The US healthcare system is being buffeted by winds of change. Once viewed as a model of excellence, economic and social disequilibrium have uncovered a multitude of frailties within the system. Spiraling healthcare costs in an otherwise stagnant economy have given rise to skepticism regarding the motivations of healthcare providers. What are the issues that confront the healthcare system? What new demands do these issues place on the delivery system? How should an organization such as SHEA position itself to meet these new demands?

Three major issues will confront the healthcare system during the next decade. First, 10% to 14% of the US population have limited or no access to healthcare. Steps must be taken through the political process to assure that every person living in the United States has access to a reasonable standard of medical care. Second, despite implicit rationing, the costs of healthcare continue to consume an ever-increasing proportion of society's resources. In response, a potpourri of strategies have been implemented to contain increasing costs. Third, as society learns more about processes and outcomes of medical care, concern for quality intensifies. Efforts to constrain costs are juxtaposed with demands to assure excellence and quality in medical care. During the decade of the 90s the critical questions will be how much medical care should be provided to whom and at what level of quality? If society insists that medical care should be provided to all who live in the United States but refuses to increase present resources, difficult decisions will have to be made regarding how to reallocate those resources and how to minimize the impact of reallocation on quality of care.