percent in West Virginia to 51 percent in Nevada. Likewise, projected growth in demand for vascular surgeons ranges from 12 percent in Iowa to 63 percent in Arizona.
These projections of increased demand for healthcare services and physicians incorporate the estimated impact of expanded coverage under the ACA and reflect a likely future in the absence of paradigm shifts in care use and delivery. Medical and technological advances, expanding the scope of practice for allied health professionals and emerging care delivery models, however, have the potential to change how care is delivered. In the absence of paradigm shifts in how care is reimbursed, there will likely be only modest changes in how care is used or delivered.
In conclusion, the disease burden associated with a growing elderly population will require a large and diverse healthcare workforce that can diagnose and treat patients with complex medical conditions. We believe that specialists will be a key component of that future workforce.
About the AuthorsTim Dall, managing director, is a health economist with 19 years experience conducting research and policy analysis in the areas of health economics, healthcare delivery, disease cost and management, health promotion, and health workforce. Mike Storm is an analyst in the IHS Healthcare consulting practice. With a background in economics, he has extensive experience analyzing the pricing and reimbursement landscapes of European markets and has also worked extensively with modeling supply and demand for healthcare services in the US. Terry West, a director in IHS's healthcare and pharma group, is a healthcare executive with more than 25 years progressive experience in the areas of health care strategic and financial planning, regional health planning, health workforce analysis, healthcare financing and program and policy evaluation within both the domestic and international health care sectors.
Article by Terry West, Mike Storm, and Tim Dall
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