“We believe the economy made the consumer hide, closed their purse strings, not engage in commercial activity, which caused a downward trend ... during 2010 that will not recur in 2011,” Zubretsky said.

Even in December, just over half of Americans put off medical care because of the cost, a Kaiser Family Foundation monthly survey found. One in four said their household had trouble paying medical bills over the past year.

Zubretsky sees the industry embarking on a period of “normalized utilization.”

“I’m not sure what normal means anymore, but clearly the inflection point in 2009 was aberrant and abnormal,” he said. “And we also believe that the softness the industry experienced in 2010 was equally as abnormal.”

CEO Wayne Smith of Community Health Systems, which manages 126 hospitals in 29 states, told the conference that he did not expect admissions to rise much in 2011 from 2010.

While 2011 may be better than 2010, weakness in certain areas, like orthopedic procedures, which are more sensitive to the economy since they often can be deferred, is expected to persist.

Stryker CEO Stephen MacMillan provided a rosy outlook for its businesses in 2011, but acknowledged that growth in the spinal market will be in the low single-digit percentage range.

Zimmer Holdings CEO David Dvorak said he did not see a big change in fundamentals and did not expect demand for orthopedic implants to improve until at least the second half of 2011.

For healthcare overall, “2011 probably won’t look materially different from 2010,” Dvorak said. “We’re going in the right direction, but it’ll be a slow recovery.”

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By Debra Sherman

SAN FRANCISCO