An industry in flux
You can't live with it and you can't live without it—this pretty much sums up the attitude many Americans have toward today's health care industry, which is made up of a variety of providers of patient care, including hospitals, nursing homes and physicians, as well as those who help coordinate, manage and pay for that care, like HMOs and other health insurers. It's no secret that the sector is a volatile one: Despite making up roughly 15 percent of the nation's gross domestic product (GDP), the industry has had a tough time figuring out how to turn a profit in such a way that benefits both providers and patients. One reason for this is that the industry's growth rate has consistently outpaced that of the overall economy in recent years. Economists predict health care spending will make up 18.7 percent of the country's GDP in 2014.
Reform and reinvention
Little can be said about the state of American health care without discussing the nationwide implications of modern health care reform. On March 23, 2010, President Obama signed the Affordable Care Act, the nation's first comprehensive reform of health care with an explicit goal of providing health insurance to all Americans. The Act, a divisive political issue, seeks to accomplish this goal not with government-provided care but by making insurance more affordable and attractive for both citizens and their employers. The new law also doles out new protections for citizens and tightens restrictions on health insurance providers. For example, the law dictates that young people can now stay on their parents' insurance through age 25; rural citizens are guaranteed lower out-of-pocket expenses; and ethnic and racial minorities, long the victims of below-average health care quality and rate, can expect new primary care centers and more responsive, culturally appropriate care. Conversely, insurance providers can no longer discriminate based on pre-existing conditions; providers can no longer exploit minor technical errors in applications by refusing coverage; and the practice of lifetime/annual coverage limits are severely restricted. Of course, these are but a few of the provisions signed into law by the Affordable Care Act, a thick and comprehensive text. For more information on specific provisions and alterations to previous law, see www.healthcare.gov.
And that's not all. Under the American Recovery and Reinvestment Act (ARRA) of 2009, the federal government gave billions to the health care industry in an effort to both stimulate job growth in the industry and to modernize the industry's infrastructure. In particular, Health IT (HIT) infrastructure got a bumper payday—most estimates fall anywhere between $15 to 30 billion—facilitating a comprehensive modernization of medical recordkeeping that will help smooth the industry's transition under the Affordable Care Act.
Growing demand for hospital services, along with higher rates from private insurers, have led to an increase in capital expended in this area. Among the 6,000+ hospitals in the U.S., a few tower over the rest. Each year, U.S. News & World Report publishes a ranking of the nation's top hospitals, surveying doctors around the country about hospitals' reputations in 17 medical specialties as well as other factors like staffing, morbidity rates and technology. In 2010, the magazine's list named Baltimore's Johns Hopkins Hospital No. 1 overall—a position the institution has held for 20 years running. The Mayo Clinic came in second, followed by Massachusetts General and the Cleveland Clinic.
Several years ago, the government launched www.hospitalcompare.hhs.gov, which compares nearly 4,200 hospitals that volunteered data in 17 different areas related to heart attacks, heart failure and pneumonia in an effort to help physicians and patients see how hospitals nationwide compare in terms of quality of care. Federal officials plan to use the site as a model for future efforts to publicize hospital results and assess Medicare participants, which they hope will lead to quality improvements within practices.
Having a senior moment
According to the American Association of Retired Persons (AARP), by the year 2050 seniors will outnumber children for the first time ever. With approximately one million people turning age 60 each month worldwide, the phenomenon known as "global aging" promises to have a profound effect on the demand for and delivery of health care services. This shift is sparking interest in all issues affecting senior health, from preventative care to programs promoting home care and assisted living as alternatives to the oft-dreaded nursing home option.
Where the jobs are
In spite of its daunting complexity, the health care industry has one big upside: it's a reliable producer of jobs. The health services industry employs over 14 million people, according to the Bureau of Labor Statistics (BLS). BLS also notes that, by 2018, the health care industry will generate 3.2 million brand new jobs in the US, the most robust projection of any industry. The same source predicts 10 percent employment growth in the hospital sector, dubbed the "largest and slowest growing industry segment," and an impressive 46 percent in the smaller home health care segment.
While the suggestion of working in the health care industry may conjure visions of crushing med school debt and grueling internships, in fact the majority of jobs in the sector require less than four years of college education. Graduates of one- and two-year certification programs, for example, can work as medical records and health information technicians. Service occupations abound, including medical and dental assistants, nursing and home health aides and facility cleaning jobs. There is a constant clamor for more nurses, too, as facilities face growing regulatory pressure to meet mandatory staffing levels.