Even as recently as 10 years ago, it was still a little unusual outside of a strictly refractive surgery setting to be discussing how to “upsell” ophthalmology patients to the concept of a premium product, as we do in our cover story this month (p.30). Not today. And as we look ahead, it’s clear that 10 years from now, medical practice will have vastly changed again. Two predictable drivers of change will be money and technology.

Whatever the outcome of the current health-care reform effort, health-care spending will continue to play an ever-larger role in our economy. A May 2011 report from the Health Research Institute predicts that such spending will encompass nearly 20 percent of the U.S. economy by 2019. Today, 76 percent of the Fortune 50 companies are in the health industry or have a health division.

All of that money can only come from one place: you and me. Whether in taxes, insurance premiums or a greater emphasis on patient-pay, it’s safe to say that we are all going to have a far greater financial stake in our own health care. As those stakes go up, so do expectations, as any surgeon implanting premium lenses will attest.

At the same time, patient expectations of their health care are being shaped by technology. Consumers’ expectation that services will be geared to them, rather than the passive, one-size-fits-all model of the past, has been noted for some time now. Technology is both driving and responding to that expectation. Our feature on how technology is changing medicine (p.26) shows some examples. One clear trend in medicine and the economy generally is the earlier and more active role of the patient/consumer in shaping the product they ultimately receive, whether it’s a doctor visit or some other service.

An example in medicine is Zibbel Inc., which has developed an application that collects personalized, real-time data from patients outside the hospital or clinic, such as glucose monitoring or blood pressure, and then provides customized educational information to the patient’s smart phone or iPad. On the clinic’s end, the aggregation of such data helps providers to direct treatment choices more effectively.

Any time you look ahead, it’s possible to succumb to the flying car and floating cities predictions of some decades ago. What seems safe to say today is that patients will be far more invested in their own care, both financially and intellectually, that providers will increasingly tailor what should be a greater range of services to the specific patient, and that it’s all going to cost a hell of a lot more.