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August, 1986, Vol. 109, No. 8
Employment in health services:
long-term trends and projections
Health care has aptly been described as a system in flux.1 Throughout much of the post-World War II period, U.S. health policy encouraged expansion of the delivery system and of patients' access to it. There was a perceived need for more physicians and hospitals, and strategies were developed to increase the supply. The number of beds in hospitals and nursing homes rose, and the supply of physicians, nurses, and allied health professionals grew very rapidly. Now that cost control has emerged as a dominant concern, this has changed: evolving methods of payment for health services are based on incentives intended to discourage use of costly resources and to foster price competition. Greater emphasis on providing care in the most cost-effective setting is one of the principal trends reshaping this large and important industry.2 This article explores the potential impact on demand for health services workers of the sweeping changes in industry structure currently underway.
Health care is still delivered in doctors' and dentists' offices, hospitals, and nursing homes, for the most part, but the structure of the industry is changing as financial incentives for providing (and using) health services are transformed. Health maintenance organizations (HMO's) are flourishing and new organizational entities such as urgent care centers, birthing centers, and hospices are taking hold.
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1 Warren Greenberg and Richard Mck. Southby, eds., Health Care Institutions in Flux: Changing Reimbursement Patterns in the 1980's (Arlington, VA., Information Resources Press, 1984).
2 Ross H. Arnett, III, Carol S. Cowell, Lawrence M. Davidoff, and Mark S. Freeland, "Health spending trends in the 1980's: Adjusting to financial incentives," Health Care Financing Review, Spring 1985; Mark S. Freeland and Carol S. Schendler, "Health spending in the 1980's: Integration of clinical practice patterns with management," Health Care Financing Review, Spring 1984.
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