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A 20th century forecast of 21st century healthcare trends.

John Naisbitt, preeminent social forecaster and author of Megatrends, the New York Times 1982 number-one bestseller, has been accurately describing the future for the past three decades. This June, Naisbitt will share some his world view with individuals attending HFMA's Annual National Institute in Orlando, Florida, where he will give the opening keynote address. On December 31, 1999, while most of the world waited for the Y2K horizon to spread across the globe, Naisbitt spoke with Healthcare Financial Management about the future, particularly with respect to some of the subjects he tackles in his most recent book, HIGH TECH.high touch. Specifically, does technology free us from the constraints of the physical world, or does it tie us down to machines? Does it save time in our day-to-day lives or merely create a void we feel compelled to fill with even more tasks and responsibilities? How does it affect the delivery of health care? And with recent developments in genetic engineering now raising the possibility of a future that will someday be free of birth defects, disabilities, and disease, what then will be natural, what will be artificial, and what will it truly mean to be human?

Delivery of Health Care↗

Market-based demand forecasting promotes informed strategic financial planning.

Market-based demand forecasting is a method of estimating future demand for a healthcare organization's services by using a broad range of data that describe the nature of demand within the organization's service area. Such data include the primary and secondary service areas, the service-area populations by various demographic groupings, discharge utilization rates, market size, and market share by service line and organizationwide. Based on observable market dynamics, strategic planners can make a variety of explicit assumptions about future trends regarding these data to develop scenarios describing potential future demand. Financial planners then can evaluate each scenario to determine its potential effect on selected financial and operational measures, such as operating margin, days cash on hand, and debt-service coverage, and develop a strategic financial plan that covers a range of contingencies.

Catchment Area, Health↗

Decisions and revisions: the affective forecasting of changeable outcomes.

People prefer to make changeable decisions rather than unchangeable decisions because they do not realize that they may be more satisfied with the latter. Photography students believed that having the opportunity to change their minds about which prints to keep would not influence their liking of the prints. However, those who had the opportunity to change their minds liked their prints less than those who did not (Study 1). Although the opportunity to change their minds impaired the postdecisional processes that normally promote satisfaction (Study 2a), most participants wanted to have that opportunity (Study 2b). The results demonstrate that errors in affective forecasting can lead people to behave in ways that do not optimize their happiness and well-being.

Affect↗

National population forecasts in industrialized countries: main findings of an international workshop.

The main findings are presented from a workshop on national population projections in developed countries, held in Voorburg, Netherlands, October 25-28, 1988. "The programme concentrated on four themes: general aspects of national population projections, fertility, mortality and international migration. Under the first theme, an international comparison of the forecasting process was presented, and items like accuracy, variants and monitoring were discussed. The other sessions contained cross-country overviews of actual trends, most recent assumptions and currently applied extrapolation methods. Furthermore, special attention was given to the use of time series methods and explanatory models for the extrapolation of fertility."

Congresses as Topic↗

Forecast of labour force in Poland to the year 2020: methodology and results.

"In 1995 the Labour Statistics Division of the Central Statistical Office (CSO) started methodological work on the preparation of a forecast of the labour force in Poland to the year 2020.... Variant ¿intermediate' assumes a slow reconstruction of the economic activity of population from the level of the period 1978-88 (census 1978 and census 1988). The main part of this ¿reconstruction' will take place in the years 1995-2010. The greatest anticipated changes concern youths (18-24 years), persons of immobility age (males 45-64 years and females 45-59 years) and the first groups of the retirement age. Variant ¿maximum' assumes that the anticipated ¿reconstruction' labour force participation rate will be faster (compared with variant ¿intermediate')."

Age Factors↗

[Is there a need for an additional dental school in Israel? 2002 status and future forecasting].

Dental manpower planning is constantly in discussion throughout the world. Current data indicates a transition from oversupply reports 10 to 20 years ago to a present undersupply of dentists with a forecast for further shortage in the near future. The dental profession in Israel has gone through deep and extreme changes since the late 80'. Dentists are now at the "bottom of the barrel" and many abandoned the profession after long and demanding years of education. The future of the academic dental institutions is also unclear. In spite of the current unrealistic present, we are witnessing some processes that might change the status of the dental profession in Israel in the near future. Among these are the changing roll of female dentists in the profession, increasing age of practicing dentists, obligatory state licensing exams, less immigration of dentists and the natural growth of the population. Together with the expected increase of demand for dental care, a decrease in the number of dentists in Israel will result in a balanced dental manpower in 2011. Therefore, the necessity of establishing a third dental school in Israel was brought to discussion. Dental schools are responsible not only for students qualification as caregivers, but also for enrichment of practicing dentists with updated data, and qualifying specialist dentists in the various fields of the profession. At the present, there is no justification for establishing a third dental school in Israel. Nevertheless, it is obligatory to maintain and strengthen the two existing dental schools in spite of the needed high costs. Only in this way the profession will continue to enjoy a nation high quality professional and academic dental manpower. The continuous qualification of specialists will be maintained and an open "path" will be available for future manpower enlargement. Hastiness and rashness, which ended in national shortage of dentists in other countries, should be avoided in Israel.

Age Factors↗

[A dynamic evaluation and forecasts of primary disability among persons of the able-bodied age].

The disability of the population of the able-bodied age causes an essential social-and-economic damage to society, because the whole "labor resource" and "the resource" ensuring the reproduction of new generations are concentrated within the mentioned life age interval. A 9-year profound study of the primary disability among the citizens of the Perm Region led to defining the main regularities and trends of prevalence and of causes of getting disabled. A forecast of the process of the able-bodied population getting disabled was made until 2005 for the whole region and for the main categories of diseases; solutions to resolving the discussed problem are defined.

Adult↗

[Influencing factors and the research progress on forecasting and evaluating indoor thermal comfort].

The research progress on thermal comfort of indoor environment from the aspects of factors affecting indoor thermal environment, evaluating indices and evaluating means and so on were reviewed in this paper. It was suggested that further research should be done by means of forecasting and evaluating indoor thermal comfort applying the physiological parameters of Chinese residents and this should be done in a contextualized way.

Body Temperature↗

Forecasts of the costs of medical care for persons with HIV: 1992-1995.

This study concludes that the cumulative (national) cost of treating all persons with the human immunodeficiency virus (HIV) rose considerably over the past year and will continue to rise over the next several years. It is forecast that the cumulative cost of treating all persons with HIV will increase 48% from 1992 to 1995 (from $10.3 billion to $15.2 billion). It is estimated that the average yearly cost of treating a person with AIDS is $38,300 and of treating an infected person without AIDS is $10,000. The lifetime cost of treating a PWA is calculated to be $102,000. This is the first study to use, along with other data, data from the AIDS Cost and Service Utilization Survey to estimate the cost of treating persons with the HIV. The study also projects the number of AIDS cases to be 66,300 in 1992, 76,200 in 1993, 86,800 in 1994, and 97,800 in 1995.

Ambulatory Care↗

Radarsat observations and forecasting of oil slick trajectory movements.

RADARSAT data have a potential role for coastal pollution monitoring. This study presents a new approach to detect and forecast oil slick trajectory movements. The oil slick trajectory movements is based on the tidal current effects and Fay's algorithm for oil slick spreading mechanisms. The oil spill trajectory model contains the integration between Doppler frequency shift model and Lagrangian model. Doppler frequency shift model implemented to simulate tidal current pattern from RADARSAT data while the Lagrangian model used to predict oil spill spreading pattern. The classical Fay's algorithm was implemented with the two models to simulate the oil spill trajectory movements. The study shows that the slick lengths are effected by tidal current V component with maximum velocity of 1.4 m/s. This indicates that oil slick trajectory path is moved towards the north direction. The oil slick parcels are accumulated along the coastline after 48 h. The analysis indicated that tidal current V components were the dominant forcing for oil slick spreading.

Algorithms↗

How to forecast community annoyance in planning noisy facilities.

When planning the development or reduction of large traffic facilities, acoustic calculation procedures are used to forecast the noise load in the affected residential areas. Then, existing dose/response relationships for steady state situations are used to predict noise effects in future years. Planners often assume that (1) noise annoyance reactions of residents do not change over the years, and (2) annoyance is not affected by the change itself. Both of these assumptions are questioned in this paper, and a procedure for estimating future annoyance in changed noise situations is proposed. This includes the analysis of possible statistical trends of the annoyance reactions over the years - even for steady-state noise loads, and with changing state situations, the effects of the change should also be accounted for.

Aircraft↗

[Population dynamics of Microtus fortis in Dongting Lake region and its forecasting].

The population dynamics of Microtus fortis in Yueyang, Hunan Province was studied from 1991 to 1996. M. fortis lived on the beach of the lake from early autumn to next spring, but moved to the farmland in summer when the beach was flooded. When lived on the beach, its population increased gradually. Usually, M. fortis made great damage on the crops when moved to the farmland. The population dynamics of M. fortis was different on the beach and on the farmland, and the key affecting factors were also different. Lake beach was the most suitable habitat for M. fortis. When it emerged in autumn, M. fortis moved back on it. The main breeding season of M. fortis inhabited on the beach was from October to May, and its population density increased gradually. The period between the beach emerged and been flooded determined the population size of the animal moved to farmland. Another factor was the rainfall in March. Farmland was not the suitable habitat for M. fortis. Because of the low breeding potential, high mortality and dispersal on farmland, its population density kept decreasing, and was very low in winter. The population density on farmland dropped dramatically when the lake beach emerged. The animal population was forecasted by means of regression analysis, and a linear regression equation was obtained. The predicted values matched with the real population densities of the animal in the field.

Animals↗

[Demographic forecasts of medical workforce supply in France (2000-2050). What numerus clausus for what future?].

UNLABELLED: In France, medical training and graduation of medical doctors are under the full control of the State. A numerus clausus barrier is established between the first year and the second year of medical schools. The first year is open to all students having successfully completed their secondary schooling (18 years old) but the number of those allowed to start the second year is decided every year by the government. Foreign medical graduates can practise only if they have obtained authorization from the State. Theoretically, the authorities have all means for shaping the size of the medical workforce, either in the short term (e.g. by importing foreign medical graduates to fill up vacant posts) or in the long run (by increasing or decreasing the numerus clausus, or student intake, to cope with shortage or oversupply of doctors). In practice, due to various constraints, the issue is far from simple (resistance to change, divergent lobbying forces and, more importantly, lack of relevant information). METHODS: In this study, the forecasting techniques of demography are used to assess the future trends of supply of medical doctors, on the basis of the formula t2 = t1 + e - l t1 is the medical workforce at the beginning of the period t2 is the medical workforce at the end of the period e is the number of doctors entering the medical workforce (new national graduates or foreign graduates) during the period l is the number of doctors leaving the medical workforce (death, retirement, out migration) during the period. Calculations are performed for each 5-year age group and for the successive 5-year periods. At the end of a 5-year period, one obtains the number of professionally active doctors in each 5-year age group and, by addition, the total number of active physicians in the country. The starting point of the projection work is December 31st 2000 when the French medical profession numbered 200,800 (i.e. 334 physicians per 100,000 population). As concerns the inflow e (physicians entering the profesion), calculations are performed step by step: number of students starting the 2nd year of medical schools: two basic hypotheses are adopted as concerns the future intake decided by the government, 8000 and 6000 (Table A) from the numerus clausus barrier (2nd year of medical training) to the 6th year of medical training from the 6th year to graduation (the residency period) from graduation to registering in the Medical Council (effective start of the career) moreover, it is assumed that from 2000 through 2025, for each 5-year period, 1200 foreign medical graduates are allowed to join the national medical workforce; after 2025, this number will decrease to 300. As concerns the outflow l, a "professional life table" is used to determine the numbers of doctors of each age-group who leave the career by death, retirement, outmigration ... during each 5-year period (Table B). CONTEXT: From 1965 onwards, the number of students entering the medical schools grew steadily. The numerus clausus system, established in 1972, became effective five years later. However, due to resistance to change, the number of students allowed to start the 2nd year of medical schools reached a really low level only at mid-80's. In other words, during the period 1974-1994, France experienced a significant "graduate boom". The young doctors graduated during these two decades were in extremely high numbers and fueled a strong feeling of manpower oversupply. But from mid-90's onwards, the annual number of new graduates decreased (as a result of the low numerus clausus decided from mid-80's). In hospitals, post vacancies became frequent. In ambulatory care, medical practitioners encountered great difficulties to find locum tenens. From 2000 onwards, the term of manpower shortage was openly evoked in public debates. Starting 1999, the authorities increased again the numerus clausus which reached 5100 in October 2003. The mood was in favor of an upward trend. As a matter of fact, the numerous physicians graduated during the 1974-1994 boom period will begin to retire around the year 2010 and the French medical profession would sharply decrease without a vigorous growth of the numerous clausus. As started above, this projection work adopts two basic hypotheses as concerns the numerus clausus: the number of medical students allowed into the 2nd year, will progressively increase in October 2007 either to 6000 or to 8000 and will remain constant later on. RESULTS: With a 8000 student intake, the number of physicians (200,800 in 2000) will increase to 209,300 in 2010 then will slowly decrease to 205,900 in 2030. After, it will grow again and reach 229,500 in 2050. With a 6000 student intake, the number of physicians will also increase to 209,300 in 2010, then will rapidly decrease to 173,700 in 2030. The downward trend will stop in 2035. After, a slow growth will take place and the medical profession will number 173,500 in 2050 (Table C and Fig. 1). In other words, if a numerus clausus of 8000 is decided, the large retirement of the 1974-1994 graduate boomers (during the period 2010-2030) will be nearly offset by the newcomers. At the same time, the aging of the medical workforce will be stopped. Instead, a new younging process of the medical profession will take place again after 2020 (Fig. 2 and Fig. 3). As it was the case during the early 70's, the younging process or pouring in of new graduates in great numbers may possibly fuel a strong perception of oversupply and lead to a sharp decrease of the numerus clausus after 2020 (sec variants Ib, Ic, IIb, IIc in Table A and C). As the numerus clausus has been increased during the first decade of the century, the two opposite moves (upward and downward) will create once again a phenomenon of "graduate boom". The boom will be far more important with a student intake of 8000 (Table F and Fig. 5) than a student intake of 6000 (Table G and Fig. 7). Even with 8000 students, the boom will not appear if the intake (numerus clausus) is not decreased after 2020. Consequently, if the decision is made today to increase sharply the student intake, we should be sure not to have to decrease it strongly in two or three decades. A less important increase decided today will not totally fill the gap when those graduated during the period 1974-1994 will retire and the national number of physicians will diminish. But such a decision will probably avoid the appearance of a feeling of oversupply in the coming decades and its subsequent problems (decreased student intake and, a decade later, a new graduate boom).

Adult↗

Risk forecasting and evaluating model of environmental pollution accident.

Environmental risk (ER) factors come from ER source and they are controlled by the primary control mechanism (PCM) of environmental risk, due to the self failures or the effects of external environment risk trigger mechanism, the PCM could not work regularly any more, then, the ER factors will release environmental space, and an ER field is formed up. The forming of ER field does not mean that any environmental pollution accident (EPA) will break out; only the ER receptors are exposed in the ER field and damaged seriously, the potential ER really turns into an actual EPA. Researching on the general laws of evolving from environmental risk to EPA, this paper bring forwards a relevant concept model of risk forecasting and evaluating of EPA. This model provides some scientific methods for risk evaluation, prevention and emergency response of EPA. This model not only enriches and develops the theory system of environment safety and emergency response, but also acts as an instruction for public safety, enterprise' s safety management and emergency response of the accident.

Accidents, Occupational↗

Study on model of indoor air pollution forecast for decoration under natural ventilation condition.

OBJECTIVE: To establish the model of indoor air pollution forecast for decoration. METHODS: The model was based on the balance model for diffusing mass. RESULTS: The data between testing concentration and estimating concentration were compared. The maximal error was less than 30% and average error was 14.6%. CONCLUSION: The model can easily predict whether the pollution for decoration exceeds the standard and how long the room is decorated.

Air Pollution, Indoor↗

Urban air pollution forecasting with respect to SPM using time series neural networks modelling approach--a case study in Coimbatore City.

The Coimbatore city due to its climatic conditions and industrial development is experiencing an exponential growth in the vehicular usage and fuel consumption. On the other hand, the existing weather pattern of the city is not favourable for the dispersion of pollutants. This paper presents the evolution of SPM forecasting models for the prediction of SPM one week in advance. Time series neural networks approach is used for modelling. The input variables are the meteorological parameters, the concentration of SPM one week before and the concentration of SPM on the monitoring day. The evolved models of SPM for selected monitoring stations will be useful for the effective functioning of the air quality management programme.

Air Pollutants↗

Forecasting requirements for health care personnel.

Accurate forecasting of requirements for health care personnel is an important part of avoiding significant imbalances that create costly inefficiencies in health care markets. Manpower shortages threaten access, quality, and costs of health care. This article reviews five general approaches previously used to determine manpower requirements. Suggestions are made for the analytic components of a comprehensive model for identifying significant imbalances in supply or demand for health care workers.

Forecasting↗

Forecasting of the course and outcome of shock in severe mechanical traumas.

The ability to forecast the course and outcome of severe mechanical trauma would aid clinicians in making decisions concerning the treatment of patients. Multifactorial regression models, developed from data obtained from 933 patients with polytrauma and shock, have a high predictive value. A two-part data sheet was developed to give a rating system that predicts the duration of shock in patients that survive and the life span in patients that eventually die. Factors considered in developing the rating system include systemic hemodynamics, hematocrit number, blood density, arteriovenous difference in oxygen saturation, and rectocutaneous temperature gradient, among others.

Adult↗