Times are relatively good for global healthcare. Life expectancy is at its highest level in history, and new treatments and lifesaving techniques arrive on the scene every day. In the United States, recent legislation-though swirling in controversy-aims to make care more available and affordable. Along with these advances, architects are working to make hospitals and other healthcare buildings a true ally in improving public health and patient treatment.

Yet economics are clouding this rosy picture. The healthcare system absorbs $2.5 trillion annually or close to 17 percent of U.S. gross domestic product (GDP). Treatment costs tend to increase rapidly, and total spending is expected to grow to 19.5 percent of GDP by 2017, according to the U.S. Department of Health and Human Services. Hospitals and healthcare providers regularly report a shortfall in payments, which the American Hospital Association (AHA) calculates in the tens of billions of dollars (see Chart 1).

"American hospitals are financially challenged and the trends in revenues and expenses will put and even greater burden on the viability of many hospitals and their ability to fund capital projects," says Anne McLeod, vice president of finance policy for the Sacramento-based California Hospital Association. While the portion of patients with Medicaid has risen over the last decade from 11 percent to about 14 percent of the total economy, McLeod adds, rates of employer-sponsored insurance have dropped precipitously-from almost 64 percent in 2000 to about 8 percent just two years ago. States, now struggling to fill budget gaps, spend on average 14 percent of their budgets on Medicaid, according to the National Association of State Budget Officers.

The need for cost control by hospitals and healthcare providers is driving architects to innovate. Based on demographics alone, the growing need for new and refurbished healthcare facilities will continue its upward trend for years. Yet healthcare facility operators will see a softening of demand due to the recent economic downturn, resulting in fewer patient admissions and fewer elective procedures. Based on those numbers-and a resulting lack of capital-providers are revising their projections for construction spending (see Chart 2). About 40 percent of hospitals have halted projects to increase patient capacity or renovate facilities, although the slowdown has more dramatically affected purchases of new clinical technologies and IT systems.

At the Omaha Women's Methodist Hospital in Omaha, Nebraska, the architect HDR Architecture employed low-E glazings with low-reflectivity coatings on interior surfaces. Photo courtesy of Guardian Industries