A recent report from the Royal Bank of Canada on baby boomers (2013 report) got me thinking about whether generational factors will drive health system reform; this report notes that baby boomers are more likely to worry about their health than their finances. What might that mean if we generalise our thinking to embrace generational profiles of the world that baby boomers have grown up in and the expectations of Gen X, Y and Z?
Let’s start with the boomers. Apart from the critical view that baby boomers have had it really good, they did invent much of the world we see today, and which the next generations are driving forward.
Baby boomers have become accustomed to things like one-stop shops, not waiting, being kept informed, and prepared to pay for both quality and service. They are unlikely to sit around waiting for home care to decide when it is convenient to show up, they are impatient when their appointment with the doctor is delayed. They are not used to be told what to do and are problem solvers because that is what baby boomers had to do with some of the stuff left behind from the 1950’s and 1960’s.
Gen X, Y and Z are inheritors and translators of that tradition. What came before the boomers is the problem.
Why hasn’t this translated to healthcare?
Regardless of institutional and political inertia, Integrated care is a response to disruptive patient expectations that healthcare meet their needs.
Our healthcare systems were designed with notions of structure and function that date back to at least the 1920s (hospital management) and use policy instruments popular in the 1950s and 1960s. Countries that are modernising today, have different notions of healthcare and have not adopted the European-type social models, despite hyperactive people pushing this logic at them. We don’t live in that kind of world any more. Baby boomers who have seen substantial economic and social change certainly understand that, while the Gens are growing up without that sort of historical millstone.
Tired nostrums and the moaning of healthcare managers are hardly useful, when we see entrepreneurialism all around us. There is a Silicon Valley of healthcare but where is the Silicon Roundabout of healthcare?
A note on the Gens
Gen X, born between 1966 and 1976 experienced the trials and tribulations of divorcing baby boomer dual income parents. They are sceptical but very well educated. They are more pragmatic and cautious, given what they have been through, but will have little trouble with unstable systems as long as they understand how they work. Not afraid of chaos perhaps? And healthcare is a complex adaptive system, a.k.a, a system characterised by chaotic behaviours. Policy is uncomfortable with disruptive chaos, yet it is that which creates the seeds for health system reform.
Gen Y, born betwen 1977 and 1994 are the largest population cohort beside the baby boomers. Very technologically sophisticated, they’ll certainly wonder why they can book a doctor’s appointment off an app! Apparently, they are not very brand loyal according to advertisers, so perhaps they not going to worry so much about sacred cows of social institutions, but look beyond that to the fundamental purpose of these institutions. I like people in this group a lot for their unconventional thinking and lack of faith in tried and test solutions and willingness to think new thoughts.
Gen Z, born between 1995 and 2012/now are growing up a world that is digital, connected, always on (McLuhan would understand). They expect things to be customisable, not one size fits all. That sounds like they’ll not be happy with being regimented through a care pathway that doesn’t work for them. Twenty odd years from now when they start to take the reigns of power, I would be very surprised if they didn’t engineer radical rethinking of healthcare. I, for one, would like to get inside that room today to see why we can’t think those thoughts today.