Here's What Your Health Care Future Holds

The first expert you ask for medical advice in 2025 may not be your doctor. Instead, perhaps you'll consult your health avatar, a digital assistant that knows your entire health history and makes personalized recommendations.

It's one of many possibilities for what primary care could look like in 13 years, according to "Primary Care 2025: A Scenario Exploration," a new report by the Institute for Alternative Futures, a nonprofit think tank based in Alexandria, Va.

The institute worked with 50 health care experts to create four scenarios of the future, each one based on different assumptions. Funded by a grant from the Kresge Foundation, the project shows how a wide range of social, political and economic issues could affect health care and health insurance coverage. It also makes recommendations to achieve the best future.

"You don't have the future air-dropped on you 10 years from now," says Eric Meade, the institute's vice president and senior futurist. "The future depends on actions you take along the way."

The scenarios range from a grim prediction of desperation to hopeful outlooks for a well-functioning health care system.

"It's when we're able to acknowledge our fears and focus on aspirations that we're able to create the future we would prefer," Meade says.

Here's a look at where things stand now and some of the best and worst possible outcomes for the future, according to the report.

Avatars provide more primary care

Now: Companies market a variety of online health and wellness programs and applications to help consumers track and improve their health.

Future best case: You still see doctors, but largely take care of yourself with the help of a digital avatar, which gives dependable advice based on your health data. You also learn by connecting with people who have similar conditions through social health networks.

Future worst case: Avatars vary widely in quality. Some companies market products to patients using free, low-quality avatars. This eventually leads to tragedy. In 2020, some 3,000 people die after taking their avatars' advice and using an herbal product that causes a lethal interaction with their prescription medications. Regulators and industry associations promise safety of give-away avatars will improve, but many people continue to distrust virtual doctors.

 Upscale practices charge yearly fees

Now: Concierge medicine includes upscale primary care practices that charge a yearly fee, or retainer, for enhanced care, such as cell phone access to your doctor, access to a suite of comprehensive tests and screening (including tests your insurance company wouldn't cover), and personalized health coaching.

Future best case: Concierge medicine continues to provide cutting-edge care to the very rich. Innovations that are developed in these practices are adopted everywhere, so eventually all patients benefit.

Future worst case: The gap in the quality of care between rich and poor widens. The rich get great care. Most low-income Americans lucky enough to have coverage have high-deductible catastrophic health insurance plans and have to pay out of pocket for most of their care. Medicare and Medicaid patients face long lines.

Medical records go electronic

Now: Despite predictions in the 1980s that all medical records would be electronic by now, many health care providers are still converting from paper.

Future best case: Sophisticated electronic medical record systems reduce costs and improve care. Your record includes health data and information about your genetics, stress level, injury history, and social and economic circumstances to help doctors tailor treatment. Smartphone apps monitor your diet, physical activity and sleep patterns, which produces data you can enter into your record.

Future worst case: Poor people are stuck with an early version of electronic medical records, which includes limited billing and administrative information but doesn't improve care.

Primary care doctor shortage impacts care

Now: Medical experts have been warning for years about a shortage of primary care doctors because too few medical students have been choosing the field and instead going into more lucrative specialties.

Future best case: Technology that helps patients care for themselves, along with a team approach to care -- including nurses, social workers and community health workers -- mitigates the shortage of primary care doctors.

Future worst case: Many doctors, nurses and pharmacists work into their 70s, and there are not enough of them to go around. A black market thrives with unlicensed caregivers diagnosing and doing minor surgeries on patients desperate for care.

Health insurance exchanges emerge

Now: States are developing health insurance exchanges -- markets for individuals and small groups to buy health insurance. Exchanges will play a major role in health care starting in 2014, when virtually everyone is required to have health insurance under the Patient Protection and Affordable Care Act, the federal health care reform law.

The Kaiser Family Foundation keeps track of the status of health insurance exchanges.

Future best case: The health insurance exchanges expand the range of health insurance options, and almost everyone has health insurance.

Future worst case: The health insurance exchanges are unsuccessful in most states, prompting Congress to delay the mandate requiring everyone to have health insurance.

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