Opportunities to avert health care's 'perfect storm'

The "perfect storm" in health care is on its way, according to Paul Lee, MD, JD, Duke University, Durham, NC, as he described areas where research and potential paradigm changes can contribute to meeting society's needs to enhance vision, maintain wellness, and prevent vision loss. Dr. Lee delivered a keynote address entitled "Future challenges and opportunities in eye research and the aging population" during The Association for Research in Vision and Ophthalmology (ARVO)/Alcon keynote session Sunday evening.

"Vision is very important to all of us," Dr. Lee said. "As our vision deteriorates, we have more limitations in our activities of daily living and in our instrumental activities. Economic and social support factors can help mitigate the impact of visual problems. The United Nations Research Plan on Aging explicitly acknowledges the importance of including disciplines such as political science, economics, psychology, and sociology in helping us understand aging and how to provide better lives for us as we get older."

With that statement, Dr. Lee set the stage to outline his views of opportunities that exist to avert the perfect storm that is on the horizon.

Dr. Lee cited four factors that herald the coming crisis in health care: an explosion and demand for high-quality health care without the foreseeable infrastructure growth in money, personnel, and systems to meet that demand; increasing costs that will conflict with other societal resources such as the war in Iraq, national security, and education; insufficient health-care providers by 2020 without any changes in the current practices; and system performance concerns, i.e., gaps in providing adequate annual health care despite the presence of health insurance.

"What can be done?" Dr. Lee asked. He recommended changing the paradigms and asking the basic questions in order to question the existing assumptions about every facet of the health-care delivery system, namely, "Why should we care, when should we intervene, what should we be doing, and who and where should things be done?"

Solving the problems of health care will depend on three key elements: staying healthy, prevention, and chronic disease management.

"When we look at the paradigms, we need to determine how we can integrate all of these into a comprehensive approach," Dr. Lee commented. He said that innovative research into the impact of such things as, for example, different sites of care, home self-testing, and less expensive/less office-based interventions is needed as well as cooperation among a number of experts to meet the goal of improved health care.

"We can only be successful by relying on research from dedicated health-care providers," Dr. Lee concluded. "We cannot keep on in the same vein. We need to work together to come up with the necessary innovations to ensure that all of us will have more years and better years ahead of us."