title: Implications of policy and management decisions on access, quality, and the type of services for the elderly in the United States.
abstract: America has no conscious overall health policy. What we have is a system which encourages doctors to perform medical procedures on people, especially in hospitals, and which places little or no emphasis on a person's responsibility for his or her own health. There is no incentive whatsoever for doctors, except in HMOs, to provide the elderly with primary care or consultations on preventative health care. there is no reimbursement under Medicare for this type of service, and a financial disincentive exists for the doctor in that a healthier patient is less likely to use a physician's services. In addition, because there is inadequate funding for home health care and supportive services for families of the elderly who are experiencing problems functioning in their daily living, many people who could be kept out of nursing homes with proper support go into nursing homes, where they generally, after depletion of their assets, have their nursing home care covered by the Medicaid program. Because of the lack of recognition by the Medicare program of the major role of social and mental health factors on the health of the elderly, and the lack of reimbursement or other funding for services which treat the social, mental, and spiritual aspects of the person, the elderly are often inappropriately and expensively treated for physical symptoms; their other needs and problems are ignored, even though in many cases the treatment of the underlying problem would remove or ameliorate the physical symptom and expedite the recovery. Recommended changes in the health care system which will be of particular benefit to the elderly are by providing primary and preventative health care, providing alternatives to hospitalization and nursing home care wherever possible, discouraging unnecessary surgery and medication, providing for contributions to Medicare based on income of the elderly so that the poor and the rich are treated more equitably, decreasing the complexity of the Medicare reimbursement process, mandating geriatric education for health care professionals, developing public awareness concerning the quality of extended life and promoting public information programs designed to promote a new and positive image of aging in America.
mesh_terms: D000368:Aged; D006291:Health Policy; D006299:Health Services for the Aged / Q000458:organization & administration*; D006801:Humans; D008484:Medicaid; D006278:Medicare; D014481:United States