Baby boomers and the strain on U.S. health care systems

¶ … Aging Baby Boomers Affect Health Care

The objective of this work is to examine how the aging baby boomers will affect the health care system in the coming years.

INTRODUCTION recent report published by the Centers for Medicare and Medicaid Services (CMS) stated that unless "decisive action is taken, total U.S. health care spending will double to just over $4.5 trillion by 2017 or nearly 20% of the nation's gross domestic product." (Bio-Medicine, 2008) it is estimated by Tefen USA that "this figure could be considerably higher, based on its assessment of data that people over the age of 65 experience nearly three times as many hospital days per thousand as the general population, and that sixty-two percent of 50-64-year-olds report having at least one of six chronic health conditions: arthritis, high cholesterol, cancer, diabetes, heart disease and hypertension." (Bio-Medicine, 2008) This problem is only compounded by a "sharp decline in hospital capacity...[as] the number of community hospitals decreased from 5,384 to 4,915 between 1990 and 2000. During the same time period, the number of beds per 1,000 of population decreased from 4.2 to 3.0. This reduction in capacity, Tefen points out, has been accompanied by a sharp increase in hospital staffing. Between 1995 and 2000, full-time equivalent personnel increased from about 3,420,000 to about 3,911,400. At the same time, hospitals have spent almost $100 billion in facility and infrastructure improvements." (Bio-Medicine, 2008)

I. HEALTH CARE SYSTEM OUTLOOK

The study reported by Tefen USA states the following facts for the health care system outlook in the coming years:

1) the problem of uninsured Americans will escalate, as employers seek to reduce the burden of retiree health care coverage, trim their contributions to health care premiums and, in some instances, eliminate the health care benefit entirely;

2) Health care quality will suffer, with wide variation in treatments and big differences in death rates and surgical complications.

3) Federal spending on Medicare and Medicaid will skyrocket, forcing politicians to raise taxes or severely curtail a wide range of other government programs;

4) State budgets will suffer under the crush of soaring Medicaid costs, compromising support for education and other local initiatives; and 5) the nation as a whole will have fewer and fewer dollars to spend on education, environmental protection, scientific research and national security.

II. ALZHEIMER'S DISEASE & DEMENTIA

It is reported that approximately "14 million baby boomers, or 18% likely will develop Alzheimer's disease or some other form of dementia, a development that could cost the U.S. health care system as much as $160 billion by 2010." (Medical News Today, 2008) the 2008 Alzheimer's Disease Facts & Figures states that without a cure "the U.S. will have about 500,000 new cases of Alzheimer's in 2010 and almost one million new cases by the middle of the century." (Medical News Today, 2008) Medicare spent the amount of $91 billion on Alzheimer's treatment in 2005 along with treatment for other dementia and the estimates state that spending will likely be around $160 billion on the same treatment by 2010 and approximately $189 billion by 2015. Approximately seventy-percent of individuals with Alzheimer's and other such dementia live at home with family members and friends providing their care. In total approximately "10 million U.S. residents ages 18 and older provided about $89 billion in 8.4 billion hours of unpaid care to Alzheimer's patients in 2007." (Medical News Today, 2008)

IV. POLICY ISSUE - CHANGES in CONSUMER PREFERENCE & STRUCTURAL FRAGMENTATION

Dennison states that another "set of realities involves changes in consumer preferences. Nursing home utilization, on a per capita basis, has declined over the past ten to fifteen years. Some of the reasons for this decline include lower levels of disability among the elderly, expansion of home care and availability of alternative options such as assisted living. We can expect that consumerism will play even a larger role in the choice of care options as the baby boomers, with a history of individualism, enter the long-term care system." (Dennison, 2008) Dennison relates that alternative program options with a blend of "acute and long-term care" and integration of Medicare and Medicaid financing "such as the Program for All-Inclusive Care of the Elderly (PACE) which is a model of managed care, have been developed. However, the mainstream of health care remains in two separate camps, each with their own financing stream and each with their own paradigm of service." (Dennison, 2008)

Dennison states that this "structural fragmentation is underscored by the poorly integrated education and training of the professional involved in the delivery of health care services." (2008) Required in coping with the "range of medical and social needs of the elderly" is a multidisciplinary perspective. Presently, physicians and nurses along with other personnel are educated in what Dennison terms "splendid isolation." (2008) it is necessary that individuals be educated and trained to work with other health care professionals in order to bring more efficiency and effectiveness to health care of the large population of baby boomers.

V. POLICY ISSUE - ACUTE CARE SERVICES

One of the policy issues is related to acute care services and this issue is one that "revolves around affordability." (Dennison, 2008) According to Dennis the issue of prescription drugs is important since "most Medicare enrollees do not have adequate coverage for outpatient drug expenditures as Medicare covers only drugs prescribed for inpatient use." (Dennison, 2008) a larger part of the problem is that the delivery of acute care for the elderly is that geriatric medicine has tended to focus mainly on the "management of acute ad chronic diseases, with much less emphasis on health promotion and prevention of disease." (Dennison, 2008) Needed is a view focused on preventative care is likely to have more consistency in viewing the demands that the baby boomer population will place on the health care system in the years to come.

V. POLICY ISSUE - LONGTERM CARE

Also a policy issue is that of long-term care. Dennison (2008) report that the Medicaid spending in 1996 on "nursing homes and home care represented approximately 35% of total Medicaid spending. The costs of long-term care are essentially divided between the Medicaid program and private patient payments, with Medicare and private long-term care insurance representing only a small portion. However, Medicare and Medicaid spending for home and community-based care varies widely from state to state. The financing structure of Medicare and Medicaid creates incentives for the states to shift spending to Medicare and encourages the federal government to develop approaches to shift spending to Medicaid." (Dennison, 2008) if the reduction of the cost of long-term care "to the public purse is to be reduced, the burden will increasingly fall on the individual. Individuals and their families will have to plan and pay for more care through either traditional retirement savings or through the acquisition of risk pooling mechanisms like long-term care insurance." (Dennison, 2008)

V. LEGAL ISSUE - TORT REFORM

The solution is stated to be something other that a "single-payer system" and additionally stated is "while socialized medicine provides some advantages from an access standpoint, it does not address the underlying cost and quality issues that threaten the functional integrity of health care in the U.S." (Liu, 2008) the actual solution to the challenges facing the health care system in the United States is one that makes a requirement of three components:

implementing tort reforms; mandating the use of best practices; and driving systemic process improvement. (Liu, 2008)

This report states that the threat of litigation gets in the way of health care delivery in that is "causes providers to hide problems and engage in unnecessary procedures to avoid potential negative occurrences. If caregivers document mistakes, they are immediately exposed to litigation. Consequently, obfuscation and secrecy become the standard practice when confronted with errors. Quality issues are concealed and knowledge is suppressed, leading to the high likelihood that mistakes will be replicated." (Liu, 2008)

The answer in addressing quality issues and medical errors is a "system of health courts practice to the arbitration system utilized to address other complex issues requiring dispute resolution, such as workers' compensation, tax and patent disputes and vaccine liability, where claims against institutions are adjudicated. Health courts would administer peer reviews and independent analysis of procedural errors - differentiating between human error and negligence - and determining damages proportionate to the mistakes." (Liu, 2008) the answer is also inclusive of mandating 'best practices' in which providers are held accountable for health care delivery to the best known standard." (Liu, 2008)

VI. ECONOMIC ISSUE - FUNDING and CONSUMER PREFERENCE

The requirements in today's health care system and the challenges presented in the provision of health care and the expanding group of elderly population are complex in nature and cross disciplinary boundaries. New methods of financing health care must be designed and long-term care desperately needs new and innovative methods of long-term health care provision. There is a requirement for ongoing integration and management of both acute and long-term health care services and a need for the addition of new services to the continuum of care. Since today's consumers are more individualized and knowledgeable than the previous generation, development of health care services that are efficient and effective will necessarily require the input of this generation of aging individuals who believe in getting the most for their hard-earned money. Naturally, as new services need not be added if they are not going to positively contribute to the health care provision in terms of what the consumer requires then these services will represent ill-spent funding so much research is required in this area in establishing precisely what requirements will be presenting to the health care system in the years to come.

SUMMARY & CONCLUSION

As reported in this study the total spending in U.S. Health care is estimated to be $4.5 trillion by 2017 representing approximately 20% of the GDP. Chronic health care conditions and dementia will be relevant in the extremely large group of the elderly population by 2017 comprised mainly of baby boomers. This combined with a reduction in capacity of health care institutions due to staff shortages presents many challenges to the health care system. New and different methods of health care financing and new services for health care provision are necessary requirements in addressing these challenges in future health care in the United States and specifically in providing health care for the extremely large group represented by the baby boomers that will comprise the elderly population.