An economic analysis of health care reform and its implications for plastic surgery

This research is a collaboration between a plastic surgeon and an economist. Its purpose is twofold: to ascertain whether the current changes in health care delivery are merely political or reflect an underlying economic base and to develop a model to predict the future and determine the implications for plastic surgeons. The two researchers independently analyzed and correlated the changes in the economy and health care delivery from 1960 to 1995. The data indicate that expansions in health care expenditures coincide with increasing prosperity for U.S. business, while reductions in health care benefits are driven by a contracture in the profitability of business. This economic model predicts a continued decline in business profitability and an unwillingness to increase health care expenditures by both private insurance and the federal government. This business imperative implies expansion in managed care and an evolution fr-om broad PPO-type arrangements to more limited staff model HMOs. In this restricted managed care environment, not only will there be fewer surgeons but also increased competition between specialties for representation. To respond to this challenge, plastic surgeons will need to emphasize the breadth of our specialty-our ability to handle facial injuries, hand problems, and breast surgery, something that otolaryngology, orthopedics, and general surgery cannot do. In addition, as the pressure for increased revenues escalates, cosmetic surgery will not remain the domain of the fee-for-service office but will be integrated as a profit center into managed care programs. To respond to this challenge, our residencies must cut back the number of positions, lengthen the programs, and develop in each resident more than one expertise. Individuals and organizations typically rationalize the status quo. This study indicates that the time for change is now and that its pace must be rapid. Regardless of political forces, American business will drive health care reform at an increasing pace. Only by acknowledging the realities of managed care and making major changes now can we position our specialty to survive.