The U.S. Mail Age Scenario

Imagine a world in which consumers, using traditional information gathering processes rather than those enabled by high technology, aggressively shop for those products and services that provide them with the greatest personal value. Active consumerism, linking dollars to perceived value, has pervaded all aspects of daily life as an aging population becomes increasingly concerned with the cost of post-retirement living and the prospects of diminishing health status. High value is placed on services that are personalized and offer satisfaction in terms of positive outcomes, personal convenience, pleasant amenities and acceptable cost. Due to the confusing array of equipment incompatibilities, access choices, high cost, and limited availability in all but the most urban areas, high technology communications services have not been adopted widely by society. Most people still rely on radio, television, newspapers, magazines, direct mailings, and friends and family for meeting their information needs. In this situation, location equals accessibility, and the university requires a physical presence and competes in a predominantly regional market. UTMB develops a 90-acre second campus on Interstate 45.

Local consumers have organized special interest groups to apply legislative, economic and public opinion pressures on health care provider organizations that do not meet perceived needs adequately. UTMB has had difficulty in overcoming public misconceptions about its priorities, in addressing issues of health care rationing, and in projecting its desired image to local consumers. This has been exacerbated by the local concentration of health science centers and health care providers and by direct competition with the Texas Medical Center institutions. Telemedicine and distance education programs have had limited success because of the inability to attract sufficient numbers of patients and students.

Academic health centers have responded to these trends by attempting to expand the range of choices available both to health professional students and to patients. Efforts to capture market share in the varied mix of traditional and non-traditional education and patient care markets have stimulated intense regional competition among academic health centers, especially in state-assisted institutions. After initial enthusiastic development of distance education programs, UTMB has returned to more traditional teaching methods. In some cases, distance learning is combined with traditional methods by faculty who participate in teaching at multiple campuses. Successful service delivery of education and health care has required increases in the number and types of community outreach initiatives, expansion of delivery networks, and stepped-up advertising and marketing plans. Along with this has come the need to re-engineer procedures and re-train faculty and staff to function increasingly like hospitality industry properties and employees.

Increased tailoring of services to local markets and extensive cost-cutting to make more money available for experimentation with niche markets has had a significant impact on institutional organizational and support infrastructures. Whereas consumers have tended to avoid high technology, academic health centers have been forced to spend more on technology to seamlessly link disparate sites where education and the delivery of care take place. Additionally, it has been necessary to insure that academic health centers have access to state-of-the-art equipment in order to increase customer comfort and confidence. Significant costs to the institution result from providing structures and buildings to provide points of presence and access across the region.

In Texas, particularly in the Houston/Galveston area, competition among the health science centers for patient dollars and students has resulted in the establishment of agreements among the academic health centers as to which niches they will serve. For example, UTMB patients go to M.D. Anderson for cancer diagnoses and initiation of treatment and return to UTMB for their routine follow-up, while HIV patients from Houston are treated and managed by UTMB. Similarly, graduate education and post-graduate medical education strengths no longer overlap, with each academic health center focusing its research and teaching expertise in areas of mutually acknowledged excellence. For example, UTMB’s GSBS maintains educational programs in infectious diseases, neurosciences and medical humanities while UT Houston Health Sciences Center and M.D. Anderson train students in cell biology, medical informatics and cancer biology. Had the health centers in the Houston/Galveston area not formed cooperative relationships, competition between centers, along with competition from other health care providers, may have eliminated some of them.

Active consumerism also has had a major influence on the research missions and activities of academic health centers. Increasing pressure on local, state and federal governments from affliction advocacy groups and high-profile celebrities has been successful in re-channeling increasing amounts of public money into directed research areas. Disease-specific, community-specific, and public health-oriented research areas thrive. Some institutions have chosen to focus primarily on regional research priorities, making it more difficult to attract and retain top-notch investigators with broader interests. This also has posed wrenching conflicts for researchers seeking collaborators in regional research from nearby institutions that are competing at every level for research dollars, students and patients.

Inability to enroll new patients (or health care contracts) or students in distance or technology-based programs (or maintain numbers in these programs)
Increased creation of consumer-initiated services (alternative treatment options or novel degree programs)
Emerging state legislative concerns concerning redundancy in the state-assisted health industry in the Houston/Galveston area
Survey information indicating the need for increased responsiveness to consumer needs or dissatisfaction with current levels of service
Increased regional pressure to build satellite clinics and satellite educational facilities
Continued territorial market disputes with San Antonio- and Houston-based institutions
Loss of national and international prestige for UTMB research/educational programs
Increase in "old-fashioned" advertising (television commercials, billboards, etc.) utilized by regional medical centers
Continued inability of producers to make home computing accessible to consumers with no technical skills
Trends that indicate the public is rejecting information technology for use and application in the medical field (examples: declines in values of certain internet companies' stock values, drop in home computer sales.)
Proliferation of health industry consumer advocacy groups
Increase in targeted research funding.

Factors precipitating this scenario may include:

Inability to move expediently to capture new distance markets, resulting in a lockout in the larger markets --“the low lying fruit will already be picked”
Reluctance to change current practices and programs
Ineffectual leadership at the university and System levels
Effective political maneuvering from the private sector to restrict the university enterprise to regional concerns
Excessive regulation by state and federal oversight agencies
Inability to convert the general public to the electronic world (“we don’t like the metric system” mentality)
Inability to afford and implement electronic infrastructure changes to compete in the electronic world
Increase in targeted research funding.