RAND Health Abstract

Medicare Quality and Getting Older: A Personal Essay.

Brook RH. Health Affairs, Vol. 14, No. 4, 1995, pp. 73-81 (Available as RAND Reprint RP-493.)

Presents a personal perspective on the future of Medicare. The number of persons over age 65 is increasing dramatically, and the need for medical care grows as one ages, despite what one does to practice good health behavior. This need increases greatly if the purpose of medical care is expanded beyond curative medicine to include the maintenance of physical, mental, and social functioning. At the same time that complicated choices must be made about health care, the mental ability to deal with abstractions and choices is diminishing. Four goals of health care for the elderly are presented: all necessary care should be provided; waste (i.e., unnecessary care) should be eliminated; the mean level of quality should be raised and its variation decreased; and elderly patients must take more responsibility in ensuring that the overall health care system works for them. Research developments may bring about an exceptional health care system in this country, including new methodologies to measure quality, necessity, efficacy, effectiveness, and outcomes; new technologies that will enable providers to reduce inefficiencies; and the incorporation of patient preferences into the practice of medicine.