Elderly Health Care in the United States
The population of the elderly in the United States has increased steadily over the 20th century. The declining mortality in the elderly age groups, do to increased knowledge and technology in the medical field, has an exerting impact on the accumulation of the elderly and the vulnerable with in our society. General health and well being for this demographic is a growing concern as well as financing Medicare. With these growing numbers of the elderly population it is safe to say that elderly health care in the United States is going to be a growing concern and an issue in the years to come. With the “baby boomers” beginning to reach the thresh hold of this growing elderly demographic this issue on elderly health and well-being will only grow faster and become more complex. The ability of the elderly to access quality health care will become more difficult with the rising cost of the services, the increasing complexity of the healthcare system, and the decline in the number of primary-care providers, coupled with the growing number of older individuals. Elderly Health Care is an issue that is only growing and in need of changes.
The issue of elderly health care in the United States is one that has personally touched my life. On the 15th of January 2012 Daniel J. O’Leary passed away at the age of 81 after a strong fight with Parkinson’s. This man was my grandfather. Watching his last few years and his fight with Parkinson’s it was apparent at times frustrating for my grandfather because certain issues with his Medicare would restrict certain medications or not cover certain routine procedures concerning his Parkinson’s. I was fortunate enough to spend time with him while he spent his last days in the hospital in Natick Massachusetts. The nursing staff and the doctors were less than adequate and seemed to be irritated when my grandfather wasn’t able to stay still, do to his Parkinson’s, during certain routine procedures. I never saw a doctor except for the morning he passed away. We asked a number of times for the nurses to come in to assist my grandfather and often the nurses would take too long, a cousin, who is a registered nurse, would step in and assist our grandfather. The lack of care for my grandfather made me look at the holes in the health care system for the elderly. It sparked an interest in the public health field and how my degree in Anthropology could make a difference for someone like my grandfather. The present state of healthcare reform raises many ethical concerns about the availability of health care for the American public. Adequate access to health care has gained the attention of the US government, professional associations, and healthcare providers alike.
The American Nurses’ Association advocates for reform ensuring that all people have access to high-quality health care. (Trotochaud 2006) Many professional healthcare associations currently view access to health care as a primary concern, particularly among the elderly population. (Trotochaud 2006) There are concerns that the nation’s elderly may experience more hardships related to a lack of access to health care as a result of Medicare’s declining reimbursement rates combined with Medicaid’s already low reimbursements. Many healthcare providers are limiting the number of Medicare patients they see or opting out of Medicare and Medicaid completely. (Lyons 1996) Factors that have a strong influence on the elderly population’s access to health care include the type of insurance coverage, socioeconomic status, and sociodemographic factors. (Stevens 2005) The socioeconomic status appears to be the most significant issue that keeps the elderly from obtaining access to health care. The access to quality health care services will become more difficult for the elderly as the cost continues to rise. These days having health insurance coverage through Medicare does not guarantee elderly patients access to healthcare services. In 2008, the Medicare Payment Advisory Commission reported that 28% of Medicare beneficiaries had difficulty finding access to a primary-care provider. This figure represented an increase of 4% since 2007. (Siegel 2009) Every year there are a number of healthcare providers who are opting out of government healthcare plans, like Medicare and Medicaid that number is increasing. This trend is due to a combination of factors, such as a continued decline in reimbursements, longer delays in payments, and increased operating expenses (Siegel 2009) Providers are finding it increasingly difficult to keep their practices financially sustainable. Access is not any easier for the elderly who have Medicaid as their secondary health insurance coverage.
The numbers of healthcare providers choosing not to provide services to Medicaid patients are even greater than those opting out of Medicare (Siegel 2009) The US Census Bureau has projected that the number of Americans over the age of 65 will increase from 37 million in 2006 to 71.5 million by the year 2030. (aoa.gov 2006) According to the National Healthcare Disparities Report, 2.3 million Americans (6.7% of the elderly population) meet the criteria for being “near poor,” with incomes ranging between 100% to 125% of the federal poverty threshold/level (FPL), in 2004. (NHCDR 2007) The same report also revealed that another 3.6 million elderly Americans were living beneath the FPL, which equals a poverty rate of 9.8%. (NHCDR 2007) These numbers should further fuel the need for change in health care regarding the elderly. In the next 20 years the disparities in healthcare access will only become larger the problem will be bigger and more difficult to resolve if change isn’t instituted now. Sociodemographic factors among the elderly, such as race, ethnicity, gender, and rural living, have a strong influence on healthcare access. (James and Garfield 2007) The United States is built on diversity when it comes to ethnicity and race. This diversity will continue to increase in the years to come. In 2005 one-third of the US population identified themselves as belonging to a racial or ethnic minority group; by 2050, this number is anticipated to increase by almost half. (James and Garfield 2007) The elderly minority population is more likely to have incomes less than 200% of the FPL, which means they are more likely to experience limited healthcare access.
Of the elderly population, nearly 70% of the Hispanics, two-thirds of the African Americans, and half of the Asians, Pacific Islanders, American Indians, and Alaskan natives are considered poor or near poor, compared with 38% of the Caucasian population. (James and Garfield 2007) These older minority populations continue to experience limited healthcare access and poorer health outcomes than the elderly Caucasian population. The Center for American Progress revealed that 2.3 million elderly women were living in poverty compared with 1 million elderly men. The low-income elderly residing in rural locations have even more pronounced rates of poverty along with limited access to healthcare services when compared with urban low-income elderly. (Cawthorne 2008) The poor elderly living in rural locations also have less access to public services such as transportation. Barriers to the access of health care are slowly rising among the rural population due to the longer distances to the closest healthcare facility and limitations in transportation. (Cawthorne 2008)
With new government reforms in health care have many elderly worried. With the new Obamacare government reform many elderly are resisting in fear that this new health care program will not meet their needs. President Obama argues the elderly have nothing to worry about that this program will benefit then and all the citizens of the United States. However the elderly’s fears of the program has exposed a fundamental truth about what Obama care is proposing; once health care is nationalized, or mostly nationalized, rationing care is inevitable, and those who have lived longest will find their health care needs the most restricted (WSJ 2009) Once health care is a “free good” the government pays for demand will soar and government costs will soar too. When the public finally reaches its taxing limit, something will have to give on the care and spending side. In a word, care will be rationed by politics. (WSJ 2009) The question of whom and what will be rationed is a growing concern for the elderly. President Obama defends Obamacare by arguing with the fact that private insurance companies already ration, by deciding which procedures or care is cover and which is not. However there is a great disparity between decisions made on rationing by private insurance companies and rationing decisions made by governments. Virtually every European government with “universal” health care restricts access in one way or another to control costs. The British system is most restrictive, using a black-box actuarial formula known as “quality-adjusted life years,” or QALYs, that determines who can receive what care. If a treatment isn’t deemed to be cost-effective for specific populations, particularly the elderly, the National Health Service simply doesn’t pay for it. Even France—which has a mix of public and private medicine—has fixed reimbursement rates since the 1970s and strictly controls the use of specialists and the introduction of new medical technologies such as CT scans and MRIs. (WSJ 2009) The Question politicians become confronted with, do to a limited budget, are it worth spending money on a terminally ill patient where the odds of survival or remission are low or non existent, or should money go to improve quality of life such as a joint replacement surgery for elderly. The inevitable question the government will eventually face is quality over quantity of life. From an anthropological standpoint on the issue of elderly health care I believe Anthropologists can contribute a very significant viewpoint to the issues and help to resolve them. One of the major contributions anthropology brings to the field of public health that can help the elderly health care system is translating public health knowledge into effective action. Anthropologists have a better approach to public health policy.
Anthropologists are better equipped to deal with sensitive issues regarding public health with in a community. Anthropologists work with in the community and use forums and discussion groups as research, which educates the community and builds trust with the community. The integrated perspective of culture is used to better identify and categorize a problem in a public health context. In Namino Glantz’s research with the elderly in Chiapas Mexico, she is out in the community interviewing the elderly educating them on the health clinic nearest them and finding out why the elderly are not taking advantage of the clinic. In the study Glantz looks beyond the issue of health and puts other factors into the declining health of Mexico’s elderly. She discusses infrastructure, lack of funds, lack of government support, lack of resources and a lack of a support system. Theses factors all contribute to the declining health of the elderly and action is called for because of Glantz’s work with organizations and the government and its policy makers. In the article by JK Eckert and RL Rubinstein, “Older Men’s Health,” anthropologically the authors breaks down the four major factors that effect older men’s health, culture, class, race and ethnicity, and social organizations. This article further emphasizes public health knowledge into effective action, with social organizations and how involvement positively affects older men’s health. The qualitative methodology of ethnography separates anthropology from all of the natural sciences and many of the social sciences.
Quantitative data can create a false perception of reality in cases. Anthropologists through qualitative analysis strive to understand the worldview of its patients while quantitative analysis can impose a foreign view of the issue. The qualitative data anthropologist’s gathers often can identify more issues and variables with in the public. This data can be used with the quantitative and have a better effect on the population as a whole. Anthropologist can give much need qualitative research that can help fill the holes in elderly health care system the quantitative data are missing. At the end of the day
a person is more then a number, chart, or statistic and to meet the needs of that person and to be successful you will need to look beyond the quantitative data. Elderly health care is an issue that can no longer be ignored in the United States; people need to really look into the issue of elderly health care and work on a viable solution. I believe Anthropologists can help provide answers for the people and the government through ethnographies, fieldwork, obtaining qualitative data and realizing a person is more then just a statistic. Today it is our grandparents who fight there way through the health care system tomorrow it’s our parents and after that it’s us.
Eckert JK, Rubinstein RL
1999. Older Men’s Health. Sociocultural and Ecological Perspectives. Medical Clinics of North America 83(5): 1151-1172.
2009. Using Formative Research to Explore and Address Elder Health and Care in Chiapas,
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Society Robert A. Hahn and Marcia Inhorn, eds. Pp. 266-297
Kaiser Family Foundation, Cara James, Rachel Garfield
2007. Key Facts: Race, Ethnicity, and Medical Care.
Wall Street Journal
2009. Obama’s Senior Moment. Why the elderly are right to worry when the government rations medical care. 14th August. http://online.wsj.com/article/SB10001424052970203863204574344900152168372.
National Healthcare Disparities Report
2007. Agency for Healthcare Research and Quality. www.ahrq.gov/qual/nhdr07/nhdr07.pdf
Number of older Americans. www.aoa.gov/agingstatsdotnet/Main_Site/Data/2008_Documents/Population.aspx
2009. When doctors opt out: We already know what government-run health care looks like. The Wall Street Journal.17th April. http://online.wsj.com/article/SB123993462778328019.html
Shi L, Stevens G.
2005. Vulnerable Populations in the United States. San Francisco, CA: Jossey-Bass.
2008.Elderly poverty: the challenge before us. Center for American Progress. www.americanprogress.org/issues/2008/07/elderly_poverty.html
2006. Ethical issues and access to healthcare. J.Infus.Nurse. 29(3):165-170.
Rowland D., Lyons B.
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Elderly Health Care in the United States