Question

Discussion:

How will the aging of the U.S. population affect health care programs in the future? Are there better solutions than Medicare and Medicaid for providing better health care for older people at less cost?

Answer 1

Discussion:

How will the aging of the U.S. population affect health care programs in the future?

Advancement in the field of public health, socioeconomic development, and medical technology during last century has resulted in increase in life expectancy. Most people born today will live past the age of 65 years, and many will survive past the age of 85 years. But this increased life expectancy has exposed that segment of population to risk of disability and chronic illnesses and deteriorated quality of life.

According to the Global Health and Aging report presented by the World Health Organization (WHO), “The number of people aged 65 or older is projected to grow from an estimated 524 million in 2010 to nearly 1.5 billion in 2050, with most of the increase in developing countries.” In addition, by 2050, the number of people 65 years or older is expected to significantly outnumber children younger than 5 years of age.

Neither low, nor middle, nor high income countries are immune to the implications of this change. As people age, they suffer from more and more illnesses, increasing burden on health systems. Demographic change, not merely affect public services, but also the social climate of the nation.

Life expectancy rates in the United States also have been increasing

Before the recent slight/ negligible decline (2014-2017) in life expectancy had been steadily rising in the U.S. for most of the past 60 years. According to data from the Centre for Disease Control and Prevention a baby born in 2017 is expected to live to be 78.6 years old, which is down from 78.7 the year before.

As a result of extended life expectancy the proportion of the US population above 65 years old is increasing dramatically, and the group over 85 years old, the “oldest old,” is the most rapidly growing segment.

In the United States, the number of Americans over the age of 65 is expected to be doubled from roughly 50 million today to nearly 100 million by 2060.

Rising proportion of aging population and life expectancy had been particularly significant in context of U.S. — a nation particularly the one that spends more money per citizen on health care than any other country.

This leads to the question: what are the implications of the aging population on health care?

Researchers have contradictory views, few believe that in increased population disability rats will be reduced due to medical advancements with time, others believe that as life expectancy increases, the prevalence of disability will increase.

However there are certain health conditions that are expected to be a challenge to our health care system with the increasing aging population. These conditions include cancer, dementia, increase in the number of falls, obesity, and diabetes and other non communicable chronic diseases.

This population shift will place great pressure on systems of health care, public health, and other supports for older persons. Expected challenges to the health care system include the following-

· resource needs will continue to increase across all health care settings

· a shortage of health care professionals is expected

· changes in family structure may lead to fewer family caregivers

· the diversity of caregivers’ lags behind the growing diversity of patients

· care has to be focused addressing comorbidities

· the sustainability and structure of federal programs in relation to the increasing aging population are a concern

· adapting and adjusting to the affordable care act pose challenges

To address the needs of increasing aging population, the health care system must take on these challenges.

Looking forward, our health care system is unprepared to provide the medical and support services needed for previously unimagined numbers of sick older persons, and we are not investing in keeping people healthy into their highest ages. Other major challenges at health policy and program formulation and implementation level are related to cost of meeting such needs. Many people already work less than half a lifetime because of extended periods of schooling and training in early life, earlier retirement, and enhanced longevity, posing a challenge to the sustainability of systems designed to support older persons. If the trend toward increased longevity continues without a parallel extension in working life, the stress on these systems could be even greater.

· How can we control expenditures for health and long-term care in the face of the projected growth of the elderly who are at risk of chronic illness often requiring extensive medical and long-term care services? Will people have to do without medical care?

· What aspects of the growing health needs of an aging society are most affected by the pressures to constrain budgetary and economic resources devoted to health care?

· What mechanisms are needed to share the burden of health care expenditures for an aging society more equitably among all members of society?

· With the growing financial burden of out-of-pocket expenditures for certain groups of the elderly who are disabled and require extensive treatment, what are the alternative equitable financing mechanisms to pay for these services?

· What alternative financing mechanisms for the supply of long-term care services should be supported and by whom?

· What changes in funding mechanisms, legislation, and public policy are necessary to shift the emphasis away from hospital and nursing home care toward less costly alternatives?

· Can less costly and less restrictive alternative services to institutionalization be developed to maintain the independence of the elderly? Can economic incentives be developed for in-home and community-based services to maintain the elderly at home?

· What are the costs (direct and indirect) of chronic illnesses such as Alzheimer's disease and what are the implications of helping to meet those costs through public funding?

· To what extent is there an emerging intergenerational inequity with the aging of the baby boom generation—Americans born between 1946 and 1964—and low fertility rates in which a smaller number of the working population will bear the burden of support of the larger number of retired elderly beginning about the year 2010?

Are there better solutions than Medicare and Medicaid for providing better health care for older people at less cost?

The expected and impending change in population pyramids had forced all of us to scrutinize our old ways of thinking and design new services and ways of delivering care. Governments must plan decades ahead, studying the economic and social implications of aging. As societies age, all those involved in the healthcare and social care systems must adapt their services, and continuously learn.

In describing the current methods of financing care for the elderly, it is appropriate to begin with a brief description of the public programs, in particular Medicare and Medicaid. These are the most important sources of funding, and the structure of these program affects the nature of the insurance policies that are offered by the private sector.

Approximately 95 percent of all people age 65 and over in the United States are covered by the Medicare program. Medicare consists of two separate but complementary programs: Hospital Insurance (HI) for services furnished in hospitals, in skilled nursing facilities, and by home health agencies; and Supplementary Medical Insurance (SMI) for the services of physicians, home health visits (for people who may not be covered by HI), outpatient services, and the costs of durable medical equipment and prostheses. Coverage for outpatient mental health services is very restricted. In addition, some services frequently used by the elderly, such as outpatient drugs, dental services, and eyeglasses, are not covered.

As a result of the rapid escalation in the cost of the program, the reimbursement changes have been made and other ways of lowering the costs of the program are in line for evaluation, such as increasing the cost-sharing requirements, changing the age for eligibility, increasing the premium costs, making Medicare the second payer for those who are employed and eligible for employer-provided health insurance, increasing Medicare enrolment in HMOs, and changing the Medicare program to a voucher program.

Medicaid, a program to provide medical services to the poor, is administered by the states under federal guidelines. With respect to the elderly, Medicaid pays for the medical care for those who meet Supplementary Security Income (SSI) standards. States have the option of covering medically needy individuals (those with incomes slightly above the SSI levels) and individuals who have incurred sufficiently high medical expenditures that they "spend down" to Medicaid income eligibility levels. Like the Medicare program, the costs of the Medicaid program have been increasing at a rapid rate. As with Medicare, there is a concerted effort to reevaluate the structure of the program, in particular with respect to long-term services, to revise the methods used to reimburse providers, especially nursing homes, and to change the income eligibility levels.

We can learn a great deal from example of Sweden. Sweden has a high average life expectancy for women at eighty-four years and for men eighty years. It is expected to keep rising in Sweden, to eighty-nine years for women and eighty-seven years for men between now and 2060. If population trends continue, the Swedish population pyramid will look less like a pyramid and more like a cylinder by 2050. Sweden is now designing new approaches to accommodate the growing population of elders. One approach uses mobile teams to fill gaps in elder care.

Approaches other than Medicare and Medicaid for providing low cost health care for elderly may be :

· Mobile care units, palliative care units, rehabilitation care units and so on to reduce the cost as well as burden on hospitals. These units can be equipped with a team of professional and facilities to provide targeted care to elderly, bringing better patient satisfaction.

· Designing and building age friendly houses or communities, modifications to prevent falls, better lighting, alarm system.

· Smart homes which allows for measurement and monitoring of various key physiological signs of the elderly using low-cost sensors from a remote healthcare service centre, over a secured communication platform, thus offering a cost-effective solution for long-term health monitoring. Use of e- health and telemedicine facilities.

· Community based old age homes for providing semi institutional care to at risk older adults who have multiple chronic conditions

Changing leave policies, modifying retirement plans can also be an option.

.Choice regarding end of life issues can also be considered for cghronically ill patients

Enhance social engagement of elderly by volunteering activities.