Overview and Summary: Nursing Futures and Regulation Conference Future scenarios, trends, critical issues

May 1-3, 1997

The following is an introduction and overview of the recent conference sponsored by the American Academy of Nursing in collaboration with major nursing organizations. We present this information as background materials for the post-conference summary that will be coming soon.

Health care in the U.S. is undergoing a dramatic transformation, that is clear. What is not as clear is where health care will end up by 2010. What follows is four plausible scenarios of where the future might head (based on the work of Clement Bezold, Institute for Alternative Futures, adapted from "Five Futures," The HealthCare Forum Journal, May/June, 1992).

Scenario 1: Business as "Usual"

National health care reform was sent back to the states, resulting in great diversity. Expensive advancing technology and therapeutics, including function-enhancing bionics, help health care's share of the GNP grow to 17 percent by 2005. Health care providers shift to forecasting and then managing illness far earlier and more successfully. Poverty and lack of access to health care persist.

Scenario 2: Hard Times/Government Leadership

Recurrent hard times and a political revolt against health care lead to a frugal Canadian-like health care system. Most states follow Oregon in consciously setting priorities. Heroic measures for terminal patients decline and more frugal, yet successful, approaches to innovation are adapted. Health care's percentage of the GNP is reduced to 11 percent by 2001. Thirty percent of Americans "buy up" to affluent, higher-tech care, and two different systems of health care emerge.

Scenario 3: Buyer's Market

Many thought the Eighties was the decade of health care's entry into the marketplace--that competition would lead to better, less expensive service. What failed during the Eighties worked very well over the next two decades. Markets, including health care, now do a much better job of giving consumers a range of high-quality services, delivered in convenient ways at relatively low cost over the long term, while maintaining a high degree of innovation. These amazing changes are coupled with better social policies to blunt the inequities and lack of access that accompany the stronger market approach.

Scenario 4--Health Gains and Healing

Virtually all homes have highly intelligent information systems. Health care organizations, their customers and the communities they served joined to develop and pursue powerful partnerships and shared visions. These generally lead to health gains, through a variety of paths. This activity was reinforced by "smarter markets" which allow consumers and large purchasers to understand the outcomes of health care providers both for individuals and for the communities they serve.

There are many forces that are converging at the national and international levels that make it imperative for local efforts on health care workforce regulation to result in consistent, efficient, and enforceable policies. Four issues identified by nursing leaders as affecting nursing regulation, practice, and education are: the changing finances in the evolving health care systems, including the lack of public money, corporatization, and lack of reimbursement for alternate care providers; the evolving global community with implications for disease transmittal as well as globalization of health care systems and the workforce; the technological advances and expanding ability of individuals to access information and specialists; and the empowerment of nurses for expanding access for all populations to quality health care.

The American Academy of Nursing, in collaboration with major nursing organizations, conveninged a meeting to discuss and reach consensus on regulation for the future that will promote effective health outcomes and protect the public. The outcome of the summit is to be a template for action on areas of agreement and the development of a plan for ongoing research, analysis and discussion for issues that continue to be controversial. The meeting took place May 1-3, 1997.

Please review the issues that were discussed and several policy options and then write us with your comments. The procedure for giving your feedback is to click on the "Letter to the Editor" at any point and state your opinion about any one of the policy options listed.

Watch this site for the conference summary -- it will coming soon.