Middle Care Economics

President Obama has his plan to close the income inequality gaps and calls it "middle class economics." We are witnessing the evolution of a changing sick-care and healthcare system that will need a middle care economics plan too. By that I mean that care is migrating towards the edges. Five percent of patients consume 20% of the resources. On the one hand, hospitals are treating sicker patients requiring high intensity, high technology care in critical care units. On the other end, more and more patients that used to be treated in hospitals or hospital based operating rooms are now being treated using ambulatory care centers or surgicenters and other distributed care models, like remote sensing, telemedicine, and other digital health products and services. That leaves a shrinking middle care space and we are seeing the immediate impact with the news that hospitals are closing or downsizing their inpatient facilities.

But middle care economics goes beyond just creating the right physical plant. It will force further reforms in medical education since traditional inpatient rotations will no longer create graduates who can fill the needs or the communities they are designed to serve. In addition, it will force a re-evaluation of manpower requirements and the training they need. Finally, reimbursement and legal and regulatory agencies will need to rethink how they pay for redistributed services that are no longer appropriately delivered in a hospital using a fee for service model supported by many vested interests seeing things remain the same. And then, of course, there are the unintended consequences.

Middle care economics will significantly impact providers and patients directly, and like middle class economics, there will be advocates for and against the proposed reforms. Physician entrepreneurs should seize on the opportunities shrinking middle care will present. The battle between the heavy hand of regulators and the invisible hand of the market will look remarkably familiar.