• We are sorry, but NCBI web applications do not support your browser and may not function properly. More information
Logo of jurbhealthspringer.comThis journalToc AlertsSubmit OnlineOpen ChoiceThis journal
J Urban Health. Mar 1999; 76(1): 24–38.
PMCID: PMC3456704

The changing elderly population and future health care needs


The impending growth of the elderly population requires both fiscal and substantive changes in Medicare and Medicaid that are responsive to cost issues and to changing patterns of need. More emphasis is required on chronic disease management, on meaningful integration between acute and long-term case services, and on improved coordination between Medicare and Medicaid initiatives. This paper reviews various trends, including the growth in managed-care approaches, experience with social health maintenance organizations and Program of All-Inclusive Care for the Elderly demonstrations, and the need for a coherent long-term care policy. Such policies, however, transcend health care and require a broad range of community initiatives.

Full Text

The Full Text of this article is available as a PDF (869K).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
1. Preston SH. Children will pay. New York Times Magazine. 1996;29:96–97.
2. Welch HG, Wennberg DE, Welch WP. The use of Medicare home health services. N Engl J Med. 1996;335:324–329. doi: 10.1056/NEJM199608013350506. [PubMed] [Cross Ref]
3. Moon M. Medicare Now and in the Future. 2nd ed. Washington, DC: Urban Institute Press; 1996.
4. Levit K, Cowan C, Braden B, Stiller J, Sensenig A, Lazenby H. National health expenditures in 1997: more slow growth. Health Aff. 1998;17:100–100. [PubMed]
5. Medicaid Managed Care: Serving the Disabled Challenges State Programs. Washington, DC: Government Printing Office; 1996.
6. Callahan D. What Kind of Life: the Limits of Medical Progress. Washington, DC: Georgetown University Press; 1990.
7. Mechanic D. Sociological dimensions of illness behavior. Soc Sci Med. 1995;41:1207–1216. doi: 10.1016/0277-9536(95)00025-3. [PubMed] [Cross Ref]
8. United States, 1995. Hyattsville, Md: Public Health Service; 1996. pp. 138–138.
9. Lubitz J, Prihoda R. Use and costs of Medicare services in the last two years of life. Health Care Fin Rev. 1985;5:117–131. [PubMed]
10. Scitovsky AA. The high cost of dying revisited. Milbank Mem Fund Q. 1999;72:561–591. [PubMed]
11. Annual Statistical Supplement 1996 to the Social Security Bulletin. Washington, DC: SSA; 1996. pp. 5–5.
12. Ware JE, Jr, Bayliss MS, Rogers WH, Kosinski M, Tarlov AR. Differences in 4-year health outcomes for elderly and the poor, chronically ill patients treated in HMO and fee-for-service systems. JAMA. 1996;276:1039–1047. doi: 10.1001/jama.276.13.1039b. [PubMed] [Cross Ref]
13. Mechanic D, Schlesinger M, McAlpine D. Management of mental health and substance abuse services: state of the art and early results. Milbank Mem Fund Q. 1995;73:19–55. [PubMed]
14. Singh GK, Mathews TJ, Clarke SC, et al. Annual summary of births, marriages, divorces, and deaths: United States, 1994.Monthly Vital Statistics Rep. 1995;43.
15. Weissert WG. Seven reasons why it is so difficult to make community based longterm care cost effective. Health Serv Res. 1985;20:423–433. [PMC free article] [PubMed]
16. Carcagno GJ, Kemper P. The evaluation of the National Long Term Care Demonstration. 1. An overview of the channeling demonstration and its evaluation. Health Serv Res. 1988;23:1–22. [PMC free article] [PubMed]
17. Christianson JB. The evaluation of the National Long Term Care Demonstration. 6. The effect of channeling on informal care. Health Serv Res. 1988;23:99–117. [PMC free article] [PubMed]
18. Harrington C, Newcomer RJ. Social health maintenance organization service use and costs, 1985–89. Health Care Fin Rev. 1991;12:37–52. [PubMed]
19. Vladeck B. Long term care options: PACE and S/HMO. Testimony before the Subcommittee on Health, House Committee on Ways and Means, April 18, 1996. Available at: http://www/hcfa.gov/testmony/+041896.htm.
20. Wiener JM, Skaggs J. Current Approaches to Integrating Acute and Long-term Care Financing and Services. Washington, DC: American Association of Retired Persons; 1995.
21. Ball R, Bethell J. Wére All in This Together. Washington, DC: Families USA Foundation; 1989.

Articles from Journal of Urban Health : Bulletin of the New York Academy of Medicine are provided here courtesy of New York Academy of Medicine


Related citations in PubMed

See reviews...See all...


  • MedGen
    Related information in MedGen
  • PubMed
    PubMed citations for these articles

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...