james h. johnson, jr. william rand kenan, jr. distinguished professor of entrepreneurship &...
TRANSCRIPT
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James H. Johnson, Jr.William Rand Kenan, Jr. Distinguished Professor of Entrepreneurship & Strategy
Kenan-Flagler Business School Director, Urban Investment Strategies Center
Frank Hawkins Kenan Institute of Private EnterpriseUniversity of North Carolina at Chapel Hill
DISRUPTIVE DEMOGRAPHICSThe Changing Face of the
Patient of the Future
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Overview
Disruptive Demographics
Opportunities & Challenges
Implications for Healthcare Planning & Delivery
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Disruptive Demographics
The “Browning” of America
The “Greying” of America
The Nexus of Diversity Issues
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Veterans(1922-1945)
Baby Boomers(1946-1964)
Generation X(1965-1980)
Generation Y(1981-2000)
Core Values Respect for authorityConformersDiscipline
OptimismInvolvement
SkepticismFunInformality
RealismConfidenceExtreme funSocial
Family TraditionalNuclear
Disintegrating Latch-key kids Merged families
Education A dream A birthright A way to get there An incredible expense
Communicationmedia
Rotary phonesOne-on-oneWrite a memo
Touch-tone phonesCall me anytime
Cell phonesCall me only at work
InternetPicture phonesE-mail
Dealing with Money
Put it awayPay cash
Buy now, pay later CautiousConservativeSave, save, save
Earn to spend
Personal and Lifestyle Characteristics by Generation
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Veterans(1922-1945)
Baby Boomers(1946-1964)
Generation X(1965-1980)
Generation Y(1981-2000)
Work Ethic and Values
Hard workRespect AuthoritySacrificeDuty before funAdhere to rules
WorkaholicsWork efficientlyCrusading causesPersonal fulfillmentDesire qualityQuestion authority
Eliminate the taskSelf-relianceWant structure and directionSkeptical
What’s nextMultitaskingTenacityEntrepreneurialTolerantGoal Oriented
Work is ….. An obligation An exciting adventure A difficult challengeA contract
A means to an endFulfillment
Leadership Style DirectiveCommand-and-control
ConsensualCollegial
Everyone is the sameChallenging othersAsk why
*TBD
Interactive Style Individual Team PlayerLoves to have meetings
Entrepreneur Participative
WORKPLACE CHARACTERISTICS
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WORKPLACE CHARACTERISTICS(CONT’D)
Veterans(1922-1945)
Baby Boomers(1946-1964)
Generation X(1965-1980)
Generation Y(1981-2000)
Communications FormalMemo
In person DirectImmediate
EmailVoice mail
Feedback and Rewards
No news is good newsSatisfaction in a job well done
Don’t appreciate itMoneyTitle recognition
Sorry to interrupt but how am I doing?Freedom is the best reward
Whenever I want it, at the push of a buttonMeaningful work
Messages That Motivate
Your experience is respected
You are valuedYou are needed
Do it your wayForget the rules
You will work with other bright, creative people
Work and Family Life Ne’er the twain shall meet
No balanceWork to live
Balance Balance
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People On The Move
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Legal Immigrants: 1920-1961: 206,000 annually 1961-1992: 561,000 annually 1993-1998: 800,654 annually 1999-2004: 879,400 annually 2005-2008: 1,137,000 annuallyRefugees, Parolees, Asylees 1961-1993: 2.1 million (65,000
annually) 1994-1998: 428,361 (85,672
annually) 1999-2004: 487,386 (81,231
annually) 2005-2008: 203,642 (75,661
annually)
Illegal Immigrants: 300,000 to 400,000 annually
over the past two decades Three million granted
amnesty in 1986 2.7 million illegal immigrants
remained in U.S. after 1986 reforms
October 1996: INS estimated that there were 5 million illegal immigrants in the U.S.
August 2005: Illegal population range from 7 to 15 million.
The Numbers
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Year All Classes Exchange Visitors Academic & Vocational Students
1981 11,756,903 108,023 (1%) 271,861 (2%)
1985 9,539,880 141,213 (1%) 285,496 (3%)
1990 17,574,055 214,644 (1%) 355,207 (2%)
1995 22,640,540 241,364 (1%) 395,480 (2%)
2000 33,690,082 351,743 (1%) 699,953 (2%)
2001 32,824,088 389,435 (1%) 741,921 (2%)
2002 27,907,139 370,176 (1%) 687,506 (2%)
2004 30,781,330 360,777(1%) 656,373(2%)
2008 39,381,928 506,138 (1%) 917,373(2%)
Non-Immigrants Admitted to the United States
1981 - 2008
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World Region of Birth for U.S. Population, 1970-2008
2008
2004
2000
1990
1980
1970
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Europe Asia Latin America Other Areas
Percent
Year
9,619,302
14,709,906
19,767,316
34,244,000
28,379,000
37,264,000
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GROUP % CHANGE
All Races 50%
Whites 29%
Blacks 94%
Native Americans 109%
Hispanics 238%
Asians/Pacific Islanders 412%
Population Estimates by Race/Ethnicity1988 - 2050
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RACE / ETHNICITY TOTAL FERTILITY RATE
Hispanic 2.99
Non-Hispanic White 1.87
Blacks 2.13
Asian 2.04
Native American 1.86
Total Fertility Rates of U.S. Women by Race/Ethnicity
1988 - 2050
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America’s Color Adjustment
Race/Ethnicity 1995 2050
White 73.6 52.8
Blacks 12.0 13.5
Hispanics 10.2 24.5
Asian 3.3 8.2
American Indian 0.7 0.9
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Relative Distribution of U.S. Population by Race/Ethnicity, 2005
& 2050
RACE / ETHNICITY 2005 2050
White 67% 47%
Blacks 12.8% 13%
Hispanics 14% 29%
Asian 5% 9%
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Women who had a birth in the last 12 months, Ages 15 – 50, by Select Characteristics
2006
CHARACTERISTICBirths
per 1,000 Women
All U.S. Women 55
Nativity
Native Born 52
Foreign Born 71
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Women who had a birth in the last 12 months, Ages 15 – 50, by Select Characteristics
2006 (Cont’d)
CHARACTERISTICBirths
per 1,000 Women
All U.S. Women 55
Race
White, non-Hispanic 50
Black 58
American Indian/Alaska Native 68
Asian 54
Native Hawaiian and Pacific Islander 61
Some other Race 78
Two or More Races 58
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Women who had a birth in the last 12 months, Ages 15 – 50, by Select Characteristics
2006 (Cont’d)
CHARACTERISTICBirths
per 1,000 Women
All U.S. Women 55
Hispanic Origin
Hispanic (any race) 74
Non-Hispanic 51
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Women who had a birth in the last 12 months, Ages 15 – 50, by Select Characteristics
2006 (Cont’d)
CHARACTERISTICBirths
per 1,000 Women
All U.S. Women 55
Citizenship
Naturalized Citizen 49
Not a Citizen 83
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Percent Distribution of U.S. Births by Race/Ethnicity
1990 & 2008RACE / ETHNICITY 1990 2008
White 66% 50%
Blacks 17% 16%
Hispanics 15% 26%
Other 2% 8%
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Race Total Male Female
United States 36.8 35.4 38.2
White Alone 38.3 37.0 39.6
White, Non-Hispanic 41.2 39.9 42.6
Black Alone 31.3 29.4 33.3
AIAN Alone 29.5 29.0 30.2
Asian Alone 33.6 32.6 34.6
NHPI Alone 29.9 29.5 30.3
Two or More Races 19.7 18.9 20.5
Hispanic 27.4 27.4 27.5
Median Age of U.S. Population by Race, Hispanic Origin & Gender, 2009
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Completed Fertility for Women 40 - 44 Years Old
Year Percent Childless
Avg. Number of Children
Percent Higher Order
Births*
2006 20 1.9 28
1976 10 3.1 59
*Three or more Children
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U.S. Total and Foreign Born Population Change,
1990-2000
2000Population
Absolute Change
1990 - 2000
% Change1990 - 2000
Total 281,243,499 33,323,643 13.4%
Foreign Born 32,989,429 11,472,676 53.3%
Hispanic (Foreign Born) 14,410,703 6,331,264 78.4%
Hispanic (Native Born) 20,760,734 7,057,303 51.5%
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Change in Regional Distribution of Foreign Born Population, 1970 - 2008
2008
2004
2000
1990
1980
1970
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
West South Midwest Northeast
Percent
Year
9,619,302
14,709,906
19,767,316
34,244,000
28,379,000
37,960,935
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Percent Change in Total and Foreign Born Population, by Region, 1990-
2000
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Net Population Change Attributable to Non-White Population Growth,
1990 - 2000
Region 2000 Population
Net Change
1990-2000
% of Net ChangeDue to Nonwhite
Population Growth
United States 281,421,906 32,712,033 65%
Northeast 53,594,378 2,785,149 100%
Midwest 64,392,776 4,724,144 62%
South 100,236,820 14,790,890 52%
West 63,197,932 10,411,850 69%
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Net Population Change Attributable to Non-White Population Growth,
2000 - 2004
Region 2004 Population Net Change2000-2004
% of Net ChangeDue to Nonwhite
Population Growth
United States 293,655,404 12,233,498 81.5%
Northeast 54,571,147 976,769 100.0%
Midwest 65,729,852 1,337,076 82.5%
South 105,944,965 5,708,145 74.4%
West 67,409,440 4,211,508 81.0%
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In-Migration, Out-Migration, Net Migration, and Movers from Abroad
for Regions, 1990-2000
Region In OutNet
InternalMigration
MoversFrom
Abroad
NetMigration(including
from abroad)
Northeast 3,666 6,178 -2,512 2,222 -290
Midwest 6,978 6,909 69 1,641 1,711
South 11,761 9,357 2,404 4,185 6,588
West 6,751 6,731 38 4,185 4,222
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New England Midwest South West
-1,032 -2,008 +2,287 +46
-346 -71 +376 +41
-292 -109 +520 -117
-115 +42 +97 -27
-147 -3 +145 +3
TOTALTOTAL
BlackBlack
HispanicHispanic
ElderlyElderly
ForeignBornForeignBorn
= Net Import = Net Export
Net Migration Trends, 2000-2008
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U.S. Population Change by Region, 2000 - 2009
Region 2009Population
AbsolutePopulationChange, 2000-2009
PercentPopulation
Change,2000-2009
U.S. 307,006,550 248,345,932 8.8%Northeast 55,283,679 1,616,173 3.0%Midwest 66,836,911 2,342,955 3.6%South 113,317,879 12,757,940 12.7%West 71,568,879 8,117,525 12.8%North Carolina 9,380,884 1,301,501 16.1%
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Population by Race and Hispanic Origin for the United States: 2000
RACE & HISPANIC OR LATINO NUMBER % OF TOTAL
Total Population 281,421,906 100.0%
One Race 274,595,678 97.6%
White 211,460,626 75.1%
Black or African American 34,658,190 12.3%
American Indian & Alaskan Native 2,475,986 0.9%
Asian 10,242,998 3.6%
Native Hawaiian & Other Pacific Islander 398,835 0.1%
Some other Race 15,359,073 5.5%
Two or More Races 6,826,228 2.4%
Hispanic or Latino (of any race) 35,305,818 12.5%
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Net Population Change in the United States by Race and Hispanic or Latino Origin,
1990 - 2000
Race and Hispanic or Latino 2000Population
Net Gain1990-2000
PercentChange
Total 281,421,906 32,712,033 13.2%
White 211,460,626 11,774,556 5.9%
Black or African American 34,658,190 4,672,130 15.6%
American Indian or Alaska Native 2,475,956 2,475,956 131.8%
Asian 10,242,998 3,334,360 48.3%
Native Hawaiian and other Pacific Islander 398,835 33,811 9.3%
Some Other Race 15,359,073 5,554,226 56.6%
Hispanic or Latino (of any race) 35,305,818 12,951,759 57.9%
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Race 2009 Population Absolute Change2000 – 2009
Percentage Change2000 - 2009
Total 307,806,550 24,834,539 8.8
Non-Hispanic 258,587,226 12,057,648 4.9
White 199,851,240 4,088,448 2.1
Black 37,681,544 3,276,661 9.5
AIAN 2,360,807 256,564 12.2
Asian 13,686,083 3,233,417 30.9
NHPI 448,510 79,260 21.5Two or More Races 4,559,042 1,123,298 32.7
Hispanic 48,419,324 12,776,945 35.8
U.S. Population Change by Race & Ethnicity, 2000 - 2009
U.S. Population Change by Race & Ethnicity, 2000 - 2009
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U.S. Population Turning 50, 55, 62, and 65 Years of Age,
2007 - 2015
Age 50 Age 55 Age 62 Age 65
Average Number / Day 12,344 11,541 9,221 8,032
Average Number / Minute 8.6 8.0 6.4 5.6
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Absolute and Relative Change in the Gender/Age Composition of the U.S. Population, 1990 - 2000
Gender/Age2000
PopulationNet Change1990-2000
% Change1990-2000
Total 281,421,906 32,712,033 13.2%
Male 138,053,563 16,814,145 13.9%
Female 143,368,343 15,897,888 12.5%
Age 18-34 67,035,178 -2,878,520 -4.1%
Age 35-54 82,826,479 20,024,490 31.9%
Age 55-64 24,274,684 3,126,761 14.8%
Age 65+ 34,991,753 3,749,922 12.0%
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Age 2009 Absolute Change2000 - 2009
Percentage Change2000 - 2009
<25 104,960,250 5,258,492 5.3
25-44 84,096,278 -1,898,345 -2.2
45-64 79,379,439 16,977,567 27.2
65+ 39,570,590 4,496,886 12.8
TOTAL 307,006,550 24,834,593 8.8
U.S. Population Change By Age, 2000 - 2009
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Age Profile of UNC - CH Faculty, 2002
Employee Type Number < 40 40-59 60+ Average Age
Tenured/Tenure Track 1,821 310 1,213 298 50.4
(%) (100) (17) (67) (16)
Fixed Term 870 254 570 46 45.5
(%) (100) (29) (66) (5)
Total 2,691 564 1,783 344 48.8
(%) (100) (21) (66) (13)
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Absolute and Percent Change in U.S. Population by Age,
2005 - 2050*
Age 2005 2050 % Change
Total 296 438 50.0%
Age 0-17 73 102 39.7%
Age 18-64 186 255 37.1%
Age 65+ 37 81 118.9%
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Implications and Challenges
Managing transition from the “graying” to the “browning” of America.
Competition for talent will be fierce – and global. Successful recruitment and retention will hinge on your
ability to effectively manage the full nexus of “diversity” issues.
Patient- & Staff-Centric Cultural Elasticity will be in great demand.
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Age 2005 2050*
Total 186 million 255 million
Hispanic Share 14% 31%
Foreign-born Share 15% 23%
Change in Foreign Born and Hispanic Shares of Working Age Population
(18-64), 2005 - 2050
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In-, Out-, and Net- Migration, North Carolina,
2004-2008
Year Arriving Migrants Departing Migrants Net Migration
2004-05 124,293 95,917 +28,376
2005-06 139,107 97,352 +41,755
2006-07 142,540 101,273 +41,267
2007-08 144,936 103,941 +40,995
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Major Redistributors of Population to North Carolina,
2004 - 2008
State of Origin Number of Arriving Migrants
Florida 62,528
Virginia 53,536
New York 49,284
South Carolina 39,096
Georgia 28,264
California 27,813
Pennsylvania 23,185
New Jersey 22,620
Foreign 22,533
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Per Capita Income of Arriving & Departing Migrants, North
Carolina, 2004 - 2008
Year Arriving Income Departing Income Difference
2004-05$22,464 $21,124 $1,522
2005-06$23,327 $22,333 $ 994
2006-07$24,576 $22,422 $2,154
2007-08$25,000 $23,530 $1,470
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NC Population Change by Race & Ethnicity, 2000 - 2009
2009Population
AbsolutePopulation Change,
2000-2009
PercentPopulation Change,
2000-2009
Total 9,380,884 1,301,501 16.1%
White Alone 8,663,222 967,429 12.6%
White, Non-Hispanic 6,267,309 591,048 10.4%
Black Alone 1,990,501 253,493 14.6%
AIAN Alone 105,582 8,892 9.2%
Asian Alone 187,866 70,905 60.6%
NHPI Alone 5,077 1,766 53.3%
Two or More Races 106,887 41,325 63.0%
Hispanic 717,662 334,072 87.1%
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Median Age of U.S. and N.C. Population by Race & Hispanic Origin, 2009
US NC
Total 36.8% 36.9%
White Alone 38.3% 38.6%
White, Non-Hispanic 41.2% 40.5%
Black Alone 31.3% 32.7%
AIAN Alone 29.5% 32.2%
Asian Alone 33.6% 32.5%
NHPI Alone 29.9% 27.2%
Two or More Races 19.7% 16.8%
Hispanic 27.4% 23.6%
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North Carolina’s Hispanic and Not-Hispanic Population by Age,
2009
Under 5 years 5 to 19 years 20 to 44 years 45 to 54 years 55 to 64 years 65 years and older0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
40.0%
45.0%
16.3%
28.0%
41.4%
8.2%
3.5% 2.6%
6.3%
19.5%
33.8%
14.7%12.2%
13.5%
Hispanic Non-Hispanic
Age
% o
f Pop
ulat
ion
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Population Change by Age, North Carolina, 2000 - 2009
Age 2009Population
AbsolutePopulationChange, 2000-2009
Percent Population
Change,2000-2009
<25 1,560,551 214,366 15.9%
25-44 1,283,420 37,632 3.0%
45-64 1,253,434 309,607 32.8%
65+ 693,294 111,303 19.1%
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Demand for Cultural Elasticity
Linguistic Religious Family Structure Lifestyle Sexual Orientation Generational
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Older Workers in U.S. Workforce
65 or Older 75 or Older
2008 16.8% 7.3%
1998 11.9% 4.7%
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Strategies to Attract and Retain Older Workers
Flexible work arrangements (consultant, temporary and part-time assignments)
Phased-retirement program Retirement health benefits Prescription drug coverage Superior vision and dental plans Defined benefit pension Long-term care insurance
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Outsourcing Trends in Health Care Industry
Administrative Services Information Technology Revenue Cycle Functions Insurance Claims Processing Medical Transcription Virtual Practice Management Telemarketing Activities Fulfillment Services
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Outsourcing Trends in Health Care Industry
Patient Care Services Tele-radiology Services Intensive Care Unit Monitoring Medical Tourism
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Medical Tourism Cost Comparison
Type U.S. India
Hip Replacement (partial)
$18,000 $4,500
Hip Replacement (full) $39,000 $3,000
Orthopedic surgery $4,500 $18,000
Cardiac surgery $40,000 $6,500
Gall bladder surgery $60,000 $7,500
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Implications for NC’s Health and Competitiveness
Create healthy and viable communities Active living by design Health eating by design Infuse health and wellness education
throughout K-16 curriculum Strategically re-position health
disparities as a competitiveness issue.
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