The Impact of the Aging Population on Public Health Care - Research Paper Example

The Impact of the Aging Population on Public Health Care Introduction The growth of biomedicine within the past decades has led to numerous medical innovations, especially in geriatrics. However, this medical development was not able to prevent the rapid aging of population, especially in highly developed countries such as the United States and the United Kingdom. The necessity to reform the medical or health care system of the United States has eventually surfaced. The two major health care issues nowadays are lack of access and rising costs. A more remote but possibly more difficult issue is the aging of the population. The number of retirees will rise rapidly. Immediately afterward the population of old people with sickness will grow rapidly. The outcome could be a massive allotment of resources to the elderly (Callahan 4). An effective solution to the current issue in the medical system should recognize these changes demography, and it should consider not just individual’s wellbeing but also the stability of the society and the wellbeing of the public. This research paper discusses the impact of an aging population on all aspects of the medical system, and the potential solutions to this health care issue. The impact of the aging population is more striking in the mental health care sector. Overview of the Problem The percentage of older people across the globe is continuously rising. For the elderly, mental health problems are a major reason for early mortality and morbidity. Severe depression and dementia are the two most common mental health disorders among the elderly. Specific medical needs of the older people should be recognized and provided by the medical system. Long-term care has been a serious issue brought about by the rapid aging of the population. The most evident impacts of an aging population are to be found in highly developed countries and developing nations like Latin America and China (Rao & Shaji 1). Because of the unparalleled rate of population aging, these countries would have difficulties creating healthcare and social policies on time to address the medical requirements of the older people. The poor priority given to the medical needs of the aged seems to contribute to the public’s insufficient knowledge about older people’s mental health disorders. Dementia and other neuropsychological problems of the elderly are still unknown issues seldom prioritized by policymakers and medical practitioners. General health services are still centralized or hospital-based and normally require long queues in jam-packed hospitals. The common priority in these situations is acute illnesses that can be treated and non on long-term care (Bartels & Smyer 14-15). The elderly find it hard to travel to these hospitals. The number of physicians serving in rural areas remains inadequate. Qualified health practitioners serve an important function in providing medical services in rural settings. Yet, they do not regard addressing the medical needs of the aged their main concern. They lack adequate training in diagnosing and administering treatment for the illnesses of the elderly (Bartels & Smyer 15). To solve this issue, healthcare practitioners may be taught to diagnose illnesses in the area and provide home-based care. Lack of qualified healthcare workers and insufficient resources for medical care will greatly hamper the improvement of health care services. Health care professionals responsible for delivering and organizing medical services have failed to recognize the fast aging of the population. The family is the key long-term care providers of older people. This is particularly true in developing nations where the family is the sole provider of care for physically infirmed or mentally distressed elderly. Hospital-based care is not available in many areas and is expensive (Rao & Shaji 2). However, it would be incorrect to think that home-based care is not costly. Normally, home-based care is linked to major financial and emotional difficulties. Most frequently, the women are the caregivers and lack access to resources or support required to perform this obligation (Rao & Shaji 2). The current community outreach programs are not sufficiently prepared or endowed to provide home-based care for the elderly. Societies are continuously subjected to external and internal pressures. Because of diverse changes in demography, economy, and the social environment, family capabilities and resources are diminishing. The size of the family is shrinking. Human mobility or migration is continuously building up leading to changes in urban and rural social conditions. Infirmity and financial difficulties of non-elderly members of the family can further cause difficulties to elderly care (Bartels & Smyer 15). Home-based care of older people will become more and more challenging in the future as female family members, whom the responsibilities of caring for the elderly most often fall, are more and more expected to enter the labor market. However, as stated earlier, two of the most serious problems faced by the health care system of the United States are limited access and rising costs. Americans who have the resources to pay for their medical needs receive premium health care services. The difficult challenge is to maintain the effectiveness or quality of current medical services while trying to effectively manage unidentifiable costs and provide health care access to all Americans. It is evident that the issues of access and costs are connected. Most apparently, a smaller number of people are able to get insurance as costs increase (Hackler 4). A current survey by the Agency for Health Care Policy and Research of the Department of Health and Human Services has discovered that the percentage of those with no health insurance is twenty percent of the U.S. population. In 1987, roughly 24 million people did not have health insurance. Roughly 50 million people had policies that offer insufficient coverage (Hackler 4-5). Medicaid includes merely the poorest individuals in many states. Most of the uninsured are the members of the poor working class and their dependents. Several small organizations are not able to provide health insurance for their employees, and a number of bigger and more established businesses keep away from the expenditure by recruiting part-time employees (Hackler 4). Temporary or seasonal employees and self-employed individuals may also be uninsured. People without insurance usually receive insufficient care under degrading circumstances. Several doctors avoid patients without insurance, and some even reject Medicaid-covered patients. Patients may not receive vital optional treatments until their medical condition become acute. In this case they may resort to costly emergency rooms where they will receive the needed treatment right away (Callahan 84-86). If they are not able to pay for their treatment, the expense is transferred to patients with insurance, further adding to the price of premiums, which is another issue within the complex correlation between access and cost. On the other hand, health care costs have risen over the recent decades (Hackler 1-2): Health care spending in the U.S. for 1992 was $838.5 billion, more than 14 percent of our gross domestic product (GDP). The previous director of the Office of Management and Budget testified before Congress that without serious structural changes, health care would account for 17 percent of the GDP by 2000 and 37 percent by 2030. *image taken from Hackler 1994, 2 These predictions are now inaccurate. Individuals with fixed earnings are the most severely affected by increasing costs. Older people in the United States paid out 10.6% of their net earnings for medical services in 1961, prior to the endorsement of Medicare, which handles the bulk of the health care cost of every individual aged 65 and above (Hackler 5). As shown by Hackler (1994), in 1991, even with Medicare assistance, medical costs used up 17.1% of their earnings (5). Increasing health care expenses do not only affect individual consumers. Bigger government expenses via Medicaid and Medicare worsen the federal shortage. To manage expenses the government has trimmed down Medicare assistance, paid merely a fraction of Medicaid expenses, and enforced a potential payment system derived from averages instead of real costs. The actual cost of medical services has not declined in relation to the reduced sums paid back to hospitals and doctors (Bartels & Smyer 16). As a result, the extra costs have been transferred to private payers. This transferring of cost has sped up the rising health insurance cost and health coverage cost. There are numerous causes of this continuous increase in health care cost. Mismanaged insurance premiums continuously exist, revealing growing legal actions and greater awards. A large number of doctors perform alleged defensive medicine, commissioning procedures and examinations of minor importance simply to avoid a possible malpractice case. A current study revealed that roughly $10 billion is used up annually in this way (Hackler 5-6). Preventive care and patient education are given less priority within the existing system, which places more importance on cure than prevention. Medical costs are not discussed in medical training, thus doctors are seldom informed about the cost of a procedure or examination they require. This fact reveals a more persistent pattern. Consumers want premium health care services, which they associate with the most costly, extensive, and thorough. People are inclined to view health care as a total necessity, not dependent on the cost-benefit analysis that normally informs their economic decisions. Furthermore, because the expenses are often handled by third parties, providers and consumers do not have the motivation to regulate their expenditures. Consequently, hospitals use up massive resources buying, modernizing, and developing sophisticated technologies and facilities to attract more patients (Callahan 121-122). Without a doubt, a more cost-efficient resource allocation would substantially cut down overall health care cost. In the meantime, shortage of health care practitioners addressing the medical needs of the older people will persist. The curriculum of medical students has to be amended to resolve the issues of the aging population. Commissioning outreach services and training health care workers are other domains that should be prioritized. Addressing the health care needs of the elderly will have to be prioritized by the outreach programs. Research, which leads the formulation of medical services, is a vital domain (Rao & Shaji 3). It can help policymakers and professionals distribute resources rationally. Developing and maintaining research capability and financially supporting research are weak areas that should be strengthened. At present there are roughly 35.1 million Americans aged 65 and above. Approximately 26.3% of the elderly have a mental problem (Bartels & Smyer 14). The population of older people with acute mental disorders will increase considerably in the near future. By 2030, the population of older people with mental problems will exceed the population in late middle age and early adulthood. The prevalence of mental problems among the elderly is linked to increased mortality, caregiver burnout, poor outcomes and quality of life, and weakened functioning. Furthermore, people aged 75 and above have the greatest suicidal tendency (Bartels & Smyer 14-15). Hence, the need to reform the health care sector for the elderly is apparent. The mental health care sector for the elderly is presently inadequately financed, disjointed, and poorly serves the population of mentally unwell elderly. The primary sources of mental health services for the elderly are providers of long-term care, primary health care, and specialty mental health. Although the population of older people in the United States comprises 13% of the country’s total population, they make up 7% of the total inpatient mental health care, 9% of private psychiatric services, and 6% of community-based mental health care (Bartels & Smyer 14). Roughly 3% of people aged 65 and above obtain mental health services from providers of specialty mental health care; this is a very low level of service use compared to other adult age group. Infrequent use of specialty mental health care by this age group could be associated with the stigma attributed to mental disorder, low number of trained health care practitioners, absence of effective coordination and cooperation between aging and mental health systems, financial support, and lack of access (Bartels & Smyer 14). Even though providers of community-based care are enhancing their responsiveness to older people’s mental health problems, these health care practitioners usually lack sufficient resources and the manpower to meet the mental health and medical needs of the elderly. In general, according to Perry and Webster, it is approximated that merely one-third of the elderly population who reside in rural areas and who require mental health and medical services really receive them (29). Almost all older adults receiving mental health services are handled by providers of primary health care. Coexisting mental problems are discovered in roughly 30% of patients in primary care and are related to permanent decline in functioning (Bartels & Smyer 14). Generally, acute mental disorders are associated with longer duration of hospitalization and greater expense for inpatient medical services. For instance, major depression in elderly patients in primary care is related to the substantial rise in general medical care cost. In spite of the commonness of these illnesses and their connection to greater costs and poor health outcomes, identification and treatment of mental health disorders in the primary care sectors are insufficient (Bartels & Smyer 14-15). The elderly are especially vulnerable because they are less likely to consult providers of mental health care and are more likely to obtain unsuitable and vague pharmacological medications. The rapid aging of the American population with chronic mental or medical disorders has created more difficulties for long-term care institutions in the United States. Roughly 80% of the elderly cared for by long-term care organizations such as nursing homes have serious behavioral or mental disorders (Perry & Webster 30). Nursing homes are the main source of formal long-term care for the elderly with mental disorders. Mental problems in long-term care facilities are related to higher level of service use and costs. Empirical findings show that the delivery of mental health care in nursing homes is related to emergency service utilization, reduced hospitalization, and better health outcomes (Perry & Webster 30). Nevertheless, in spite of the positive outcomes of mental health interventions, only a small number of nursing home patients receive them. Furthermore, the most mentally ill, weakest and oldest patients are the most prioritized. Mental problems among the elderly are one of the most costly public health issues facing the United States, with substantial effects on consumer spending and federal resources. Estimated and actual economic costs of mental problems are overwhelming and will have a major effect on health care costs. The annual expenditure on chronic mental disorders across all age groups is projected to go over $300 billion (Bartels & Smyer 18). More than 4 million people are presently suffering from Alzheimer’s disease, one of the most expensive aging problems. Overall expenditure on Alzheimer’s disease is roughly $100 billion yearly. Depression represents another widespread and expensive disorder among the elderly. Roughly 15% of older people experience major depression (Bartels & Smyer 18-19). This mental health problem is related to higher mortality rates and impairment, poorer outcomes, and greater use of medical services and costs. Across all age groups, the expenditure on depression has been roughly $43 billion annually (Bartels & Smyer 19). In spite of the high incidence of mental problems in older adults and the related effect on general healthcare use, quality of life, and functioning, only a small portion of the overall Medicare spending is allocated for mental health care. Although Medicare does stand for an essentially vital provider of federal health insurance for the elderly population, the coverage of Medicare is not inclusive (Hackler 6). Mental health coverage is not uniform with medical coverage, prescription medications are not covered, and coverage for inpatient specialty services and community-based care is inadequate (Hackler 6). In spite of the firmly established effect of mental health disorders on healthcare expenditures and public health, poor Medicare coverage for mental health care is still a serious barrier to treatment. New proposals from a consensus declaration on the impending crisis in the health care sector for the elderly, the Administration on Aging Report on Older Adults and Mental Health highlight the critical need for frameworks of healthcare and community-based medical services for the elderly. As the aging of the population continues, it is important that empirical research be financially supported to make sure that procedures and treatments are discovered for some of the most distressing mental and medical disorders experienced by the elderly (Perry & Webster 30). However, in spite significant financial support for the National Institute of Mental Health (NIMH) in the past decade, the organization’s support for external studies on geriatric mental health has failed to cope with its research subsidy for other age groups (Perry & Webster 30). Additional financial support for research on service and outcomes is important to develop quality medical services, standards for health care use, and best practices. The discrepancy between medical practice and research outcomes is aggravated by the lack of qualified providers. The present number of qualified geriatric practitioners is inadequate to fulfill service requirements. Shortages are predicted to become more difficult with the predicted growth in elderly population and their medical needs. The most critical need is for geriatric professionals who can train general practitioners who administer most geriatric medical services. Training opportunities are required as well for new and existing workers in geriatrics (Rao & Shaji 4). Impediments to the realization of training opportunities for practitioners who are not experts in aging involve shortage in qualified trainers and training facilities and a view of older adults as an unimportant segment of the population. The Vulnerable Elderly Older people are particularly exposed to medication-related complications due to a number of causes (Perry & Webster 29): (1) the physiological changes that occur with aging, (2) a lack of knowledge and training among health professionals and caregivers about the special medication-related needs of older people, (3) a deficiency of research about the effects of medications in this population, especially the oldest old, and (4) the lack of a comprehensive system for collecting, processing, and analyzing data on medication effects. As the aging of the population continues, the burden on the medical system as regards medication for the elderly will become heavier. Individuals aged 65 and above are the most vulnerable to medication-related complications due to the quantity of medications they have to get and the natural changes accompanied by aging and illness. A particular study calculated the proportion of hospitalizations of ailing older adults because of medication-related complications to be 17% (Perry & Webster 29-30). Harmful medication outcomes among the elderly like confusion, coordination difficulties, fatigue, and drowsiness—can lead to severe damage caused by accidents, or less injurious but similarly damaging consequences, like memory problems and poor functioning (Perry & Webster 30). In spite of current developments in research on new treatments and medications for the elderly, poor representation of individuals aged 65 and above and especially people aged 75 and above in medical studies has led to inadequate information about the levels of dosage and the outcomes of various medications for the age group that takes them the most (Perry & Webster 30). In order to assist medical practitioners improve their services, additional knowledge is required about medication use in these age groups. Other aspects that make the elderly vulnerable involve cognitive disorders that make it harder to follow correctly recommended medication routines, eyesight difficulties that can make it hard to follow or read instructions properly, financial factors that influence the acquisition and regular intake of medications, and absence of a primary care provider to assist with medication use. The American health care system also goes through a lack of an effective scheme for gathering and analyzing information about the effects of medication (Hackler 43-45). However, all these health care problems caused by rapid population aging are solvable. Potential Solutions Expansion in knowledge or understanding about the different features of the medical health of the elderly has to be transformed into accessible and easy to use services. Prospective set of services for the elderly has to be modified to match the situation of health systems. In poor societies with inadequate resources, the priority should be primary care services (Callahan 1995, 103). First of all, the community-based primary care sectors peopled by health staff, nurses, and physicians have to be facilitated to address the medical needs of the growing elderly population. This would require a change in perspective outside the existing focus on plain curative treatments. Primary care has to include management of chronic diseases and long-term care services. Primary care physicians should be capable of diagnosing and treating depression, dementia, and hallucination. Health care practitioners require training in the identification and treatment of widespread medical problems of older people. Improved capability and knowledge will allow them to supervise and lead the outreach programs successfully (Bartels & Smyer 20). Their assistance and supervision alone can guarantee the effectiveness of outreach programs. The National Initiative on Care for Elderly (NICE) is a project of the central government, which aspires to improve the provision of care to older people in the community context (Bartels & Smyer 20). Another level of care that should be focused on would be respite care in nursing homes or day centers. These institutions may function as training facilities for providers of care. Nursing homes and day-care respite care are costlier than home-based care. However, these are important to fulfill the demands of the community, especially for individuals with more severe dementia. Nongovernmental organizations and the private sector may be motivated to set up such facilities. Processes for guaranteeing service quality would depend on the government (Rao & Shaji 5). Long-term care costs should be addressed. Complimentary services incorporated into primary care will contribute to the reduction of healthcare expenditures. The government must initiate policies that will expand access to social security services (Hackler 209). Providing financial support to care providers who are not able to enter employment because of care-giving responsibilities require significant consideration. Moreover, Geriatric Psychiatry must be seriously considered in postgraduate education. The need to take into account the likelihood of embarking on specialization studies in Geriatric Psychiatry has to be considered. Research is vital for the development of services for older adults. First-rate research can assist in the distribution of resources rationally (Perry & Webster 31). Research should be prioritized and their expansion supported. Information dissemination is also essential for enhancing the outcome of medical conditions. Sustained attempts at dissemination of research outcomes have to be carried out on a regular basis. Rapid population aging took place alongside poor financing in services and research. The population of older people with mental problems is predicted to grow drastically in the near future. This increase will have a serious effect on the demand for long-term and acute care and will lead to substantial rise in the costs and use of medical services. Although effective medications or treatments are available for numerous medical disorders attributed to aging, there is a discrepancy between the existing health care system and the infrastructure needed to fulfill future needs (Perry & Webster 31). This inadequate emphasis on service development and research may result in a public health catastrophe. What is required is a new perspective of analyzing the overall cost of medication. Usually, when payers of medications view costs, they concentrate solely on utilization, cost of distribution, and cost of production. However, there is an intrinsic limitation to this method because it does not consider the costs related to avoidable medication-related complications. It is safe to assume that the volume of resources the United States allocates for medication-related complications estimates the cost of delivering medications (Perry & Webster 31). With this overwhelming quantity of resources involved, it is important that consumers, healthcare officials, and payers should become informed about the massive cost of the inability to deal with avoidable medication-related complications. The majority of third-party payers, in an attempt to lessen medication costs, concentrate quite solely on cutting down product spending by resorting to generic medications, on cutting down the cost of distribution by regulating pharmacy distribution costs or using mail order, and on cutting down utilization via pre-approval conditions and larger copayments (Hackler 157; Bartels & Smyers 20). Uneducated decisions and misguided choices and short-term, reckless containment approaches eventually result in more often and more severe medication-related complications. The overall medication cost cannot be determined without considering the expenses in medication-related complications (Perry & Webster 31). When payers have successfully reduced cost by reducing the costs of distribution and production and lessening utilization, they can afterward reduce medication-related complications. Existing cost-containment approaches adopted by Medicaid policies and managed care agencies may be especially dangerous for the elderly, particularly when these approaches result in limited access to newly-developed medications with more positive side-effect background than earlier medications. American Society of Consultant Pharmacists (ASCP) has formulated a theoretical framework of the overall medication cost that covers the numerous methods senior care pharmacist employ to enhance the effectiveness of care and cut down the expenses related to avoidable medication-related complications (Perry & Webster 31). These methods are developed to integrate cost containment for all features of medication, such as cost of medication-related complications, utilization, cost of distribution and production. ASCP develops various programs to update and inform state and federal policymakers about the function of senior care pharmacist in supplying the elderly with required and proper pharmaceutical or medication services (Perry & Webster 31). As explained by Perry and Webster, the organization’s Prescription for Quality Care sums up its plan to guarantee safe, effective, and proper use of medication for the elderly, for avoiding medication-related complications, and for enhancing the utilization of the pharmaceutical system (31-32). Potential solutions to the health care problems caused by rapid population aging should engage all healthcare practitioners and agencies, as well as the members of the aging group in order to realize the desired outcomes of the abovementioned potential solutions. Knowledgeable and regularly updated older adults and care providers are keys to all potential solutions to the healthcare problems brought about by a rapidly aging population. Conclusions The estimated increase in the number of older adults needing medical attention in the near future, alongside insufficient research funding and service development, is expected to generate a public health crisis. This issue is apparent in the combination of a number of major aspects. Demographic data reveal that there will be an unparalleled rise in medical infirmity and mental disorder among older adults. This dramatic increase is projected to have a substantial effect on the costs and utilization of health care services. The rapid aging of the population, particularly in highly developed (e.g. United States, United Kingdom) and fast developing countries (e.g. India, China, are causing several major health care problems: increasing cost, lack of access, lack of qualified providers of medical services for older adults, increasing medication-related complications, and so on. These problems are more prominent in the mental health care sector. The aging population is commonly beset by mental health problems. And the rapid population aging places much more burden on mental health care agencies. However, there are already available potential solutions to these health care problems caused by rapid population aging. First of all, it is important to further invest on research and service development in the field of geriatrics. In this way, health care policymakers and professionals will be informed of the best ways to prevent these medical difficulties attributed to aging. References Bartels, Stephen J. & Smyer, Michael. “Mental Disorders of Aging: An Emerging Public Health Crisis?” Generations 26 (2002): 14+. Print. Callahan, Daniel. Setting Limits: Medical Goals in an Aging Society. Washington, DC: Georgetown University Press, 1995. Print. Hackler, Chris. Health Care for an Aging Population. New York: SUNY Press, 1994. Print. Perry, Daniel & Webster, Tim. “Medication-Related Problems in Aging: Implications for Professionals and Policy Makers.” Generations 24 (2001): 28+. Print. Rao, Sathvanaravana & Shaji, K. “Demographic Aging: Implications for Mental Health.” Indian Journal of Psychiatry 49 (2007): 1+. Print. Read More