The Gerontologist, Vol 34, Issue 5 590-597, Copyright © 1994 by The Gerontological Society of America
Health care reform from the view of a geriatrician
MB Gerety
Education and Clinical Center, Audie L. Murphy Memorial Veterans Affairs Hospital, San Antonio, TX 78284.
In an ideal world, all citizens would receive high-quality health care, all
services which are appropriate and necessary, in the setting that can best
meet the patients' needs and preferences. The frail, dependent, chronically
ill person has been considered an outlier by third party payment systems,
including Medicare, the health care system designed for the elderly.
Physician payment systems have penalized those who care for the frail,
resulting in an inadequate medical workforce to care for the elderly.
Medicare and state-financed long- term care systems, by attempting to limit
expenditures of public funds on long-term care, have become biased toward
institutional care. Although the frail and disabled represent a minority
(approximately 12%) of those aged 65 or older, their numbers are large and
growing. The health care system of today and the system proposed for
tomorrow by the Clinton Administration is not prepared to care for large
numbers of people with chronic, disabling illness. Only when the health
care system or new health alliances share responsibility for all care
provided to every citizen will the looming problems of large numbers of
persons with chronic illness and functional dependency be faced. Care must
be driven by patient needs and preferences, not by reimbursement
regulations and financial incentives. The Clinton plan institutionalizes
the segregation of chronic long-term care from hospital and outpatient
care. Responsibility for these services is relegated to states. This
political compromise, as disappointing as it may be to geriatricians, may
offer opportunity for experimentation. Fifty new state-regulated systems
may serve as health services experiments.(ABSTRACT TRUNCATED AT 250 WORDS)
