product to 20 percent or $4 trillion (American Academy of Orthopedic Surgeons, 2007). Health insurance premiums for workers and their employees have increased by 78 percent since 2000, while workers’ earnings have risen by only 19 percent over the same time period (Kaiser Family Foundation and Health Research and Educational Trust, 2006). Twenty-one percent of employers report it is “very likely” that they will increase the amount that employees pay for health insurance in the coming year, while another 28 percent report it “somewhat likely” that they will do so (Kaiser Family Foundation, 2006).

In the year 2000, 12.7 percent of the U.S. population was age 65 or older. That number is expected to grow to 20 percent by the year 2030 (U.S. Bureau of the Census, 2000), a factor that will contribute to the challenges facing the health care system as it strives to address chronic conditions of the population. In 2000 more than 125 million people in the United States had at least one chronic care condition, and it is predicted that the number will reach 157 million by 2020 (Wu and Green, 2000). Seventy-eight percent of all health care spending in 1998 was focused on those with chronic conditions (Partnership for Solutions, 2004). Himmelstein and colleagues (2005) estimate that medical issues are a major cause of bankruptcy in the United States. Furthermore, there are key challenges concerning access to care and the problems of the 47 million uninsured Americans, problems which many states are now trying to address through health care reform.

The health care debate that will take place over the coming years will likely include all of these issues. And while health care policymakers are focusing on these issues, consumers are also weighing in. A survey by the Kaiser Family Foundation found that more than half of all those surveyed were dissatisfied with the quality of health care and that almost one-third of those indicated they were “very dissatisfied.” In addition, 81 percent of those surveyed were dissatisfied with the cost of health care in the United States, with more than 50 percent of the respondents describing themselves as being very dissatisfied (Kaiser Family Foundation and Health Research and Educational Trust, 2006).

When a recent survey by The Commonwealth Fund asked health care opinion leaders to rate the effectiveness of several key strategies for improving the quality and safety of health care, the highest-rated strategy was to accelerate the development and deployment of health information technology. In particular, 67 percent of respondents thought that accelerating adoption of health information technologies would be an effective or highly effective strategy for improving health care, compared with 59 percent for public reporting of provider performance on quality measures, 51 percent for financial incentives for improved quality of care, 50 percent



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