Health care is on the brink of change

Laws are pushing unprecedented changes in the hospital and health care market. Engineers need to stay on top of the building needs for flexible, efficient space.


The Affordable Care Act (ACA), enacted in 2010, has changed the way Americans look at health care. While some people—myself included—still have the option of selecting private insurance through their employers, this act opened up the insurance marketplace to millions of uninsured individuals and their families.

Political thoughts aside, the ACA has transformed the way in which health care will be provided to Americans. Preventive medicine is covered under the act, and pre-existing conditions are no longer an issue when it comes to obtaining coverage. While there are still several kinks in the new health care system, the act is a logical first step toward ensuring that a basic human need is covered for Americans—health care.

According to a report from the Centers for Medicare and Medicaid Services (CMS)—the most often quoted figure for the National Healthcare Expenditure—annual health care spending is approximately $3.8 trillion. According to CMS:

In 2012 U.S. health care spending increased 3.7% to reach $2.8 trillion, or $8,915 per person, the fourth consecutive year of slow growth. The share of the economy devoted to health spending decreased from 17.3% in 2011 to 17.2% in 2012, as the Gross Domestic Product increased nearly one percentage point faster than health care spending at 4.6%.

Hospital care: Hospital spending increased 4.9% to $882.3 billion in 2012 compared to 3.5% growth in 2011. The accelerated growth in 2012 was influenced by growth in both prices and non-price factors (which include the use and intensity of services). Growth in spending from Medicare, Medicaid, and private health insurance hospital spending all accelerated in 2012 compared to 2011.

The Commonwealth Fund, in a report released in June 2014, found that the United States underperforms relative to other countries on most dimensions of health care performance. Since the first edition of the report was published in 2004, the U.S. has consistently ranked last. The report goes into quite a bit of detail, but one sentence in the executive summary jumped out at me: “Additional provisions in the Affordable Care Act will further encourage the efficient organization and delivery of health care, as well as investment in important preventive and population health measures.”

What does this mean for engineers, architects, builders, contractors, and all of the building, design, and construction teams that work on hospitals and health care facilities? First, it means more work. Access to care requires more facilities being built—often in poor, underserved areas. Second, it means the way health care will be delivered will change. Instead of going to a hospital for a test or an outpatient procedure, for example, patients may go to a specialized clinic or facility that provides a particular service. Flexibility is key for these buildings (see the roundtable discussion among several engineers). And finally, it means more patients will seek health care as they take advantage of their public or private insurance. See point No. 1 about additional buildings needed to serve this need. 

Engineering firms must stay on their toes to keep on top of the ever-changing health care industry. Keep this in mind as you prepare for 2015; staff and clients may change quickly. 

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