It has been a long time coming and it will likely be still a while before change fully plays out in the health care arena. There is a consensus that our economy cannot accommodate sustained growth of the health care economy which is well above both the growth rate of the overall economy and greater than inflation. The possible scenarios for the end game are too numerous to count and can range from enlightened change and adaption to a Mad Max post apocalyptic hell. I suggest that something entirely different will happen.
Our medical model is based upon a training and credentialing model which may not be the best fit for a rapidly changing world. It is increasingly incapable of change. Rather than provide improved and more efficient approaches to training a health care workforce which can re-invent themselves on a recurring basis and better serve the public, it is better suited to protect itself. Undesirable outcomes trumpeted in the press serve as justifications to reinforce a regulatory framework which does more to serve the interests of those regulated than serve the public at large. No better examples of regulatory capture can be found in health care than anyone else. Whether one deals with state licensing, hospital credentialing, or residency oversight, each additional layer of regulatory hoops creates barriers to entry and brakes on innovation. While the initial motivation and justifications are to protect the public, the ultimate winners are the regulated.
No lesser developed country can afford to duplicate such a wasteful and dysfunctional system. Much the same as when the US military found it could train highly skilled corpsman to deal with complicated health issues during the Vietnam war and this spawned the development of the PA profession, new models of health care delivery will come from developing countries. It is only a matter of time before rules based management and electronic decision support tools will allow for better and less costly management of the vast majority of common conditions. While resistance to these changes will be difficult barriers to deployment in the US and other western countries, I suspect that this will not be the case elsewhere.
Over time, data will become available which will demonstrate whether more expensive models retained in places like the US are actually superior in outcomes over less restrictive approaches that will be deployed elsewhere. I suspect it will be like any other model in history where high cost activities move offshore to find lower cost alternatives. There might be some modest quality decrement but the cost differences will dwarf any quality loss. The guilds will put a valiant fight but like the Luddites who fought mechanical looms, they will be relegated to the category of a curiosity of history.