This is one of those times that mark both a beginning and an end.
As the world counts down the days until the new century and a new millennium, healthcare providers can reflect on what a remarkable 100 years this has been. They can recall the evolution of what was essentially a cottage industry into an economic sector constituting about 14% of the gross domestic product.
They can also contemplate the fantastic opportunities and, perhaps, perils that the next century holds.
The past year was in some ways a transitional one. The pace of mergers and consolidations began to cool. Hospital giant Columbia/HCA Healthcare Corp. turned from acquirer to divestor. Once high-flying managed-care companies struggled to regain their financial footing.
As the year came to a close, evidence of widespread hospital layoffs and restructurings mounted. A variety of financial pressures or perceived financial pressures led executives to retrench and dismiss some staffers. Among the problems was the inability of some systems to digest the numerous and diverse acquisitions they had swallowed.
One ominous sign appeared when Allegheny Health, Education and Research Foundation tumbled into bankruptcy. The startling event raised questions about the financial stability of similar not-for-profit systems that have expanded aggressively in recent years. The new year may tell us if Allegheny was an aberration or the norm.
In the following pages, our staff reporters take a look at what 1999 might hold for segments of the industry they cover. While they boast a good track record on forecasting the trends, you can be sure the last year of the century will bring a few surprises. Let's hope that whatever happens, 1999 turns out to be a segue to a prosperous and productive era for healthcare.