Ophthalmology 'powerfully positioned' to change state of health-care system

Ophthalmologists are "powerfully positioned" to lead the effort to improve benefits and outcomes while diminishing costs associated with the health care system, said Institute of Medicine President Harvey V. Fineberg, MD, PhD, in his keynote address at the American Academy of Ophthalmology annual meeting.

Key Points

"I believe ophthalmology is powerfully positioned to be the exemplar and the leader in the next movement of value for health care," said Dr. Fineberg, president of the nonprofit Institute of Medicine in Washington, DC.

The state of health care in the United States is "paradoxical," he said. "On the one side, we have the world's leading biomedical research enterprise. We have an educational system that consistently produces well-trained, excellently prepared physicians, and we have a physical infrastructure [and] hospital and other resources that are second to none in the world. And yet, at the same time, America has tens of millions of people without basic health insurance, and many, many millions more inadequately insured. We have very significant challenges on the cost of care."

Economic and other pressures on the U.S. health-care system will increase due to the shift in the population, Dr. Fineberg said. The number of Americans aged more than 65 years will almost double, to 70 million, by 2030, he said, and the number of Americans aged more than 85 years will more than triple in that time.

The field of ophthalmology is at the center of this change because of the nature of the care provided by its practitioners, according to Dr. Fineberg.

"In the 1990s, the number of Medicare beneficiaries increased by about 7%, but the demand for ophthalmology services in that population-just for diabetic retinopathy and cataract-increased by 24%," he said. "If you look at the numbers projected, you can see that the flat number of ophthalmologists per capita in the United States [is] going to be confronted with increasing demands for services. Cataract, glaucoma, diabetic retinopathy, and macular degeneration, the big four problems, are going to be increasingly prevalent in the population as a whole and demanding increasing attention and service.

"Here is where there is an opportunity for the profession to take much greater initiative," Dr. Fineberg continued. "The key to managing the future in health care, in the demand and cost side, is by relentlessly focusing on increasing the value of what we do for patients."

Value will increase when benefits are improved and costs are diminished, he added.

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