Options to control the rising health care costs of older Americans

Article Abstract:

The enormous cost of providing health care for older Americans is continuing to escalate. These costs accelerate rapidly in the last few years of life. Yearly Medicare costs for individuals at age 65 are $1,239 versus $2,583 for patients 85 and older. Demographically, the average age in the United States is getting older. The fastest growing age group (cohort) is currently that designated as the oldest (85 years and older), and it is projected to grow from its current size of 2.5 million to 24 million in 2040. Several measures have been proposed to reduce the cost of providing health care to the elderly. One approach is to ration the provision of health care beyond some age, implicitly defining a natural life span. This plan proposes withholding all Medicare reimbursements for all technology and antibiotics, and limits care to provide relief from pain and suffering. This plan is vigorously resisted on the basis of ethical concern for the elderly. Also the rationing of health care by age is a step backward, in that the individuals and the families of the afflicted are essentially removed from the decision-making process. Furthermore, age as a sole criterion does not take in to account the fact that not all individuals of the same age share a common physical condition or vitality. Another approach to the rising cost of health care provision for the rapidly aging population is to further the investment in research on those diseases which afflict the aged. Although only approximately 4 percent of individuals at 65 years of age have Alzheimer's disease, as many as half of those individuals over 85 suffer from this or other forms of dementia. Research which resulted in containment of this and other diseases of the aged could have strong effects on the economics of provision of health care to this group. It is useful to recall how research during the first part of this century has led to a virtual elimination of many acute infectious disease with accompanying societal costs.

Management

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The aging of America: impact on health care costs

Article Abstract:

Health care costs rose at a rate exceeding inflation by almost 80 percent between 1976 and 1987 and their continued increase is a result of many factors. One of these is the 'aging of the aged', the survival of large numbers of people into their eighties and nineties. Recent projections of the US Census Bureau take into account the diminished mortality among this group and are used to project costs for Medicare, nursing homes, and relevant specific diseases. By the year 2020, the average life expectancy will be 82.0 years for women and 74.2 years for men, and people at older ages need correspondingly more health care services. Costs of Medicare, which currently does not cover most long-term care, may nearly double by the year 2020. Forty-five percent of nursing home residents are now 85 years old or older, and this population will increase as the population ages. The costs of senile dementia and hip fracture treatment, both of which will increase as more older people survive, are discussed. Although one approach to reducing costs is to reduce health care reimbursement, this will not cover the situation where the number of affected individuals increases dramatically. Rationing health care by age (not covering people for certain disorders past a given age) has been proposed but faces many objections. Another partial solution is increasing research efforts that will lead to cures for some diseases: at present, each dollar spent to care for an Alzheimer's patient is matched by an expenditure of 0.1 and 0.2 cents on basic research on that disease. The prospective health-care problems of an aging America require long-term solutions. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Nursing homes, Long term care

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Old age and new policy

Article Abstract:

An analysis of the provision of medical care to the elderly shows that stopgap changes in the Medicare system will be unable to deal with the growing disparity between costs of medical care to the elderly and the availability of funds to pay for it. A recent study shows the magnitude of the problem. Using current projections of cost that do not fully include many new proposals and pending legislation, the deficits for Medicare by the year 2000 will be $27.3 billion per year and the annual loss by 2020 will be $117 billion. More pessimistic, but more likely progressions show the projected losses at $62.5 billion and $210 billion per year for the same periods. In the face of these data, nothing short of a generalized re-evaluation will close the gap. Tinkering with the system will not help; only a coherent and comprehensive re-evaluation of acceptable and reasonable health care goals for the elderly can provide a solution. While many have proposed belt-tightening measures throughout the health care delivery system, these efforts have not worked. A new vision of health care policy for the elderly is required. A system that allows each person an adequate, but not indefinitely long, life is required.

Laws, regulations and rules, Ethical aspects, column, Life and death, Power over, Power over life and death

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