In the book Understanding the U. S. Healthcare Services System by Barton, there are a number of forces influencing changes in the U. S. health services delivery system.  The forces include:

• The raised level of consciousness that employers and payers are experiencing about the costs of providing employee health insurance
• The perverse incentives that fee-for-service care establishes
• The effects on utilization of self-referral, doctor-shopping, and open access to specialists
• The need for both private and public payers to better predict total health expenditures
• The need for accountability of health expenditures within a society
• The belief that optimal rather than maximal use of limited resources is more appropriate
• The need to increase efficiency in the system, including the appropriate use of inpatient and outpatient services and the reduction of overcapacity. 

 I am sure there are several more forces that are just as important that have developed over the past few years.  How do you think the impact on the current Administration will change these forces overall.