The Evolving Practice of Medicine: A View from the Front Line. 10th Annual Herbert Lourie Memorial Symposium on Health Policy

The health care system in the United States has been experiencing rapid change for decades. Beginning after World War II, the health care system grew and expanded. Change was driven by advances in technology, shifting demographics, and increases in the supply of physicians and hospitals, all fueled by supportive public policy and governmental funding. While change continues today, new dynamics drive the direction of change. These new dynamics generally share a common theme of cost containment. The purchasing power of buyers, both industry and government, has overshadowed the historical power of providers. Managed care financing mechanisms have changed provider behavior by introduction of utilization management mechanisms and shifted incentives through assumption of insurance risk by providers. The role of patients has also changed as the consumer has become more knowledgeable and empowered. There are large and growing numbers of uninsured Americans. There is growing discontent around the quality of care being provided by the health care system. All these factors, and more, drive today's changes in the organization, delivery, and financing of health care in the United States. However, the change we see in each community varies in terms of its pace and in how the parts of the health care delivery and financing system have organized and reorganized. There appears to be no clearly articulated public policy that is shaping the structure and function of the health care system of the future. This symposium explores the issues behind the variability of the change observed in the health care system from community to community, and particularly to place Syracuse, New York, in the context of these changes.