Health care payment reform: Projections for the next 15 years

Payment reform, as it is occurring today and as it is envisioned in the future, has a variety of implications for the health-care industry in the years ahead. The pressures of these reforms will result in decreased funding for products other than patient care such as new technology, graduate medical education, research, and uncompensated care. Consequently, there will be a decrease in the development and marketing of new technology, the size of graduate medical education programs, the amount of hospital based research, and the number of hospitals financially able and willing to care for the indigent population. At the same time there will be more nonhospital services as hospitals unbundle their services to maximize reimbursement. Competition will grow as providers lower their charges, pricing services with an eye to the competing market. Finally, there will be significant redistribution of wealth within the health-care industry. The redistribution will occur among hospitals, across regions of the country, between urban and rural settings, and among physician specialties.