With 20,000 General Electric employees in 23 states on strike because their health care premiums are increasing and two dozen West Virginian surgeons on strike because of increasing malpractice rates, 2003 has already turned into a critical year for the health care sector.

Health care companies developing or implementing their marketing plans might be interested in the following predictions about health care policy and media coverage of that policy.

• Health insurance and Social Security move up on the legislative agenda as boomers and Gen X-ers get older, the economy becomes less predictable and new health threats emerge.
  
• Even while the U.S. government faces the budget-busting costs of military activities and Homeland Security programs, it's a safe bet that the current administration will advance some concrete proposals to solve the nation's health care dilemma. Patients, health care providers, insurance companies and employers alike loathe the current system. While the overall quality of care declines, some doctors are leaving their practices due to spiraling malpractice insurance premiums. At the same time, more medical facilities in border states will close their doors because they are overwhelmed by illegal immigrants seeking treatment but unable to pay for it. As a result, the federal government is expected to introduce pilot programs featuring new types of medical facilities and payment schemes.
  
• Because recent changes in the health care system have somewhat ruptured the traditional doctor-patient relationship, increasingly, patients will turn to outside sources for medical advice. These non-traditional sources will include Web sites, where patients can access information provided by others with similar maladies, local and national news broadcasts, which almost daily carry medical news features, and pharmaceutical advertising, which blankets the broadcast and print media with solutions for everything from arthritis to depression to impotence.
  
• Frequently, consumers are introduced to these pharmaceutical wonders through paid celebrity endorsements. In addition, celebrities often are used to create "awareness" programs for certain diseases and to promote the use of increased public funding to find cures for these illnesses. However, the media will continue to be skeptical about celebrity awareness programs for diseases and medical conditions and for endorsements of products that can "cure" those afflicted. In 2002, ABC and CNN issued policies about identifying celebrities as paid endorsers when they talk about a condition/drug during their appearances. Other media will take their lead, with debate strong on both sides. One camp argues that it is misleading not to cite a celebrity's paid connection to a company; the other argues that celebrities are often more effective than doctors to generate attention for these conditions, noting that NBC's Katie Couric has raised millions for colon research and screening, saving an untold number of lives. This debate could significantly impact marketing direct-to-consumer (DTC) products across broadcast, print and online media - as well as consumer perception of doctors (and, perhaps, medical associations) if they, too, must disclose relationships with health care companies. The FDA has not issued any rulings, and is not likely to do so, because the concerns seem to be generated by the media, not the consumer.
  
• More procedures will be available and conducted away from traditional hospital settings. Already, hospitals have been branching out with new locations to be closer to their patients. But now, the malls will become important locations for medical diagnoses and fast, simple procedures. Following LASIK surgery and medical scans, which are now widely available at malls, we can expect to see a rush of quick, non-invasive procedures that involve a significant emotional upside and little pain and quick recovery times. The reason: even for issues that are not medically necessary, patients have already demonstrated they are willing to pay for treatment - even when most of these services fall outside insurance coverage. At the same time, because these procedures are not covered, expect to see ads and Web sites touting "affordable fees."
  
• The Department of Health and Human Services, Department of Homeland Security, FEMA, the Red Cross and the health care industry will have to contend with threats of bioterrorism. The anthrax scare in 2001 demonstrated how ill prepared government agencies and the industry are in dealing with a biochemical attack. Concerns about smallpox vaccination policies will heat up if war occurs.
  

Susan Eldred, John Parker and Norman Birnbach are all with Birnbach Communications Inc., a strategic business communications consultancy that offers service with experienced, senior-level attention across a range of industries, including technology, health care and life sciences, telecommunications and travel and transportation.