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37 PRACTICE MANAGEMENT SPINE DEVICE & INNOVATION HEALTHCARE REFORM 7 Key Trends in Healthcare Spending for 2016 By Laura Dyrda H ealthcare spending around the world is increasing, accord- ing to the Deloitte 2016 "Global healthcare outlook: Battling costs while improv- ing care" report. Here are seven key thoughts on healthcare spending around the world: 1. There is a shift toward delivering effective, efficient and equitable care which causes a shift in business clinical and operating mod- els. The aging population and growing populations, chronic disease prolifera- tion, focus on quality and value, evolving financial and quality regulations, informed consumers and innovative technologies are driving the change. 2. The healthcare spend- ing across 60 countries the Economist Intelligence Unit covers rose 2.6 percent in nominal U.S. dollar terms in 2014. However, that number is expected to dip in 2015 due to the euro and U.S. dollar weakness. 3. Healthcare spending continues to vary greatly between developed and developing countries when considering healthcare spending on a Gross Domes- tic Product and per-capita basis, according to the World Health Organization. 4. The 2015 dip in health- care spending is expected to be temporary and accelerate again this year. Spending growth is expected to top 4 percent in 2016, according to the report, and continue to rise more than 6 percent per year in 2017 and 2018. 5. Rapid growth in markets, led by Asia and the Middle East, will drive change as public and private health- care systems develop in some countries. There is also a trend toward universal healthcare as a growth driver in many markets. 6. Pressure to reduce costs, increase efficiency and demonstrate value will "con- tinue to intensify." As a result, the EIU projects global healthcare spending to jump 4.3 percent during 2015 to 2019, more slowly than it did during the recession. The average GDP is expected to decline from the forecasted 10.3 percent last year to 10.1 percent in 2019. 7. The per-capita healthcare spending for various coun- tries around the world in 2013 based on data from the World Health include: • United States: $9,146 • Netherlands: $6,145 • Australia: $5,827 • Canada: $5,718 • Germany: $5,006 • Japan: $3,966 • United Kingdom: $3,498 • Middle East—Saudi Arabia, United Arab Emrites, Qatar): $1,473 • Brazil: $1,083 • Mexico: $664 • China: $367 • India: $61 n Will Spine Face Bundled Payments in the Future? By Anuja Vaidya Question: Last year, CMS finalized a bundled payments initiative for hip and knee replacements. Do you see a similar initiative for spine coming down the pipeline in the future? Scott Blumenthal, MD, Texas Back Institute, Plano: I think the intent for bundled payments in spine is there, but due to the heterogeneity of spine procedures it will be difficult, though not impossible, to figure out. ere are so many ways to treat a spine condition and it would be difficult to figure out a way to bundle payments. I anticipate there will be some resistance. William Taylor, MD, Director, Spine Surgery, Vice Chairman, Division of Neurological Surgery, University of California, San Diego: Yes, we are going to see this extend into all areas of healthcare. is can be beneficial for spine surgeons if we concentrate on episodes of care. Surgical intervention remains a cost-effective solution for all types of spine diagnoses. ere is little evidence that conservative management for many episodes offer improved outcomes that are sustained. Brian R. Gantwerker, MD, The Craniospinal Center of Los Angeles: Unfortunately, yes. e trend for the healthcare system has been oversimplification of surgical care within the system and per- petually forcing square blocks into round holes. My hope is our pro- fessional organizations will make a serious effort and make the govern- ment play fair, or toss it out for spine altogether. n Dr. Scott Blumenthal Dr. William Taylor Dr. Brian R. Gantwerker